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MSK > Lecture 5 - Lumbosacral plexus > Flashcards

Lecture 5 - Lumbosacral plexus Flashcards

1
Q

Lumbar plexus

A 
Iliolingual nerve - L1
Genitofemoral nerve- L1,L2
Lateral femoral cutaneous nerve - L2,L3
Obturator nerve - L2,L3,L4
Femoral nerve - L2, L3, L4
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2
Q

What is the lumbar plexus formed from?

A

Anterior rami of the L1 - L4 spinal nerves

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3
Q

Iliolingual nerve

A

L1

Innervates skin of genitalia and upper medial thigh

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4
Q

Genitofemoral

A

L1, L2
Divides into the genital and femoral branch
Femoral branch innervates the upper anterior thigh

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5
Q

Lateral femoral cutaneous nerve

A

Posterior divisions of the L2, L3
Purely sensory
Enters thigh at lateral region of inguinal ligament

Supplies the anterolateral thigh to knee

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6
Q

Obturator nerve

A

Anterior divisions of L2,L3,L4
Innervates skin over the medial thigh
Motor nerve to medial compartment of thigh

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7
Q

Muscles innervated by the obturator nerve

A 
Obturator externus
Pectineus
Adductor longus
Adductor brevis 
Adductor magnus 
Gracilis
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8
Q

Femoral nerve

A

Posterior divisions of L2,L3,L4
Innervates anterior thigh via lateral cutaneous femoral branch

Saphenous branch - innervates skin of the medial leg

Motor innervation to anterior compartment of the thigh

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9
Q

Muscles innervated by the femoral nerve

A 
Iliacus 
Pectineus
Sartorius 
Rectus femoris 
Vastus lateralis 
Vastus medialis
Vastus intermedius
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10
Q

What is the sacral plexus formed from?

A

Anterior rami of S1, S2, S3, S4, S5

And contribution from L4 and L5 from lumbosacral trunk

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11
Q

Sacral plexus

A 
Superior gluteal nerve - L4, L5, S1
Inferior glutal nerve - L5, S1, S2
Sciatic nerve - L4, L5, S1 , S2, S3
Posterior femoral - S1, S2, S3 
Pudendal - S2, S3, S4
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12
Q

Superior gluteal nerve

A

L4, L5, S1
Leaves the pelvis via the greater sciatic foramen
Enters gluteal region above the piriformis
Accompanied by the sciatic artery and vein

Motor innervation to:

  • Gluteus medius
  • Gluteus minimus
  • Tensor fascia lata
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13
Q

Inferior gluteal nerve

A

L5, S1, S2
Leaves the pelvis via the greater sciatic foramen
Enters gluteal region BELOW the piriformis
Accompanied by the inferior gluteal artery and vein

Motor innervation to:
- Gluteus maximus

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14
Q

Sciatic nerve

A 
Longest nerve in body 
L4, L5, S1, S2, S3
No branches in gluteal region
Emerges transversely from the pelvic cavity midway between the posterior superior iliac spine and ischial tuberosity
Under the piriformis

In posterior thigh:

  • lies on the posterior surface of the adductor magnus
  • crossed by long head of the biceps femoris

Divides into:

  • tibial nerve
  • common fibular (peroneal) nerve

(at the superior end of the popliteal fossa)

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15
Q

Tibial nerve

A

Motor innervation to hamstrings:

  • Semitendinosus
  • Semimembrinosus
  • Biceps femoris long head
  • Ischial part oft the adductor magnus
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16
Q

Common peroneal nerve

A

Motor innervation to:

- Biceps femoris short head

17
Q

Posterior cutaneous nerve of the thigh

A

Posterior divisions of S1, S2
Anterior divisions of S2, S3

Leaves the pelvis via the greater sciatic foramen under the piriformis

Innervates the skin of the posterior thigh and leg

18
Q

Which structures exit the pelvis inferior to the piriformis?

A 
Inferior gluteal nerve, artery and vein 
Sciatic nerve 
Posterior femoral cutaneous nerve 
Nerve to quadratus femoris
Nerve to obturator internus 
Pudendal nerve, inferior pudendal artery and vein
19
Q

Structures that pass through the lesser sciatic foramen

A

Nerve to obturator internus
Tendon of the obturator internus
Pudendal nerve
Internal pudendal vessels

20
Q

Safe site for intramuscular injections in the gluteal region

A

Avoid sciatic nerve
Therefore upper, outer quadrant = dorsogluteal site (children over 3)

ventrogluteal site- 7yrs old to adults (further from neurovascular bundle but requires compliance)

21
Q

How to locate the ventrogluteal region?

A
  1. Place palm over the greater trochanter
  2. Point thumb to inguinal region and index finger to ASIC
  3. Spread index and middle finger to make V
  4. Inject between the proximal interphalangeal joints into
    the gluteus medius

MSK (28 decks)

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