FPP - Lower Limb Nerves

Femoral Nerve

Formed in Ventral Rami of L2, L3, and L4

Articular Branches:

Hip

Knee

Muscular Branches:

Anterior Division

Sartorius

Posterior Division

Rectus femoris

Vastus lateralis

Vastus medialis

Vastus intermedius

Nerve Pathway:

1. Palpate iliac crest to find L4 vertebra. Beginning of nerve

2. Palpate ASIS, and locate pelvic tubercle to find path of inguinal Ligament

3. Nerve travels under inguinal ligament (lateral side)

4. Nerve passes through femoral triangle to mid thigh

5. Divides into anterior and posterior divisions

Tension Test:

Prone Tension Test:

1. Flex knee and extend leg

2. Hold back pelvis to ensure tension on nerve

Side Laying Tension Test:

1. Flex knee and extend leg

2. Hold back pelvis to ensure tension on nerve

Positive test - recreates pain

Negative test - feel tightness, but no pain

Sciatic Nerve

Formed from Ventral Rami of L4,L5, S1,S2,and S3

Articular Branches:

Hip

Muscular Branches:

Semitendinosus

Semimembranosus

Biceps Femoris

Adductor Magnus (ischial head)

Nerve Pathway:

1. Palpate iliac crest to find L4 vertebra. Beginning of nerve

2. Nerve passes through the greater sciatic foramen, next to the piriformis muscle

3. Palpate ischial tuberosity and greater trochanter. Nerve travels between these

4. Nerve goes down the leg until it splits near the tendons of the biceps femoris and the semitendinosus

Tension Test:

Slump Test:

1. Patient slumps forward with hands on knees while in a seated position

2. Chin to chest

3. Extend leg

4. Dorsiflexion

Laying Test:

1. Patient lays on back

2. Bring thigh up with leg extended, then dorsiflex toes OR

2. Bring thigh up and keep leg parallel with bed, then extend knee and dorsiflex toes

Positive test - recreates pain

Negative test - feel tightness, but no pain

Tibial Nerve

Medial branch of Sciatic Nerve

Articular Branches:

Knee

Muscular Branches:

Gastrocnemius

Soleus

Plantaris

Popliteus

Tibialis Posterior

Flexor Digitorum Longus

Flexor Hallucis Longus

Common Peroneal Nerve

Lateral branch of Sciatic Nerve

Articular Branches:

Knee

Superior tibiofibular joint

Muscular Branches:

None

Superficial Peroneal Nerve

Descends vertically between the Peroneus Longus and Peroneus Brevis and the Extensor Digitorum Longus

Articular Branches:

None

Muscular Branches:

Peroneus (Fibularis)Longus

Peroneus (Fibularis) Brevis

Deep Peroneal Nerve

Passes into anterior compartment of the leg deep to Extensor Digitorum Longus

Articular Branches:

Inferior Tibiofibular joint

Ankle

Muscular Branches:

Extensor Hallucis Longus

Extensor Digitorum Longus

Tibialis Anterior

Peroneus Tertius