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Physio Anatomy > Nerves of the lower limb > Flashcards

Nerves of the lower limb Flashcards

1
Q

What is/are the nerve root(s) of the femoral nerve?

A

L2-L4 (L2,3&4)

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2
Q

What are the motor functions of the femoral nerve?

A

Innervates the anterior thigh muscles that flex the hip joint (Pectineus, Iliacus, Sartorius) and extend the knee (Quadriceps femoris: Rectus femoris, Vastus lateralis, Vastus medialis and Vastus intermedius).

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3
Q

Describe the anatomical course of the femoral nerve.

A
  1. It is derived from the anterior rami of nerve roots L2,L3 and L4.
  2. After arising from the lumbar plexus, the femoral nerve travels inferiorly through the psoas major muscle of the posterior abdominal wall.
  3. It supplies branches to the iliacus and pectineus muscles prior to entering the thigh.
  4. The femoral nerve then passes underneath the inguinal ligament to enter the femoral triangle.
  5. Within this triangle, the nerve is located lateral to the femoral vessels Approximately 4cm below the inguinal ligament, the femoral nerve divides into anterior and posterior divisions:
  6. The terminal cutaneous branch of the femoral nerve is the saphenous nerve. It travels through the adductor canal (accompanied by the femoral artery and vein) and exits prior to the adductor hiatus.
  7. The saphenous nerve innervates the medial aspect of the leg and the foot.
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4
Q

What are the anterior divisions of the femoral nerve?

A

Anterior cutaneous branches
Branch to sartorius
Branch to pectineus

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5
Q

What are the posterior divisions of the femoral nerve?

A

Saphenous nerve

Branches to quadriceps femoris

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6
Q

What are the sensory functions of the femoral nerve?

A

Supplies cutaneous branches to the anteromedial thigh (anterior cutaneous branches of the femoral nerve) and the medial side of the leg and foot (saphenous nerve).

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7
Q

What is the obturator nerve?

A

The obturator nerve is a major peripheral nerve of the lower limb.

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8
Q

What are the nerve roots of the obturator nerve?

A

L2-4

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9
Q

What are the motor functions of the obturator nerve?

A

Innervates all the muscles of the medial compartment of the thigh:
(obturator externus, adductor longus, adductor brevis, adductor magnus and gracilis).
Except the hamstring part of abductor magnus

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10
Q

What are the sensory functions of the obturator nerve?

A

Cutaneous branches of the obturator nerve innervate the skin of the middle part of the medial thigh.

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11
Q

What is the anatomical course of the obturator nerve?

A
  1. The obturator nerve is formed from the lumbar plexus. It receives fibres from the anterior divisions of L2, L3 and L4.
  2. After its formation, the obturator nerve descends through the fibres of the psoas major and emerges from its medial border.
  3. It then travels posteriorly to the common iliac arteries and laterally along the pelvic wall – towards the obturator foramen of the pelvis.
  4. The obturator nerve enters the medial thigh via the obturator canal (formed within the obturator foramen by the obturator membrane).
  5. It then divides into anterior and posterior branches:
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12
Q

What are the anterior branches/divisions of the obturator nerve?

A
  • Descends between the adductor longus and adductor brevis (towards the femoral artery).
  • Here, it supplies motor fibres to the adductor longus, adductor brevis and gracilis. In rare cases, it can also supply the pectineus muscle.
  • It then pierces the fascia lata to become the cutaneous branch of the obturator nerve.
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13
Q

What are the posterior divisions/branches of the obturator nerve?

/ What is the course of the obturator nerve and what muscles does it innervate on it way?

A
  • Passes through the obturator externus muscle and then travels anteriorly to reach the adductor magnus.
  • Innervates the obturator externus and adductor magnus muscles.
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14
Q

What are the nerve roots for the sciatic nerve?

A

L4-S3

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15
Q

What are the motor functions of the sciatic nerve?

A

Innervates the muscles of the posterior thigh
(biceps femoris, semimembranosus and semitendinosus) and the hamstring portion of the adductor magnus (remaining portion of which is supplied by the obturator nerve).
Indirectly innervates (via its 2 terminal branches) all the muscles of the leg and foot.

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16
Q

What are the sensory functions of the sciatic nerve?

A 
No direct sensory functions / no direct cutaneous functions. 
Indirectly innervates (via its 2 terminal branches) (AKA via common peroneal and tibial nerves) the skin of the lateral leg, heel, and both the dorsal and plantar surfaces of the foot.
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17
Q

What is the anatomical course of the sciatic nerve?

A
  1. The sciatic nerve is derived from the lumbosacral plexus. After its formation, it leaves the pelvis and enters the gluteal region via greater sciatic foramen.
  2. It emerges inferiorly to the piriformis muscle and descends in an inferolateral direction.
  3. As the nerve moves through the gluteal region, it crosses the posterior surface of the superior gemellus, obturator internus, inferior gemellus and quadratus femoris muscles.
  4. It then enters the posterior thigh by passing deep to the long head of the biceps femoris.
  5. Within the posterior thigh, the nerve gives rise to branches to the hamstring muscles and adductor magnus.
  6. When the sciatic nerve reaches the apex of the popliteal fossa, it terminates by bifurcating into the tibial and common fibular nerves.
18
Q

What are the sciatic nerve’s 2 terminal branches

and what do they innervate?

A

Common fibula nerve: the muscles of the anterior leg, lateral leg, and the remaining intrinsic foot muscles.

Tibial nerve: the muscles of the posterior leg (calf muscles), and some of the intrinsic muscles of the foot.

19
Q

What are the 2 terminal branches of the sciatic nerve and what do they innervate?

A

Tibial nerve – innervates the posterolateral and anterolateral sides of the leg, and the plantar surface of the foot (the sole).
Common fibular nerve – innervates the lateral leg and the dorsal surface of the foot.

20
Q

What is piriformis syndrome? or deep gluteal syndrome?

Same thing

A

Piriformis syndrome refers to compression of the sciatic nerve by the piriformis muscle. It is also known as deep gluteal syndrome.
Clinical features include radicular pain, numbness, muscle weakness and buttock tenderness. The pain can occasionally be exacerbated by internal rotation of the lower limb at the hip.

two ways to fix it, either surgical or physiotherapy.

21
Q

What are the nerve roots of the tibial nerve?

A

L4-S3

22
Q

What are the sensory functions of the tibial nerve?

brief

A

Innervates the skin of the posterolateral side of the leg, lateral side of the foot, and the sole of the foot.

23
Q

What are the motor functions of the tibial nerve?

A

Innervates the all the muscles of the posterior compartment of the leg and the majority of the intrinsic foot muscles.

24
Q

What is the anatomical course of the tibial nerve?

A
  1. The tibial nerve is a branch of the sciatic nerve, and arises at the apex of the popliteal fossa.
  2. It travels through the popliteal fossa, giving off branches to muscles in the superficial posterior compartment of the leg.
  3. Here, the tibial nerve also gives rise to branches that contribute towards the sural nerve, which innervates the posterolateral aspect of the leg.
  4. The tibial nerve continues its course down the leg, posterior to the tibia. During its descent, it supplies the deep muscles of the posterior leg.
  5. At the foot, the nerve passes posteriorly and inferiorly to the medial malleolus, through a structure known as the tarsal tunnel.
  6. This tunnel is covered superiorly by the flexor retinaculum. Within this tunnel, branches arise from the tibial nerve to supply cutaneous innervation to the heel
    Immediately distal to the tarsal tunnel.
  7. The tibial nerve terminates by dividing into sensory branches, which innervate the sole of the foot.
25
Q

What is Tarsal tunnel syndrome?

  • causes?
  • symptoms?
  • treatment?
A

This is a condition where the tibial nerve is compressed within the tarsal tunnel (posterior to the medial malleolus). There are varying causes, of which the main three are:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Post-trauma ankle deformities

Patients complain of paraesthesia in the ankle and sole of the foot, which can radiate up the leg slightly. It is aggravated by activity and relieved by rest.
Tarsal tunnel symptoms can be treated conservatively by anti-inflammatory drugs and changes in footwear. If these interventions are not successful, the flexor retinaculum can be cut surgically, which releases the pressure.

26
Q

What are the sensory functions of the tibial nerve?

detailed

A

In the popliteal fossa, the tibial nerve gives off cutaneous branches. These combine with branches from the common fibular nerve to form the sural nerve. This sensory nerve innervates the skin of the posterolateral side of the leg and the lateral side of the foot.
The tibial nerve also supplies all the sole of the foot via three branches:
Medial calcaneal branches: These arise within the tarsal tunnel, and innervate the skin over the heel.
Medial plantar nerve: Innervates the plantar surface of the medial three and a half digits, and the associated sole area.
Lateral plantar nerve: Innervates the plantar surface of the lateral one and a half digits, and the associated sole area.

27
Q

What are the nerve roots for the Common peroneal nerve aka the common fibular nerve?

A

L4-S2

28
Q

What are the motor functions of the common peroneal nerve?

A

Innervates the short head of the biceps femoris directly. Also supplies (via branches) the muscles in the lateral and anterior compartment of the leg.

29
Q

What are the sensory functions of the common peroneal nerve?

A

Innervates the skin over the upper lateral and lower posterolateral leg. Also supplies (via branches) cutaneous innervations to the skin of the anterolateral leg, and the dorsum of the foot.

30
Q

What is the anatomical course of the common peroneal nerve?

A
  1. The nerve begins at the apex of the popliteal fossa, where the sciatic nerve bifurcates into the tibial and common fibular nerves.
  2. The common fibular nerve follows the medial border of the biceps femoris, running in a lateral and inferior direction, over the lateral head of the gastrocnemius.
  3. At this point, the nerve gives rise to two cutaneous branches, which contribute to the innervation of the skin of the leg.
  4. To enter the lateral compartment of the leg, the nerve wraps around the neck of the fibula, passing between the attachments of the fibularis longus muscle.
  5. Here the common fibular nerve terminates by dividing into the superficial fibular and deep fibular nerves.
31
Q

What are the 2 cutaneous branches that arise directly from the common peroneal nerve?
And, what do they innervate

A
  1. Sural communicating nerve; this combines with a branch of the tibial nerve to from the sural nerve. Which innervates the skin over the posterolateral leg.
  2. Lateral sural cutaneous nerve; innervates skin over the upper lateral leg.
32
Q

What is the nerve roots of the superficial peroneal nerve ( aka superficial fibular nerve)

A

L4-S1

33
Q

What is the motor functions of the superficial peroneal nerve?

A

Innervates muscles in the lateral compartment of the leg. (fibularis longus and F. brevis)

34
Q

What are the sensory functions of the superficial peroneal nerve?

A

Supplies the vast majority of the skin over the dorsum of the foot, apart from the webbing between the hallux and the second digit. It also supplies the anterior and lateral aspect of the inferior third of the leg.

35
Q

What is the anatomical course of the superficial peroneal nerve?

A
  1. The superficial fibular nerve is a terminal branch of the common fibular nerve.
  2. It arises at the neck of the fibula, descending between the fibularis muscles and the lateral side of the extensor digitorum longus.
  3. Here it gives rise to motor branches, which supply the fibularis longus and brevis.
  4. The nerve continues its descent, with a purely cutaneous function, providing sensory innervation to the anterolateral aspect of the lower leg.
  5. When the superficial fibular nerve reaches the lower third of the leg, it pierces the deep crural fascia and terminates by dividing into the medial and intermedial dorsal cutaneous nerves. These nerves enter the foot to innervate the majority of its dorsal surface.
36
Q

What pathologies could occur as a result of damage to the superficial peroneal nerve?
And what are their symptoms.

A

Entrapment; pain and paraesthesia over the lower leg and dorsum of the foot. Can be caused by ankle sprains or twisting of the ankle.

Direct damage; result in loss of eversion.

37
Q

What is the nerve roots for the Deep peroneal nerve

(Aka the deep fibular nerve)?

A

L4-S1

38
Q

What are the motor functions of the deep peroneal nerve?

A

Innervates the muscles in the anterior compartment of the leg, as well as some intrinsic muscles of the foot. (EDB EHB)

39
Q

What are the sensory functions of the dep peroneal nerve?

A

Supplies the triangular region of skin between the hallux and the first of the digits lateral to the hallux.

40
Q

What is the anatomical course of the deep peroneal nerve?

A
  1. The deep fibular nerve arises in the superolateral aspect of the leg, between the fibularis longus muscle and the neck of the fibula.
  2. The nerve moves from the lateral compartment to the anterior compartment of the leg.
  3. It then follows the course of the anterior tibial artery, in an inferomedial direction.
  4. Together the two structures pass between the TA (tibialis anterior) and the EDL (extensor digitorum longus) in the superior portion of the leg, and between the TA (tibialis anterior) and the EHL (extensor hallucis longus) in the inferior leg.
  5. The deep fibular nerve crosses the ankle joint, passing anterior to the distal tibia, and travels deep to the extensor retinaculum.
  6. It terminates in the dorsum of the foot, where it divides into:
    A lateral branch: Supplies motor innervation to some of the intrinsic muscles of the foot,
    A medial branch: A cutaneous nerve, innervating the skin between the 1st and 2nd toes.
41
Q

What pathology can occur as a result of damage to the deep fibular nerve?

A

Foot drop

Physio Anatomy (15 decks)

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