Nerves of the Lower Limb PDF

Nerves of the lower limb Department of human Anatomy and Embryology Faculty of Medicine Mansoura National University, Egypt  Intended Learning Outcomes (ILOs) 1. Recognize the nerves of the supplying the lower limb( femoral, obturator, sciatic) and their branches...

Nerves of the lower limb Department of human Anatomy and Embryology Faculty of Medicine Mansoura National University, Egypt  Intended Learning Outcomes (ILOs) 1. Recognize the nerves of the supplying the lower limb( femoral, obturator, sciatic) and their branches  Agenda 1. What are the origin and branches of the nerves ( frmoral, obtuartor, sciatic) supplying the lower limb?  Nerves of the lower limb Femoral nerve Origin: arises inside the abdomen from the lumbar plexus. Root value: dorsal division of (L. 2, 3, 4). Course and relations: enters the femoral triangle by passing behind the inguinal ligament, lateral and outside the femoral sheath. Termination: it ends about one inch below the inguinal ligament by dividing into branches.  Nerves of the lower limb Branches: A-Muscular branches: supply to the following muscles: 1. Pectineus. 2. Sartorius. 3. Quadriceps. 4. Iliacus.  Nerves of the lower limb B-Cutaneous branches: 1. Medial cutaneous nerve of the thigh. 2 2. Intermediate cutaneous nerve of the thigh. 1 3. saphenous nerve: ❑ Descends with the long saphenous vein. ❑ Begins in the femoral triangle, crosses the subsartorial canal. ❑ Enters the foot by passing in front of the medial malleolus to end in 3 the skin at the middle of the medial aspect of the foot as far as the first metatarsophalangeal joint. ❑ Supply the skin of the medial side of the leg and foot till the root of the big toe  Nerves of the lower limb Obturator nerve Origin: from lumbar plexus Root value: ventral division of (L. 2, 3, 4). Course and relation: ❑ It enters the obturator canal in accompany with the obturator vessels ❑ In the obturator canal it divides into anterior and posterior branches. Branches: has 2 divisions: 1. Anterior division: 2. Posterior division:  Branches of Branches of The Posterior Division The Anterior Division Nerve to Obturator Externus Articular to The Hip Joint Nerve to Adductor Brevis (Sometimes) Nerve to Adductor Longus Nerve to Pubic Part of Adductor Magnus Nerve to Adductor Brevis Genicular Branch Nerve to Gracilis (To The Knee) Cutaneous to The Middle of The Medial Side of The Thigh  Nerves of the lower limb Anterior division Posterior division Muscular 1. Gracilis muscle. 1. Obturator externus branches to: 2. Adductor longus muscle. 2. Pubic part of adductor magnus 3. Adductor brevis muscle. 3. Adductor brevis muscle (sometimes) Articular to: Hip joint. No cutaneous branches. Cutaneous To the skin of the middle branch to: third of the medial side of the thigh  Quiz The root value of the obturator nerve is……….. A. (L. 2, 3, 4). B. (L. 2, 3) C. (S. 1, 2, 3) D. (L. 1, 2, 3) E. (L. 4, 5, S1) Answer: A  Nerves of the lower limb Sciatic nerve Origin: It is one of two terminal branches of the sacral plexus (L. 4,5 & S. 1,2,3). Course: ❑ Passes through the lower part of the greater sciatic foramen below the piriformis to enter the gluteal region ❑ Descends in the back of the thigh under cover of gluteus maximus Termination: Opposite the middle of the back of the thigh By dividing into: 1. Tibial (medial popliteal) nerve. 2. Common peroneal (Lateral popliteal) nerve  Piriformis Muscle Sciatic Nerve Lateral Popliteal Nerve (Common Peroneal) Medial Popliteal (Tibial)  Nerves of the lower limb Branches: a. Muscular to: 1. Semitendinosus. 2. Semimembranosus. 3. Biceps femoris 4. Ischial part of adductor magnus. b. Articular : to the hip joint c. Terminal : 1. Medial popliteal nerve. 2. Lateral popliteal nerve. Identify these nerve?  Nerves of the lower limb Medial popliteal (Tibial) nerve Origin: This is the larger of the two terminal branches of the sciatic nerve opposite the middle of the back of the thigh. Course: ❑ It enters the popliteal fossa at the upper angle. ❑ Traverses the fossa from above downwards. ❑ Leaves the fossa through the inferior angle. Termination: At the distal border of the popliteus muscle as the posterior tibial nerve.  BRANCHES Muscular Gastrocnemius. Plantaris. Popliteus. Soleus. P G G Cutaneous Sural nerve: P lower part of the back of the leg. Lateral side of the foot. Lateral side of the little toe. Articular S Superior medial genicular n. Inferior medial genicular n. Middle genicular n.  Nerves of the lower limb Lateral popliteal (Common peroneal) nerve Origin: This is the smallest of the two terminal branches of the sciatic nerve opposite the middle of the back of the thigh. Course and relations: ❑ Enters the popliteal fossa through its superior angle. ❑ Descends downwards and laterally close to biceps femoris muscle. ❑ Leaves the popliteal fossa through its lateral angle by curving around the neck of the fibula to reach the lateral aspect of the fibula. Termination: at the lateral aspect of the neck of the fibula by dividing into: Superficial & deep peroneal branches.  Common peroneal nerve Sural communicating. Cutaneous Lateral cutaneous nerve of the calf. Superior Lateral genicular Articular Inferior Lateral genicular Recurrent genicular Superficial peroneal. Terminal Deep peroneal.  Nerves of the leg & foot Deep Superficial Tibial nerve peroneal peroneal (in leg) nerve nerve To the posterior To the anterior To the lateral compartment compartment compartment Medial Lateral plantar plantar Enter the dorsum of the foot nerve nerve  Nerves of the lower limb Deep peroneal (Anterior tibial) nerve Origin: Is one of the two terminal branches of the common peroneal nerve. Termination: It ends by dividing into medial and lateral divisions at the ankle joint. Branches: 1. Muscular: to the muscles of the anterior compartment of the leg 2. Articular: to ankle joint. 3. Terminal: a. The lateral terminal branch: to the extensor digitorum brevis & tarsal joints. b. The medial terminal branch supplies the skin of the adjoining sides of the big and second toes. Nerves of the lower limb  Nerves of the lower limb Superficial Peroneal (musculocutaneous) nerve Origin: one of the two terminal branches of the common peroneal nerve at the lateral side of the neck of the fibula. Branches: 1. Macular: to the peroneus longus and brevis muscles. 2. Cutaneous: to the lower half of the anterior surface of the leg 3. Terminal: A. To the intermediate part of the dorsum of the foot. B. To the adjacent sides of toes except the 1st cleft between 1st and 2nd toes.  Nerves of the lower limb Posterior tibial nerve Origin: continuation of tibial nerve at lower border of popliteus. Termination: under cover of flexor retinaculum by dividing into medial and lateral planter nerves. Branches: 1. Muscular: to soleus, tibialis posterior, FHL, FDL. 2. Articular: to ankle joint. 3. Cutaneous: to supply skin of heel. 4. Terminal: Posterior tibial Medial planter nerve nerve Lateral planter nerve  Tibial nerve (in popliteal fossa) Medial Plantar n. Posterior Tibial Lateral nerve Plantar n. Nerves of the lower limb  Quiz What is the nerve supply of the FDL muscle? A. Anterior tibial N. B. Posterior tibial N. C. Superfacial peroneal N. D. Tibial N. E. Medial plantar Answer: B