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Hannah's Locomotor > Nerves of Lower Limb > Flashcards

Nerves of Lower Limb Flashcards

1
Q

Where does the lumbar plexus emerge?

A

From the substance of psoas

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2
Q

What forms the lumbar plexus?

A

Ventral rami of L1-L4

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3
Q

Which terminal branches of the lumbar plexus emerge from the lateral border of psoas?

A

Ilioinguineal and iliohypogastric
Lateral cutaneous nerve of thigh
Femoral nerve

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4
Q

Which nerve roots make up the ilioingunal and iliohypogastric nerves?

A

L1

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5
Q

Which nerve roots make up the lateral cutaneous nerve of thigh?

A

L2, L3

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6
Q

Which nerve roots make up the femoral nerve?

A

Posterior divisions of L2, L3, L4

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7
Q

Which terminal branches of the lumbar plexus emerge onto the anterior surface of psoas?

A

Genitofemoral nerve

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8
Q

Which nerve roots make up the genitofemoral nerve?

A

L1, L2

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9
Q

Which terminal branches of the lumbar plexus emerge from the medial border of psoas?

A

Obturator nerve

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10
Q

Which nerve roots make up the obturator nerve?

A

Anterior divisions of L2, L3, L4

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11
Q

Where do the ilioinguinal and iliohypogastric nerves emerge onto from the lateral border of psoas?

A

Quadratus lumborum (at the line of fascial attachment)

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12
Q

Where do the femoral nerve and lateral cutaneous nerve of thigh emerge onto from the lateral border of psoas? What does this mean in terms of the structures they supply?

A

Onto iliacus
Continues with iliacus into the anterior compartment of the thigh without supplying any of the abdominal wall (only provides supply to the lower limb)

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13
Q

To what structures do the ilioinguinal and iliohypogastric nerves provide sensory supply?

A

Skin over the inguinal region and front of the scrotum

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14
Q

To what muscles do the ilioinguinal and iliohypogastric nerves provide motor supply?

A

Lowermost fibres of internal oblique and transversus abdominis, which form the roof of the inguinal canal and insert into the pubis at the conjoint tendon

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15
Q

What is the role of the arching fibres of internal oblique and transversus abdominis? What is the clinical significance?

A

Form the roof of the inguinal canal and, when contracted, bring the roof and floor of the canal together to prevent herniation with raised intra-abdominal pressure
A non-laproscopic appendectomy may divide the nerve supply to IO and TA and prevent this from occurring, resulting in increased risk of herniation following surgery

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16
Q

When might compression of the lateral cutaneous nerve of thigh occur and what would be the presentation in such a case?

A

Can occur in pregnancy or with morbid obesity

Causes pins and needles down lateral thigh

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17
Q

Which nerve roots form the lumbosacral plexus?

A

S1-S4, with contributions from L4 and L5

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18
Q

Describe the anatomical location of the lumbosacral plexus

A

Nerve roots emerge from the sacral intervertebral foramina onto piriformis

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19
Q

Which division of the genitofemoral nerve carries L2 fibres?

A

Genital branch

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20
Q

What structures are supplied by the genital branch of the genitofemoral nerve?

A

Spermatic cord

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21
Q

Which division of the genitofemoral nerve carries L1 fibres?

A

Femoral branch

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22
Q

What structures are supplied by the femoral branch of the genitofemoral nerve?

A

Area of skin immediately beneath the middle of the inguinal ligament (i.e. the femoral triangle)

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23
Q

Where does the femoral nerve run from its origin in the lumbar plexus to the thigh?

A

Runs in the gutter of iliacus and psoas
Dives beneath the inguinal ligament
Divides into distal branches just distal to ligament and supplies structures in the anterior compartment of the thigh

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24
Q

Which compartments do the anterior and posterior nerve divisions supply in the lower limb? Why is this?

A

Anterior: flexor compartment (posterior thigh and leg)
Posterior: extensor compartment (anterior thigh and leg)
Due to the rotation of the limb bud during development

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25
Q

What types of structures are supplied by the lumbosacral plexus? What are the exceptions?

A

Mostly pelvic structures

Some exit with piriformis to enter the gluteal region and supply the lower limb

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26
Q

To what muscles does the femoral nerve provide motor supply?

A

Quadriceps femoris
Sartorius
Pectineus

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27
Q

Describe the function and nerve supply of pectineus

A

Transitional muscle of the anterior and medial compartments of the thigh, responsible for both flexion and adduction
Overlapping nerve supply (femoral and accessory obturator)

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28
Q

To what structures does the femoral nerve provide sensory supply?

A

Anteromedial thigh

Medial knee, leg, ankle

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29
Q

Which branches of the femoral nerve are responsible for its sensory innervation?

A

Anterior cutaneous branches (medial and intermediate cutaneous nerves of thigh)
Saphenous nerve

30
Q

Which nerve supplies the hip, knee, ankle and foot joints?

A

Hip: articular branches of the femoral, obturator and sciatic nerves
Knee: articular branches of the femoral nerve
Ankle and foot: articular branches of the deep fibular nerve

31
Q

Describe the nerve supply of iliopsoas

A

Segmental supply associated with plexus

32
Q

Where does the femoral nerve pass beneath the inguinal ligament relative to the vascular structures?

A

Most lateral

33
Q

Where does the femoral nerve divide into its terminal branches?

A

~2.5cm below the inguinal ligament

34
Q

On what aspect of the thigh and leg are the vessels located?

A

Flexor aspects

35
Q

What is the cutaneous distribution of the obturator nerve?

A

Inferomedial thigh, just above the medial knee

36
Q

What are the 2 terminal branches of the saphenous nerve?

A

Infrapatellar branch of saphenous nerve

Medial crural cutaneous branches of saphenous nerve

37
Q

What supplies the medial foot up to the 1st metatarsophalangeal joint?

A

Medial crural cutaneous branches of saphenous nerve

38
Q

Describe the course of the obturator nerve from its origin through the thigh

A

Emerges from medial border of psoas

Runs along the lateral wall of the pelvis and through the obturator canal into the medial compartment of the thigh

39
Q

Where do the anterior and posterior divisions of L2, L3 and L4 run relative to the adductor muscles?

A

Anterior: between longus and brevis
Posterior: between brevis and magnus

40
Q

To what muscles does the obturator nerve provide motor supply?

A

Adductor muscles
Pectineus
Hamstring part of adductor magnus

41
Q

Which nerve supplies the pelvic peritoneum? What is the clinical significance of this?

A

Obturator nerve

Can get referred pain to or from the inferomedial thigh (e.g. with ovarian cyst)

42
Q

What are the 2 nerves arising from the sacral plexus which goes on to supply the lower limb?

A

Sciatic nerve

Posterior cutaneous nerve of thigh

43
Q

Which nerve roots make up the sciatic nerve?

A

Anterior and posterior divisions of L4, L5 and S1-S3

44
Q

Describe the course of the sciatic nerve from its origin in the sacral plexus into the thigh

A

Exits the pelvis via the greater sciatic foramen
Emerges beneath piriformis and over obturator internus in the gluteal region
Passes posterior to hip halfway between the ischial tuberosity and the greater trochanter to descend in the posterior thigh (under biceps)
Divides at the apex of the popliteal fossa (subject to natural variation)

45
Q

Describe the structure of the sciatic nerve

A

Like 2 nerves in 1 sheath (tibial and common fibular)

46
Q

To what muscles does the tibial component of the sciatic nerve provide motor supply?

A

Hamstring muscles (except the short head of biceps femoris)

47
Q

To what structures does the posterior cutaneous nerve of thigh provide sensory supply?

A

Back of thigh

48
Q

When is the sciatic nerve endangered?

A

In a posterior dislocation
With a stab/gunshot wound to the buttocks
In IM injection into the right upper quadrant of the buttock region due to natural variation in the anatomy (now performed as lateral thigh injection instead)

49
Q

Why is the sciatic nerve sometimes endangered when delivering an IM injection to the right upper quadrant of the buttock region?

A

If the sciatic nerve divides into its terminal branches in the gluteal region, it is possible for the common fibular component to emerge through or on top of piriformis

50
Q

What nerves (other than the sciatic and posterior cutaneous nerve of thigh) are given off from the sacral plexus to enter the gluteal region?

A

Superior and inferior gluteal nerves

51
Q

Where does the superior gluteal nerve pass relative to piriformis and what muscles does it supply?

A

Passes above piriformis to supply gluteus medius and minimus

52
Q

Where does the inferior gluteal nerve pass relative to piriformis and what muscles does it supply?

A

Passes below piriformis to supply gluteus maximus

53
Q

What nerve supplies the short head of biceps femoris?

A

Common fibular component of the sciatic nerve

54
Q

Which nerve roots make up the tibial nerve?

A

Anterior divisions of L4, L5 and S1-S3

55
Q

Describe the course of the tibial nerve

A

Descends vertically through the popliteal fossa and beneath the fibrous arch of soleus on tibialis posterior
Passes posterior to medial malleolus and under the sole of the foot where it divides into its terminal branches

56
Q

What are the terminal branches of the tibial nerve?

A

Medial and lateral plantar nerves

57
Q

To what muscles does the tibial nerve provide motor supply?

A

Posterior leg muscles

Muscles of the sole of foot

58
Q

To what structures does the tibial nerve provide sensory supply? What are the terminal branches responsible for this cutaneous distribution?

A

Posterolateral leg and lateral side of foot via the sural nerve
Sole of the foot via the medial calcaneal, and medial and lateral plantar nerves

59
Q

What pathology may endanger the common fibular nerve? What are some signs associated with a palsy of the common fibular nerve?

A

Fractured neck of fibula

Causes foot drop (inability to dorsiflex ankle, extend the toes and evert the foot)

60
Q

What is the sural nerve?

A

Branch of the tibial nerve which also receives a contribution from the common fibular nerve
Supplies the posterolateral leg and lateral side of the foot

61
Q

Describe the course of the common fibular nerve

A

Passes medial to biceps femoris and superficial to the lateral head of gastrocnemius
Winds around the neck of the fibula
Travels in the lateral compartment of the leg with fibularis longus
Divides into terminal branches

62
Q

To what structures does the common fibular nerve provide sensory supply? Which terminal branches are responsible for this cutaneous distribution?

A

Upper lateral leg via lateral sural cutaneous nerve (which gives a communicating branch to the sural nerve)

63
Q

Which nerve roots make up the common fibular nerve?

A

Posterior divisions of L4, L5 and S1-S3

64
Q

What are the terminal branches of the common fibular nerve?

A

Deep fibular nerve

Superficial fibular nerve

65
Q

To what muscles does the deep fibular nerve provide motor supply?

A

Anterior compartment of leg

Extensor digitorum brevis (on dorsum of foot)

66
Q

To what structures does the deep fibular nerve provide sensory supply?

A

1st toe cleft on dorsum of foot (skin between great and 2nd toes)

67
Q

To what muscles does the superficial fibular nerve provide motor supply?

A

Lateral compartment of leg (fibularis longus and brevis)

68
Q

To what structures does the superficial fibular nerve provide sensory supply?

A

Lower lateral leg and dorsum of foot (except those spaces supplied by other nerves)

69
Q

Describe the course of the deep fibular nerve

A

Begins in fibularis longus
Descends deep to EDL and anterior to the interosseous membrane
Passes beneath the extensor retinaculum
Travels on the dorsum of the foot

70
Q

Describe the course of the superficial fibular nerve

A

Descends in lateral compartment of leg
Supplies fibularis longus and brevis
Becomes superficial

71
Q

Summarise the motor supply of the lower limb

A

Superior and inferior gluteal: large muscles in gluteal region
Femoral: anterior compartment of thigh
Obturator: medial compartment of thigh
Tibial part of sciatic: posterior compartment of thigh (except SHOB) and leg, sole of foot
Common fibular part of sciatic: anterior and lateral compartments of leg, dorsum of foot

72
Q

Summarise the sensory supply of the lower limb

A

Femoral: skin on anterior and medial thigh, medial leg and foot
Obturator: inferomedial thigh above knee
Tibial part of sciatic: posterior leg (via sural nerve), heel and sole of foot (via medial calcaneal, medial and lateral plantar nerves)
Common fibular part of sciatic: lateral leg and dorsum of foot
Lateral cutaneous nerve of thigh
Posterior cutaneous nerve

Hannah's Locomotor (10 decks)

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