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MD1 Locomotor > Nerves of Lower Limb > Flashcards

Nerves of Lower Limb Flashcards

1
Q

From where do the limb buds develop?

A

Out of lateral side of cavity

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2
Q

What do the limb buds take with them as they develop?

A

Ventral rami supplying that strip of wall

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3
Q

What are the two plexi that supply the lower limb?

A

Lumbar

Sacral

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4
Q

Where does the lumbar plexus divide?

A

Within substance of psoas major

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5
Q

Which ventral rami feed into the lumbar plexus?

A

L1-4

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6
Q

What do the anterior fibres of the lumbar plexus supply?

A

Flexor compartment in posterior aspect

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7
Q

What do the posterior fibres of the lumbar plexus supply?

A

Extensor compartment in anterior aspect

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8
Q

Which nerves of the lumbar plexus emerge from the lateral border of psoas?

A

Ilioinguinal and iliohypogastric nerves
Lateral cutaneous nerve of thigh
Femoral nerve

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9
Q

Which vertebral segments supply the ilioinguinal and iliohypogastric nerves?

A

L1

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10
Q

Which vertebral segments supply the lateral cutaneous nerve of thigh?

A

L2

L3

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11
Q

Which vertebral segments supply the femoral nerve?

A

L2
L3
L4
Posterior division fibres

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12
Q

Which nerves of the lumbar plexus emerge onto the anterior surface of psoas?

A

Genitofemoral nerve

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13
Q

Which vertebral segments supply the genitofemoral nerve?

A

L1

L2

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14
Q

Which nerves of the lumbar plexus emerge from the medial border of psoas?

A

Obturator nerve

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15
Q

Which vertebral segments supply the obturator nerve?

A

L2
L3
L4

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16
Q

What do the ilioinguinal and iliohypogastric nerves supply?

A

Lower part of anterior abdominal wall

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17
Q

What is another name for the lateral cutaneous nerve of thigh?

A

Lateral femoral cutaneous nerve

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18
Q

Why is the genitofemoral nerve like two nerves in one sheath?

A

Has

  • Genital branch
  • Femoral branch
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19
Q

Which muscle do the ilioinguinal and iliohypogastric nerves emerge onto?

A

Quadratus lumborum

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20
Q

What is the course of the ilioinguinal and iliohypogastric nerves in the anterior abdominal wall?

A

Slip into neurovascular plane of anterior abdominal wall - between internal oblique and transversus abdominis
Track into anteroinferior direction towards groin region
Supplies conjoined tendon that forms roof of inguinal canal
Passes directly beneath McBurney’s point

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21
Q

Which nerve emerges more superiorly onto psoas: ilioinguinal or iliohypogastric?

A

Iliohypogastric

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22
Q

What is the course of the lateral femoral cutaneous nerve of thigh after emerging from psoas?

A

Swings wide onto iliacus
Goes with iliacus beneath inguinal ligament and into lower limb
Tucks under inguinal ligament where it attaches to anterior superior iliac spine

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23
Q

What can happen to the lateral femoral cutaneous nerve of thigh in very obese, and classically, in pregnant women?

A

Can be impinged by inguinal ligament and anterior superior iliac spine

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24
Q

What does impingement of the lateral femoral cutaneous nerve of thigh cause?

A

Tingling and numbness on lateral side of thigh

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25
Q

What is the course of the femoral nerve after emerging from psoas?

A

Tucks into gutter between iliacus and psoas
Beneath inguinal ligament
Divides into terminal branches just distal to ligament all at once

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26
Q

What is the nerve supplying the anterior compartment of the thigh?

A

Femoral nerve

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27
Q

What is the course of the genitofemoral nerve after emerging from psoas?

A

Splits very quickly into genital and femoral branches
Femoral branch goes straight beneath inguinal ligament
Genital branch enters inguinal canal via deep ring

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28
Q

Which nerve supplies the skin over the femoral triangle?

A

Femoral branch of genitofemoral nerve

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29
Q

What type of nerve is the femoral branch of the genitofemoral nerve?

A

Sensory

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30
Q

What fibres is the obturator nerve carrying: anterior, posterior, or both?

A

Anterior division fibres

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31
Q

Which nerve supplies the medial compartment of the thigh?

A

Obturator nerve

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32
Q

From what are the muscles of the medial compartment of the thigh derived from, and what does this imply about their nerve supply?

A

Flexor musculature, therefore supplied by anterior division fibres

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33
Q

What part of the sacrum does piriformis arise from?

A

Anterolateral aspect

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34
Q

Which muscle do S1-4 ventral rami emerge onto?

A

Anterior surface of piriformis

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35
Q

Where is the sacral plexus formed?

A

On anterior surface of piriformis

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36
Q

What is the lumbosacral trunk?

A

Part of L4 doesn’t feed into lumbar plexus

Heads down with L5 into pelvis

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37
Q

What makes up the sacral plexus?

A

Lumbosacral trunk

S1-4

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38
Q

What does the sacral plexus supply?

A

Pelvis

Lower limb

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39
Q

How do the branches of the sacral plexus supplying the lower limb exit?

A

With piriformis into gluteal region

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40
Q

What does the femoral nerve supply?

A 
Motor to
- Quadriceps
- Sartorius
- Pectineus
Sensory to
- Anterior and anteromedial thigh - via 2 separate nerves
- Medial side of knee, leg, and ankle
- Saphenous nerve
Articular branches to
- Hip
- Knee
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41
Q

What is the innervation of iliopsoas?

A

Directly from lumbar plexus

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42
Q

For how long is the femoral nerve “the femoral nerve” for after passing below the inguinal ligament?

A

1 inch

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43
Q

To which artery and vein is the femoral nerve situated laterally?

A

Femoral artery and vein

44
Q

Is the femoral nerve within the femoral sheath?

A

No

45
Q

Which branch of the femoral nerve supplies sensory innervation to the anterior aspect of the thigh?

A

Anterior cutaneous nerve of thigh

46
Q

Which branch of the femoral nerve supplies sensory innervation to the anteromedial aspect of the thigh?

A

Anteromedial cutaneous nerve of thigh

47
Q

What nerve is the saphenous nerve a branch of?

A

Femoral nerve

48
Q

When does the saphenous nerve become cutaneous?

A

Level of knee

49
Q

What does the saphenous nerve supply sensory innervation to?

A

Skin down medial side of leg and foot up to level of 1st metatarsophalangeal joint

50
Q

What does the lateral cutaneous nerve of thigh supply?

A

Sensory to anterolateral aspect of thigh

51
Q

What is the course of the obturator nerve after emerging from psoas?

A

Drops into pelvis
Lateral wall of pelvis - almost direct descent
Obturator canal
Top of medial compartment of thigh

52
Q

What does the obturator nerve supply?

A 
Motor to
- Adductor muscles
- Pectineus
Sensory to
- Inferomedial thigh > just above knee
- Peritoneum lining side wall of pelvis
Articular branches to
- Hip
53
Q

Why does pectineus get a dual nerve supply from both the femoral and obturator nerves?

A

Transition muscle between anterior and medial compartments of thigh

54
Q

Which part of adductor magnus doesn’t the obturator nerve supply?

A

Hamstring part

55
Q

How does the obturator nerve supply the three layers of adductor muscles?

A

Splits into

  • Anterior branch of obturator nerve - between adductor longus and brevis
  • Posterior branch of obturator nerve - between adductor brevis and magnus
56
Q

Which nerve supplies gracilis?

A

Obturator nerve

57
Q

Where can pain from a pelvic pathology, classically a large ovarian cyst, be referred to, and why?

A

Pathology irritates parietal peritoneum

Pain referred to cutaneous distribution of obturator nerve

58
Q

What is the largest nerve in the body?

A

Sciatic nerve

59
Q

Which compartments does the sciatic nerve supply?

A

Posterior compartment of thigh

Everything below knee

60
Q

Which vertebral segments feed into the sciatic nerve?

A 
L4
L5
S1
S2
S3
Anterior division fibres
Posterior division fibres
61
Q

What are the two components to the sciatic nerve?

A

Tibial

Common fibular

62
Q

What is the course of the sciatic nerve?

A

Exits pelvis via greater sciatic foramen
Emerges beneath piriformis in gluteal region
Posterior to hip, running over quadratus femoris
Descends posterior thigh under biceps femoris
Divides at apex of popliteal fossa

63
Q

What does the sciatic nerve supply?

A 
Motor to
- Hamstrings
Sensory
- Via terminal branches only because deep nerve
Articular branches to
- Hip
- Knee via terminal branches
64
Q

Which components of the sciatic nerve supply each of the hamstring muscles?

A

All supplied by tibial component except short head of biceps femoris, which supplied by common fibular component

65
Q

Which nerve supplies gluteus maximus?

A

Inferior nerves - from sacral plexus

66
Q

Which vessels supply gluteus maximus?

A

Inferior gluteal vessels

67
Q

Which nerve supplies gluteus medius and minimus?

A

Superior gluteal nerve

68
Q

From where do the inferior gluteal nerves emerge?

A

Below piriformis

69
Q

From where does the superior gluteal nerve emerge?

A

Above piriformis

70
Q

What nerve supply is endangered in a posterior dislocation of the hip?

A

Sciatic nerve and all its neural supply beyond that point

71
Q

Where does the sciatic nerve classically divide into its terminal branches?

A

2/3 of way down posterior compartment of thigh - classically at apex of popliteal fossa

72
Q

What happens if the sciatic nerve divides at a point higher than usual?

A

Classically, tibial component still comes out beneath piriformis but common fibular component will come out through/above piriformis

73
Q

What are the implications of giving an intramuscular injection in the gluteal region if the common fibular part of the sciatic nerve emerges through or above piriformis?

A

Injection can endanger common fibular part, so now injections give in lateral part of thigh

74
Q

What do the two terminal branches of the sciatic nerve supply?

A

Everything below knee

75
Q

What are the vertebral segments feeding the tibial nerve?

A 
L4
L5
S1
S2
S3
Anterior division fibres
76
Q

What is the course of the tibial nerve?

A 
Continues vertical descent of sciatic nerve through popliteal fossa
Beneath fibrous arch of soleus
Descends on tibialis posterior in calf
Posterior to medial malleolus
Sole of foot
77
Q

What does the tibial nerve split into on the sole of the foot?

A

Medial and lateral plantar nerves

78
Q

What is the motor supply of the tibial nerve?

A

Posterior compartment of leg

Sole of foot

79
Q

What is the sensory supply of the tibial nerve?

A

Posterior, posterolateral, and lateral leg

Sole of foot

80
Q

Via which branch does the tibial nerve supply sensory innervation to the posterior, posterolateral, and lateral leg, as well as the lateral side of the foot?

A

Sural nerve

81
Q

Via which branch does the tibial nerve supply sensory innervation to the sole of the foot?

A

Medial calcaneal nerve

Medial and lateral plantar nerves

82
Q

Which nerve supplies the sensory innervation of the skin over the posterior aspect of the thigh, and of what is it a branch?

A

Posterior femoral cutaneous nerve, directly off sacral plexus

83
Q

From which muscles are the lateral everter muscles of the foot derived?

A

Anterior extensor muscles of leg

84
Q

What vertebral segments feed into the common fibular nerve?

A 
L4
L5
S1
S2
Posterior division fibres
85
Q

What is the course of the common fibular nerve?

A 
Divides laterally from tibial nerve
Heads medial to biceps femoris
Superficial to lateral head of gastrocnemius
Winds around neck of fibula
Sinks into fibularis longus
Divides into terminal branches
86
Q

What is the sensory supply of the common fibular nerve?

A

Upper lateral leg via lateral sural cutaneous nerve

Gives communicating branch to sural nerve

87
Q

What is the motor supply of the deep fibular nerve?

A

Anterior compartment of leg

Extensor digitorum brevis

88
Q

What is the sensory supply of the deep fibular nerve?

A

1st toe cleft

89
Q

What does the deep fibular nerve give articular branches to?

A

Ankle

Foot

90
Q

What is the motor supply of the superficial fibular nerve?

A

Lateral compartment of leg

91
Q

What is the sensory supply of the superficial fibular nerve?

A

Lower lateral leg

Dorsum of foot

92
Q

Which nerve is endangered in a fracture of the neck of the fibula, or a tight plaster compressing it to the bone?

A

Common fibular nerve

93
Q

What are the clinical features of common fibular nerve damage?

A

Lose motor supply to extensors of leg and toes, and everters > foot drop

94
Q

What is the course of the deep fibular nerve?

A

Starts in fibularis longus
Descends deep to extensor digitorum longus
Anterior to interosseus membrane, beneath tibialis anterior
Beneath extensor retinaculum
Onto dorsum of foot

95
Q

What is the course of the superficial fibular nerve?

A

Descends in lateral compartment

96
Q

Which vertebral segments control hip flexion?

A

L2,3

97
Q

Which vertebral segments control hip extension?

A

L4,5

98
Q

Which vertebral segments control knee flexion?

A

L5, S1

99
Q

Which vertebral segments control knee extension?

A

L3,4

100
Q

Which vertebral segments control ankle dorsiflexion?

A

L4,5

101
Q

Which vertebral segments control ankle plantarflexion?

A

S1,2

102
Q

Which vertebral segments control foot inversion?

A

L4

103
Q

Which vertebral segments control foot eversion?

A

L5, S1

104
Q

Which vertebral segments control big toe extension?

A

L5, S1

105
Q

Which vertebral segments control big toe flexion?

A

S1,2

MD1 Locomotor (17 decks)

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