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Anatomy exam 3 LUMBOSACRAL PLEXUS
LUMBOSACRAL PLEXUS
79
Anatomy
Graduate
09/02/2016

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Term
components of the Lumbar plexus
Definition
L1—L4
Term
components of the Lumbosacral trunk
Definition
L4—L5
Term
components of the Sacral plexus
Definition
S1—S4
Term
sensory Branches from femoral nerve
Definition
-anterior femoral cutaneous nerves of the thigh
-saphenous nerve to antero-medial leg
Term
sensory nerve that supplies anterolateral thigh
Definition
Lateral femoral cutaneous nerve (L2,3)
Term
obturator nerve innervates...
Definition
a small area of medial thigh
Term
anterolateral leg sensory is innervated by
Definition
Common fibular nerve
Term
dorsum of foot sensory is innervated by
Definition
superficial fibular nerve
Term
posterior thigh sensory innervation is by
Definition
posterior femoral cutaneous nerve (S1,2,3) with a contribution from lateral femoral cutaneous nerve
Term
lateral & posterior leg sensory innervation is by
Definition
. medial sural cutaneous of tibial & lateral sural cutaneous of common fibular nerves
Term
sole of the foot sensory innervation by
Definition
. medial plantar & lateral plantar branches
Term
Lumbar plexus
Definition
anterior rami of spinal nerves L1-4. T12 may also contribute
Term
Sacral plexus
Definition
anterior rami of spinal nerves L4-S4
Term
lumbosacral trunk
Definition
connects the Lumbar & sacral plexuses
L4-L5
Term
anterior regions of lower extremity are innervated by
Definition
posterior divisions of anterior rami of lumbosacral plexus
Term
posterior regions of extremity are innervated by
Definition
anterior divisions of anterior rami of lumbosacral plexus
Term
Femoral nerve
-from?
-enters the thigh via...
Definition
-From L2—L4, Emerges from lateral side of psoas major

-Enters thigh behind inguinal ligament
Term
Lateral Femoral Cutaneous Nerve
entrapment occurs at...
aka...
Definition
near the ASIS and inguinal ligament and is commonly known as Meralgia paresthetica
Term
L1 forms...
innervates what?
Definition
-iliohypogastric & ilioinguinal nerves
-innervating anterior abdominal wall muscles
Term
L2,3,4 anterior divisions form...
innervates what?
Definition
-obturator nerve

-MOTOR: adductor muscles of thigh
-SENSORY: sensory branches go to hip & knee joints
Term
L2,3,4 posterior divisions form...
innservates...(sensory, motor)
Definition
femoral nerve
-sensory fibers to hip & knee joints.
-motor fibers to anterior thigh muscles
Term
4-Genitofemoral nerve comes from
Definition
L1,L2
Term
lumbosacral trunk
-made of...
-descends via...
Definition
-L4,5
-descends over ala of sacrum into pelvis
Term
saphenous nerve
-comes from
-supplies
Definition
-cutaneous branch from the femoral nerve
-accompanies great saphenous vein to supply skin on medial side of leg , ankle & foot
Term
a graft for coronary by pass surgery may come from..?
what is at risk?
Definition
-great saphenous is harvested
-saphenous nerve is at risk
Term
Injury of femoral nerve : at lumbar plexus
Definition
Weakness of hip flexion , loss of knee extension
Term
Injury of femoral nerve At inguinal ligament
Definition
loss of knee extension.
Term
Obturator nerve
-comes from
-enters through
Definition
-L2—L4. Emerges from medial side of psoas major.
-Enters thigh through obturator foramen
Term
Obturator nerve innervates
Definition
-skin for medial thigh
-adductor muscles
-adductor longus
- adductor brevis
-adductor magnus
-gracilis
-sometimes the pectineus
-external obturator
Term
Injury to obturator nerve
Definition
Difficulty adducting thigh
( crossing legs while sitting )
2. Decreased sensation over upper medial thigh
Term
Accessory Obturator Nerve
Definition
-present in about 29% of cases.
-supplies pectineus and hip joint
Term
Sacral Plexus nerves
Definition
-Superior gluteal nerve
-Inferior gluteal nerve
-Posterior femoral cutaneous
-Sciatic nerve (common fibular and tibial)
Term
sciatic nerve innervates
Definition
-no structures in gluteal region
-innervates posterior thigh muscles
-all leg and foot muscles
-
Term
tibial nerve
-innervates, broadly
Definition
muscles of posterior thigh ,posterior leg and sole of foot
Term
Common fibular nerve
-innervates, broadly
Definition
anterior and lateral compartments of leg and short head of biceps femoris in thigh
Term
Superior gluteal nerve
-comes from
-innervates
Definition
-L4—S1 passes through greater sciatic foramen above piriformis.
-gluteus medius, gluteus minimus, tensor fascia latae
Term
Inferior gluteal nerve
-comes from
-innervates
Definition
-Passes through greater sciatic foramen below piriformis.

-gluteus maximus
Term
Superficial fibular nerve
-supplies
Definition
supplies fibularis longus & fibularis brevis
Term
Deep fibular nerve
-supplies
Definition
supplies muscles in anterior compartment of leg & dorsum of foot
Term
The posterior cutaneous nerve of the thigh
-aka
-innervation
Definition
aka posterior femoral cutaneous nerve
-innervation to the skin of the posterior thigh, leg, & perineum
Term
Sural Nerve
Definition
-sensory
-from collateral branches off of the tibial nerve (medial branch) and common fibular nerve (lateral branch)
-often used for graft
Term
LS plexus vulnerabilities
Definition
-Femoral nerve is superficial in the hip area
-Fibular nerve is superficial at the fibular head.
Term
common site of injury to The femoral nerve
Definition
in the upper anterior thigh with sensory and/or motor problems
Term
common site of injury to The Obturator nerve
Definition
trapped by intrapelvic masses that compress the nerve.
-may affect the gait and lead to outward swinging of the lower extremities during gait.
Term
common site of injury to The Sciatic nerve
Definition
stabbed in the buttock with a knife or a needle.
Term
common site of injury to The common fibular nerve
Definition
-injured by a cast, tight-fitting boots, or being struck by a briefcase or car bumper.
-may lead to foot drop
Term
Radiculopathy of L4 or L5 can result in
Definition
pain to the foot or foot drop.
Term
Peripheral Nerve Injuries
-effects
Definition
-All motor function and sensation supplied by nerve distal to injury is lost.
-Sensation over more than one dermatome is lost
Term
Nerve Root Injuries
-effects
Definition
-often via disc herniation
-Radiculopathy
-Sensory impairment over one dermatome.
-Muscle weakening.
Term
Iliohypogastric, Ilioinguinal & Genitofemoral Nerves
-INJURY
Definition
-Rare, usually associated with surgery
Term
Damage to the femoral nerve is called
Definition
mononeuropathy
Term
Mononeuropathy
Definition
local cause of damage to a single nerve.

-e.g., the femoral nerve
Term
Meralgia paresthetica
-what is it?
Definition
-the lateral femoral cutaneous nerve is compressed
-a terrible burning sensation felt in the outer thigh
-from repetitive leg motions, hip injury, tight clothing/low hanging belt, weight gain/pregnancy
Term
Obturator Neuropathy
-symptoms
Definition
medial thigh or groin pain, weakness with leg adduction, and sensory loss in the medial thigh.
Term
diagnosis for Obturator Neuropathy and treatment consideration
Definition
(EMG) and can be confirmed by a local nerve block
-Surgical decompression of the nerve may be considered
Term
risk factors for Obturator Neuropathy
Definition
prior surgery, pelvic trauma, hematoma or fascial entrapment.
Term
common site of Saphenous Nerve Entrapment Neuropathy
Definition
adductor canal
Term
symptoms of Saphenous Nerve Entrapment
Definition
tingling, numbness, pain on the medial side of the lower extremity with activities, burning sensation
Term
Injury to Sciatic Nerve
Definition
-Weakened hip extension
-Inability to dorsi flex , planter flex , evert or invert foot.
-Loss of cutaneous sensation over leg and foot except medial area supplied by saphenous nerve.
-Foot drop ( lack of dorsiflexion ) and flail foot ( lack of both dorsiflexion and plantarflexion)
Term
sciatica causes
Definition
-herniated disk
-bone spurs
-narrowing of the spinal canal (spinal
stenosis)
-tumor
-DM
Term
sciatica symptoms
Definition
-Pain that radiates from the lower (lumbar) spine to the buttock and down the back of the leg to the foot.
-from a mild ache -> sharp, burning sensation -> excruciating pain
Term
Posterior Femoral Cutaneous Nerve Entrapment Neuropathy
Definition
rare.
Term
Piriformis Syndrome
-what is it?
-symptoms
Definition
-when the piriformis muscle compresses the common fibular division of the sciatic nerve
-usually starts with pain, tingling, or numbness in the buttocks.
Term
Piriformis Syndrome
-causes
Definition
-Trauma to the buttocks is the most common cause of piriformis syndrome.
-Overuse (e.g. skiers)
-sitting a lot (truck drivers)
Term
Superior gluteal nerve lesion
Definition
paralysis of gluteus medius & minimus muscles
-Trendelenburg’s sign & gluteus medius (Trendelenburg) gait
Term
Trendelenburg sign
Definition
w/ superior gluteal nerve lesion
-pelvis drops down on the unaffected side
Term
Inferior gluteal nerve lesion
Definition
-difficulty rising from a seated position, climbing stairs, or running & jumping due to gluteus maximus paralysis
Term
Lesion of common fibular branch of sciatic nerve
-how does it commonly happen?
Definition
mostly occurs as it passes subcutaneously around the fibular neck
Term
the most common nerve injury of lower extremity
Definition
Lesion of common fibular branch of sciatic nerve
Term
Lesion of common fibular branch of sciatic nerve
-what does it lead to?
Definition
-It results in footdrop
-loss of motor (flaccid paralysis) function in the anterior and/or lateral regions of the leg
Term
foot drop
-manifestations
Definition
-lack of dorsiflexion
-compensation by steppage gait (extra-flexion), swing-out gait, or waddling gait of the affected limb.
Term
foot drop treatments
Definition
Orthoses & nerve stimulation
Term
waddling gait
-what is it?
-what is it telling of?
Definition
-alternate leaning trunk to opposite side
-can be from bilateral paralysis of gluteus medius
Term
Swing-out gait
Definition
compensation via abduction
Term
Compression of tibial branch of sciatic nerve in the politeal fossa
Definition
-paralysis of calf muscles (PF)
-intrinsic plantar foot muscles atrophy
-sensory loss of sole of foot
-dropping of the pelvis on the AFFECTED side (triceps surae gait)
Term
Compression of tibial branch of sciatic nerve Within tarsal tunnel
Definition
-pain, paresthesias, & sensory loss of sole of the foot
-intrinsic foot muscles also may atrophy
-also, the medial plantar branch may be affected
Term
tibial branch of the sciatic nerve
-position in ankle
Definition
deep to flexor retinaculum
Term
Medial plantar branch (from the tibial branch of the sciatic nerve)
Definition
deep to abductor hallucis muscle
Term
Tarsal Tunnel Syndrome
Definition
compression of Tibial Branch of Sciatic nerve deep to flexor retinaculum
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