TBL 14 Flashcards
Lumbar and Sacral Plexus
lumbar plexus includes:
iliohypogastric, ilioinguinal, genitofemoral, lateral cutaneous of thigh, obturator, femoral
“I (2x) Get Laid On Friday”
(T12-L4)
sacral plexus includes:
superior gluteal, inferior gluteal, posterior cutaneous thigh, pudendal, sciatic (common fibular, tibial)
S.I.P.P.S.
(L4-S4)
lies in the posterior abdominal wall
lumbar plexus
the lumbar plexus lies in the
posterior abdominal wall
the iliohypogastric and ilioinguinal nerves arise from the ___ and passes ___
anterior ramus of L1;
inferiolaterally and anterior to the quadratus lumborum
the ___ nerves arise from the anterior ramus of L1 and passes inferolaterally and anterior to the quadratus lumborum
iliohypogastric and ilioinguinal (T12-L1)
the iliohypogastric and ilioinguinal nerves run ___, innervating the ___
superior and parallel to the iliac crest;
inferior portions of the transversus abdominis and internal oblique near the ASIS
the iliohypogastric and ilioinguinal nerves pass through the ___ to supply the ___ of the ___
internal and external obliques;
abdominal muscles and skin;
inguinal and pubic regions
the ___ nerves run superior and parallel to the iliac crest, innervating the inferior portions of the transversus abdominis and internal oblique near the ASIS, then pass through the internal and external obliques to supply the abdominal muscles and skin of the inguinal and pubic regions
iliohypogastric and ilioinguinal
inferior muscular innervations of the iliohypogastric and ilioinguinal nerves include:
transversus abdominis,
internal oblique
cutaneous innervations of the iliohypogastric and ilioinguinal nerves include:
inguinal and pubic regions
inferiorly muscularly innervated by the transversus abdominis and internal oblique
iliohypogastric and ilioinguinal nerves
cutaneously innervated by the inguinal and pubic regions
iliohypogastric and ilioinguinal nerves
muscular innervation of the genitofemoral nerve
cremaster muscle
cutaneous innervation of the genitofemoral nerve
scrotum (male) / mon pubis and labia majora (female);
anterior medial thigh (femoral triangle)
pierces the psoas major and runs inferiorly on its anterior surface
genitofemoral nerve (L1 and 2)
divides lateral to the common and external iliac arteries into the femoral and genital branches
genitofemoral nerve
the genitofemoral nerve divides ___ to the ___ into the ___ branches
lateral; common and external iliac arteries;
femoral and genital
the genitofemoral nerve pierces the ___ and runs ___
psoas major;
inferiorly on its anterior surface
innervates the scrotum and the cremaster muscle in men and the mon pubis and labia majora in women
genitofemoral nerve
the genitofemoral nerve innervates the
scrotum and cremaster muscle (men) and the mon pubis and labia majora (woman)
overlaps with the ilioinguinal nerve
genitofemoral nerve
the ___ branch of the ___ nerve innervates the skin of the anterior medial thigh
femoral; genitofemoral
the femoral branch of the genitofemoral nerve innervates the
skin of the anterior medial thigh
run inferolaterally on the iliacus and enters the thigh deep to the inguinal ligament / iliopubic tract, just medial to the ASIS
lateral cutaneous nerve of the thigh or lateral femoral cutaneous nerve (L2 and 3)
lateral cutaneous nerve of the thigh or lateral femoral cutaneous nerve run ___ and enters the ___
inferolaterally on the iliacus;
thigh deep to the inguinal ligament / iliopubic trast, just medial to the ASIS
supplies skin on the anterolateral surface of the thigh
lateral cutaneous nerve of the thigh or lateral femoral cutaneous nerve (L2 and 3)
lateral cutaneous nerve of the thigh or lateral femoral cutaneous nerve supplies ___
skin on the anterolateral surface of the thigh
muscular innervation of the lateral femoral cutaneous nerve includes:
none!
nerve that doesn’t have muscular innervation
lateral femoral cutaneous nerve
cutaneous innervation of the lateral femoral cutaneous nerve
anterolateral skin of the thigh
cutaneously innervated by the anterolateral skin of the thigh
lateral femoral cutaneous nerve
susceptible to compression under the inguinal ligament
lateral femoral cutaneous nerve
the lateral femoral cutaneous nerve is susceptible to
compression under the inguinal ligament
causes burning along the lateral thigh
meralgia paresthetica (gunslinger neuralgia)
why is it called gunslinger neuralgia
caused by a low riding belt
meralgia paresthetica causes
burning along the lateral thigh
muscular innervation of the obturator includes:
direct branch,
anterior branch,
posterior branch
direct branch of the muscular innervation of the obturator includes:
obturator externus
action of obturator externus
lateral rotation and adduction of hip
anterior branch of the muscular innervation of the obturator includes:
adductor longus,
adductor brevis,
gracilis,
pectineus
action of adductor longus and brevis
adduction and flexion of hip
action of gracilis
adduction and flexion of hip,
flexion of the knee
action of pectineus
adduction and thigh flexion (slight)
posterior branch of the muscular innervation of the obturator includes:
adductor magnus
action of adductor magnus
adduction, extension, and flexion (slight)
cutaneous innervation of the obturator
small patch on the medial thigh
cutaneously innervated by a small patch on the medial thigh
obturator
muscular innervation of the femoral nerve includes:
iliopsoas, sartorius, pectineus, quadriceps femoris - rectus femoris - vastus medialis - vastus lateralis -vastus intermedius
action of the iliopsoas
flexion of the hip
action of the sartorius
flexion of the hip and knee
action of the pectineus
flexion of the hip
action of the quadriceps femoris
knee extension
which quadriceps femoris does hip flexion along with knee extension
rectus femoris
cutaneous innervation of the femoral nerve
anterior cutaneous branches (anteromedial skin of thigh), saphenous nerve (medial skin of leg)
cutaneously innervated by the anterior cutaneous branches and saphenous nerve
femoral nerve (L2, L3, L4)
enters the thigh through the obturator foramen
obturator nerve (L2, L3, L4)
divides into anterior and posterior branches
obturator nerve
obturator nerve enters the ___ through the ___ and divides into ___ branches
thigh; obturator foramen;
anterior and posterior
iliohypogastric nerve originates from ___ vertebrae
L1
ilioinguinal nerve originates from ___ vertebrae
L1
genitofemoral nerve originates from ___ vertebrae
L1, L2
lateral femoral cutaneous nerve originates from ___ vertebrae
L2, L3
obturator nerve originates from ___ vertebrae
L2, L3, L4
femoral nerve originates from ___ vertebrae
L2, L3, L4
descends between the adductor longus and adductor brevis muscles
anterior branch of the obturator
anterior branch of the obturator descends between the
adductor longus and brevis muscles
descends between the adductor brevis and adductor magnus muscles
posterior branch of the obturator
posterior branch of the obturator descends between the
adductor brevis and adductor magnus muscles
innervates the medial compartment of the thigh
obturator
obturator nerve innervates the ___ and its main action is ___ and it also helps with ___
medial compartment of the thigh;
adduction of the thigh (hip joint);
flexing the thigh
adduction of the thigh (hip joint), and flexion of thigh
obturator
direct branch of obturator includes:
obturator externus
action of obturator externus includes:
lateral rotation and adduction
anterior branch of obturator includes:
adductor longus, adductor brevis, gracilis, pectineus
posterior branch of the obturator includes:
adductor magnus
arises from within the substance of the psoas major
femoral nerve (L2, L3, L4)
emerges between the iliacus and psoas major muscles
femoral nerve
enters the thigh by passing deep to the inguinal ligament and lateral to the femoral sheath
femoral nerve
femoral nerve arises from within the ___, emerges between the ___, and enters the ___ by passing ___
substance of the psoas major;
iliacus and psoas major muscles;
thigh; deep to the inguinal ligament and lateral to the femoral sheath
gives rise to muscular branches, articular branches to the hip and knee joints, and cutaneous branches
femoral nerve
femoral nerve gives rise to ___ branches
muscular, articular to the hip and knee joints, cutaneous
innervates the anterior compartment of the thigh
femoral nerve
main action is hip flexion and knee extension
femoral nerve
the femoral nerve innervates the ___ and its main action is ___
anterior compartment of the thigh;
hip flexion and knee extension
muscular branches of the femoral nerve include:
(anterior compartment of thigh) iliopsoas, sartorius, pectineus, quadriceps femoris
anterior cutaneous branches of the femoral nerve include:
saphenous nerve
medial cutaneous branch of the leg
saphenous nerve
branches from T4 and T5 travel inferiorly over the pelvic brim to join S1 and the sacral plexus, forming the
lumbosacral trunk
the lumbosacral trunk is formed by the
branches of T4 and T5 traveling inferiorly over the pelvic brim to join S1 and the sacral plexus
sacral plexus nerves include:
superior gluteal, inferior gluteal, posterior cutaneous nerve of the thigh, pudendal sciatic (fibular, tibial)
additional nerves in the sacral region include:
superior and middle clunial nerves
arise from the posterior rami of the spinal nerves
superior and middle clunial nerves
superior clunial nerves originate from the ___ vertebrae
L1-L3
middle clunial nerves originate from the ___ vertebrae
S1-S3
innervate the skin of the superior and medial portions of the buttock
superior and middle clunial nerves
the superior and middle clunial nerves innervate the
superior and medial portions of the buttock
lateral thigh rotators include:
nerve to the piriformis,
nerve to the obturator internus,
nerve to the quadratus femoris
superior gluteal nerve originates from the ___ vertebrae
L4, L5, S1
inferior gluteal nerve originates from the ___ vertebrae
L5, S1, S2
posterior cutaneous nerve of the thigh originates from the ___ vertebrae
S1, S2, S3
pudendal nerve originates from the ___ vertebrae
S2, S3, S4
sciatic nerve originates from the ___ vertebrae
L4 - S3
enters the buttock through the greater sciatic foramen above the piriformis
superior gluteal nerve (L4, L5, S1)
the superior gluteal nerve enters the ___ through the ___ and passes between the ___ and innervates the ___
buttock;
greater sciatic foramen above the piriformis;
gluteus medius and minimus muscles;
gluteus medius and minimus, the tensor fasciae latae, and the hip joint
passes between the gluteus medius and minimus muscles
superior gluteal nerve
innervates the gluteus medius and minimus, the tensor fasciae latae, and the hip joint
superior gluteal nerve
keeps pelvis level when contralateral limb is elevated
superior gluteal nerve
superior gluteal nerve keeps ___ level when ___ is ___
pelvis;
contralateral limb;
elevated
when the patient stands on one leg, the pelvis drops on the unaffected side
gluteus medius on opposite side is damaged
when the gluteus medius on the opposite side is damaged
pelvis drops on the unaffected side when the patient stands on one leg
positive trendelenburg test
when a patient is asked to walk, a gluteal limp or waddling appearance as a compensatory movement of the body to the affected side is present
enters the buttock through the greater sciatic foramen below the piriformis
inferior gluteal, posterior cutaneous, pudendal, sciatic
innervates the overlying gluteus maximus
inferior gluteal nerve (L5, S1, S2)
main action is powerful extension of the hip and external rotation
inferior gluteal nerve
the inferior gluteal nerve enters the ___ through the ___ and innervates the ___ and its main action includes the ___
buttock;
greater sciatic foramen below the piriformis;
overlying gluteus maximus;
powerful hip extension and external rotation
the posterior cutaneous nerve to the thigh enters the ___ through the ___, runs deep to the ___ and emerges from the ___, descends on the ___ and innervates the ___
buttock; greater sciatic foramen; gluteus maximus; inferior border of the gluteus maximus; posterior thigh; skin of the inferior buttock (inferior clunial nerves), thigh, and calf, as well as a small portion of the scrotum or labium majus (perineal branches)
runs deep to the gluteus maximus and emerges from its inferior border
posterior cutaneous nerve of the thigh (S1, S2, S3)
descends on the posterior thigh
posterior cutaneous nerve of the thigh (S1, S2, S3)
innervates the skin of the inferior buttock, thigh, and calf, as well as a small portion of the scrotum or labium majus
posterior cutaneous nerve of the thigh (S1, S2, S3)
inferior clunial nerves innervates
skin of the interior buttock
perineal branches innervate the
scrotum or labium majus
passes the back of the ischial spine
pudendal nerve (S2, S3, S4)
is medial to the internal pudendal artery
pudendal nerve (S2, S3, S4)
enters the perineum with the internal pudendal artery via the lesser sciatic foramen
pudendal nerve (S2, S3, S4)
innervates the skin of the perineum and anus, as well as the muscles of the external anal and urethral sphincters
pudendal nerve (S2, S3, S4)
the pudendal nerve passes the ___ and is ___, enters the ___ with the ___ via the___, and innervates the ___
back of the ischial spine;
medial to the internal pudendal artery;
perineum; internal pudendal artery; lesser sciatic foramen;
skin of the perineum and anus, as well as the muscles of the external anal and urethral sphincters
divides at the superior border of the popliteal fossa into the tibial nerve and the common peroneal nerve
sciatic nerve
descends over the obturator internus gemelli and quadratus femoris muscles between the ischial tuberosity and the greater trochanter
sciatic nerve
common peroneal nerve
common fibular nerve
the sciatic nerve divides at the ___ into the ___ and descends over the ___ between the___
superior border of the popliteal fossa;
tibial nerve and the common peroneal nerve;
obturator internus gemelli and quadratus femoris muscles;
ischial tuberosity and the greater trochanter
smaller terminal portion of the sciatic nerve at the apex of the popliteal fossa
common peroneal (fibular) nerve (L4-S2)
the common peroneal (fibular) nerve originates from the ___ vertebrae
L4 - S2
the tibial nerve originates from the ___ vertebrae
L4 - S3
descends through the popliteal fossa, and superficially crosses the lateral head of the gastrocnemius muscle
common peroneal (fibular) nerve
passes behind the head of the fibula
common peroneal (fibular) nerve
gives rise to the lateral sural cutaneous nerve and the recurrent articular branch to the knee joint
common peroneal (fibular) nerve
supplies the skin on the lateral part of the back of the leg
lateral sural cutaneous nerve
the common peroneal (fibular) nerve is a ___ portion of the sciatic nerve at the ___ that descends through the ___ and ___ crosses the ___ and passes ___ while giving rise to the ___
smaller terminal;
apex of the popliteal fossa;
popliteal fossa;
superficially; lateral head of the gastrocnemius muscle;
behind the head of fibula;
lateral sural cutaneous nerve and the recurrent articular branch to the knee joint
the lateral sural cutaneous nerve supplies the
skin on the lateral part of the back of the leg
direct branches from the sciatic nerve innervate the
short head of the biceps femoris
innervate the short head of the biceps femoris
direct branches of the sciatic nerve
is vulnerable to injury as it winds around the neck of the fibula
common peroneal (fibular) nerve
the common peroneal (fibular) nerve is
is vulnerable to injury
the common peroneal (fibular) nerve divides into
deep fibular and superficial fibular nerves
the common peroneal (fibular) nerve laterally winds around the ___ and pierces the ___
neck of the fibula;
fibularis (peroneus) longus
pierces the fibularis (peoneus) longus
common peroneal (fibular) nerve
arises in the peroneus longus muscle on the lateral side of the neck of the fibula
superficial fibular nerve
the superficial fibular nerve arises in the ___ on the ___ making it ___
peroneus longus muscle;
lateral side of the neck of the fibula;
less vulnerable to injury
innervates the lateral compartment of the leg
superficial fibular nerve
the superficial fibular nerve innervates the ___ with the ___ muscles, and its main action is ___
lateral compartment of the leg;
fibularis (peroneus) longus and brevis;
foot eversion and plantar flexion
foot eversion and plantar flexion is performed by:
the superficial fibular nerve
the superficial fibular nerve emerges between the ___ and becomes ___ in the ___ and innervates the ___
peroneus longus and brevis muscles at the lower third of the leg;
subcutaneous; lateral compartment;
skin on the lateral side of the lower leg and the dorsum of the foot
innervates the skin on the lateral side of the lower leg and the dorsum of the foot
superficial fibular nerve
arises in the substance of the fibularis (peroneus) longus on the lateral side of the neck of the fibula
deep fibular nerve
enters the anterior compartment
deep fibular nerve
descends on the interosseous membrane between the extensor digitorum longus and the extensor hallucis longus muscles
deep fibular nerve
innervates the anterior compartment of the leg
deep fibular nerve
main action is dorsiflexion of the foot and extension of the toes
deep fibular nerve
the anterior compartment of the leg includes:
tibialis anterior,
extensors digitorum longus,
extensors hallucis longus,
fibularis tertius
the lateral branch of the deep fibular nerve reaches the
dorsum of the foot
the dorsum of the foot includes:
extensor digitorum brevis,
extensor hallucis brevis
the medial branch of the deep fibular nerve supplies the
skin on the adjacent sides of the first and second toes
the deep fibular nerve arises in the ___ on the ___ of the ___ making it ___
substance of the fibularis (peroneus);
lateral side; neck of the fibula;
vulnerable to injury
the deep fibular nerve enters the ___, descends on the ___ between the ___ and innervates the ___, and its main action is ___
anterior compartment;
interosseous membrane;
extensor digitorum longus and the extensor hallucis longus muscles;
anterior compartment of the leg;
dorsiflexion of the foot, and extension of the toes
reaches the dorsum of the foot and extends the toes
lateral branch of the deep fibular nerve
supplies the skin on the adjacent sides of the first and second toes
medial branch of the deep fibular nerve
common peroneal (fibular) nerve injury occurs specifically with the
deep fibular and anterior compartment
common peroneal (fibular) nerve injury is characterized by
injury at the neck of the fibula;
flaccid paralysis of muscles in the anterior (dorsiflexors) and lateral (evertors) leg compartments;
no dorsiflexion – foot drop;
limb becomes too long for toes to clear the ground during walking;
waddling gait;
swing-out gait;
stepping gait
body movement shifts to the unaffected side while walking
waddling gait
leg is abducted while walking
swing-out gait
increased thigh and knee flexion while walking
stepping gait
waddling gait
body movement shifts to the unaffected side while walking
swing-out gait
leg is abducted while walking
stepping gait
increased thigh and knee flexion while walking
common peroneal (fibular) nerve injury occurs at the ___ leading to ___ of muscles in ___
neck of the fibula;
flaccid paralysis;
the anterior and lateral compartments
no dorsiflexion and the toes don’t clear the ground during the swing phase of walking
foot drop
foot drop
no dorsiflexion; toes do not clear the ground during the swing phase of walking
dorsiflexors reside in the
anterior compartment
evertors reside in the
lateral compartment
descends through the popliteal fossa lying on the popliteus muscle
tibial nerve
gives rise to 3 articular branches to the knee joint
tibial nerve
gives rise to direct muscular branches of the sciatic nerve to the posterior compartment of the thigh
tibial nerve
posterior compartment of the thigh also called
the hamstring
the hamstring is the
posterior compartment of the thigh
main action of the posterior compartment of the thigh includes:
flex leg (knee) and extend hip in walking
flexes leg (knee) and extends hip in walking
direct muscular branch of the sciatic nerve
the hamstring innervated by the direct muscular branch of the sciatic nerve contains:
long head of the biceps femoris, semimembranosus, semitendinosus, and medial part of the adductor magnus
the tibial nerve descends through the ___ lying on the ___ and gives rise to ___
popliteal fossa;
popliteal muscle;
three articular branches to the knee joint
the tibial nerve branches enter the
posterior compartment of the leg
action of the posterior compartment of the leg
plantar flexion of the foot, flexion of the knee
plantar flexion of the foot and flexion of the knee are performed by
the tibial nerve branches
foot drop occurs when the ___ do not clear the ground during the ___
toes; swing phase of walking
the posterior compartment of the leg includes:
flexor digitorum longus, flexor hallucis longus, triceps surae (gastrocnemius and soleus), plantaris, popliteus, tibialis posterior
gives rise to the medial sural cutaneous nerve, the medial calcaneal branch to the skin of the heel and sole, and the articular branches to the ankle joint
tibial nerve
terminates beneath the flexor retinaculum by dividing into the medial and lateral plantar nerves
tibial nerve
innervate all the plantar muscles in the foot accomplishing adduction, abduction, and flexion of the toes
medial and lateral plantar nerves
the tibial nerve terminates beneath the ___ by dividing into the ___ which innervate ___ accomplishing ___
flexor retinaculum;
medial and lateral plantar nerves;
all the plantar muscles in the foot;
adduction, abduction, and flexion of the toes
inverts the foot
tibialis posterior
compression of the sciatic nerve can occur due to compression via the piriformis muscle
piriformis syndrome
piriformis syndrome occurs when the
piriformis muscle compresses the sciatic nerve
damage via ___ to the medial aspect of the buttock puts the ___ at risk
stab wound / intragluteal injections;
sciatic nerve, inferior gluteal, posterior cutaneous nerve of the thigh
a stab wound or intragluteal injections at the ___ can put the sciatic nerve, inferior gluteal, and posterior cutaneous nerve of the thigh at risk
medial aspect of the buttock
damage to the sciatic nerve can lead to ___ and hence ___
paralysis of hamstrings;
impairment of thigh extension and knee flexion
paralysis of hamstrings causes
impairment of thigh extension and knee flexion
paralysis of hamstrings can be caused by
damage to the sciatic nerve
femoral nerve injury can be caused by ___ and impair ___ leading to ___
trauma at femoral triangle / pelvic fracture;
weak flexion of thigh, loss of extension of leg, sensory loss on anterior thigh and medial leg;
loss of knee-jerk reflex / anesthesia on anterior thigh
obturator nerve injury can be caused by ___ and impair ___ leading to ___
anterior hip dislocation / radical retropubic prostatectomy;
loss of adduction of thigh, sensory loss on medial thigh;
((blank))
superior gluteal nerve injury can be caused by ___ and impair ___ leading to ___
surgery / posterior hip dislocation / poliomyelitis;
loss of function of gluteus medius and minimus, loss of ability to pull pelvis down, loss of abduction of thigh;
gluteus medius limp (waddling gait), positive trendelenburg sign
inferior gluteal nerve injury can be caused by ___ and impair ___ leading to ___
surgery / posterior hip dislocation;
loss of function of gluteus maximus, loss of ability to rise from a seated position, climb stairs, or jump;
lean the body trunk backward at heel strike
common fibular nerve injury can be caused by ___ and impair ___ leading to ___
blow to lateral aspect of leg / fracture of neck of fibula;
loss of foot eversion, loss of dorsiflexion, loss of toe extension, sensory loss on anterolateral leg and dorsum of foot;
foot plantar flexed (foot drop) and inverted, can’t stand on heels (foot slap)
tibial nerve injury at the popliteal fossa can be caused by ___ and impair ___ leading to ___
trauma at popliteal fossa;
weak foot inversion, loss of plantar flexion, loss of toe flexion, sensory loss on sole of foot;
foot dorsiflexed and everted, can’t stand on toes
