Chapter 62: Consolidated Neurovascular Anatomy of the Lower Limb

lumbosacral plexus supplies the _______

entire muscular and cutaneous innervation to the lower limb

lumbosacral plexus is subdivided into ______

lumbar and sacral plexus

ventral ramus _____ bifurcates into ______

L4

upper and lower division

The upper division of L4 is part of the _______ plexus

lumbar

The lower division of L4 is part of the _______ plexus

sacral

Lumbar plexus is derived from ventral rami ________

L1 to L3 and UPPER division of L4

lumbosacral plexus is formed from the _______

ventral rami of spinal nerves L1-S4

the lumbar plexus is located

on the posterior wall of the abdomen within the substance of the psoas major

lumbar plexus primarily supplies _________

lateral, anterior, and medial sides of thigh

sacral plexus is derived from _______

lower division of ventral ramus l4 AND ventral rami L5 to S4

sacral plexus is located ________

against the lateral wall of the pelvis just medial to the piriformis

sacral plexus primarily supplies _______

gluteal region, posterior thigh, leg, and foot

lumbar plexus nerves

femoral and obturator nerve

femoral nerve: ventral rami

L2, L3, upper division of L4

femoral nerve emerges ____ to _________

Lateral to the psoas major muscle

After emerging lateral to psaos major, femoral nerve courses deep to ________ and continues _____ as it passes through __________ and then into the _____

inguinal ligament

Distally

femoral triangle

Anterior thigh

femoral nerve crosses the _______ and passes through the _______

crosses the inguinal ligament and passes through the femoral triangle

branches of the femoral nerve supply

all muscles of the anterior thigh and pectineus

7 muscles

femoral nerve supplies ________

anterior thigh muscles

-iliacus part of iliopsoas

-sartorius

-rectus femoris

-vastus lateralis, medialis, and intermedius

-pectineus muscle

femoral nerve gives how many cutanoues branches

2: saphenous nerve and anterior femoral cutaneous nerve

femoral nerve gives off ____ nerve that supplies skin of _____

saphenous nerve

skin of the anteromedial leg and medial foot

femoral nerve gives off ____ nerve that supplies ____

anterior femoral cutaneous nerve

supplies ANTERIOR thigh

obturator nerve: ventral rami

L2, L3, upper division of L4

After emerging _____ to the _____ muscle, obturator nerve courses ____ along the ____ wall of _____

medial to psoas major muscle

inferiorly along the lateral wall of the pelvis

obturator nerve divides into ____ branches immediately _________. What are the two branches?

TWO

before passing through obturator foramen

Anterior and posterior branch of obturator nerve

anterior branch of obturator nerve course _____ between _______

anteroinferiorly

adductor longus and adductor brevis muscles

anterior branch of obturator nerve: supply

-BOTH adductor longus and brevis

-gacilis

-skin of mid-medial thigh

posterior branch of obturator nerve course _____ between _______

Posterio-inferiorly

adductor brevis and adductor magnus

posterior branch of obturator nerve: supply

obturator externus and adductor part of adductor magnus

additional cutaneous branches arising from lumbar plexus supply_______

-skin around lower abdominal wall

-proximal thigh

-external genitalia

4 additional cutaneous branches arising from lumbar plexus

iliohypogastric, ilioinguinal, genitofemoral nerves, lateral femoral cutaneous nerve

lateral femoral cutaneous nerve supply _________

lateral thigh

obturator nerve primarily supplies _______

medial thigh

sacral plexus nerves

8 total!!

sciatic

superior gluteal

inferior gluteal

nerve to quadratus femoris and inferior gemellus

nerve to obturator internus and superior gemellus

nerve to piriformis

posterior femoral cutaneous nerve

pudendal nerve

sciatic nerve: ventral rami

L4 lower and ventral rami of L5 - S3

Two branches of the sciatic nerve

1. common fibular part of sciatic nerve

2. tibial part of sciatic nerve

common fibular part of sciatic nerve and tibial part of sciatic nerve are wrapped in _______

epineurium

superior gluteal nerve: ventral rami

L4 lower, L5, S1

superior gluteal nerve supplies _______

gluteus medius, gluteus minimus, tensor fascia lata

inferior gluteal nerve: ventral rami

L5, S1, S2

inferior gluteal nerve innervates ________

gluteus maximus

nerve to quadratus femoris and inferior gemellus: ventral rami

L4 lower, L5, S1 (same as superior gluteal n.)

nerve to quadratus femoris and inferior gemellus supply _______

quadratus femoris and inferior gemelles

nerve to obturator internus and superior gemellus: ventral rami

L5, S1, S2 (same as inferior gluteal n.)

nerve to obturator internus and superior gemellus: supply

obturator internus and superior gemellus

nerve to piriformis: ventral rami

S2

nerve to piriformis: supply

piriformis

posterior femoral cutaneous nerve: ventral rami

S1, S2, S3

posterior femoral cutaneous nerve supplies ________

skin of posterior thigh

pudendal nerve: ventral rami

S2, S3, S4

pudendal nerve supplies _______

majority of structures in pelvis and pelvic wall

As sciatic nerve exits the ____, it courses below _____ and continues ______ and _____ to ______ towards _____

pelvis

piriformis

inferior and deep to gluteus maximus towards posterior thigh

in posterior thigh, the sciatic nerve courses between _______

hamstring muscles

the tibial part of sciatic innervates ________

extensor portion of adductor magnus (0.5 muscle)

long head of biceps femoris (0.5 muscle)

semimembranosus and semitendinosus (2 muscles)

Elephants Love Sweet Sugar

the common fibular part of sciatic nerve innervates _______

short head of biceps femoris (0.5 muscle)

the tibial and common fibular parts of sciatic nerves separate into the tibial and common fibular nerves in the ______, just ____ to ______

lower third of thigh

proximal to popliteal fossa

tibial nerve travels _____ through the middle of the ______

superficial to ___ and ____

INFERIORLY through the middle of the popliteal fossa

superficial to popliteal vein and artery

tibial nerve courses between ______, DEEP to ____ and enters ____ as it continues to course ____

between the heads of gastrocnemius

deep to soleus

enters deep compartment of the leg as it continues to course distally

tibial nerve passes deep to _____ on ____ side of ankle where it divides into 2 nerves

flexor retinaculum

medial side of ankle

tibial nerve divides into ________

medial and lateral plantar nerves

medial and lateral plantar nerves supply _________

plantar surface of the foot

tibial nerve innervates ________

ALL 7 muscles of posterior leg

gastrocnemius

soleus

plantaris

popliteus

tibialis posterior

flexor digitorum longus

flexor hallucis longus

after arising from _____ in LOWER third of thigh, common fibular nerve _____ along the _________ side of ______

sciatic nerve

descends along the lateral side of popliteal fossa

Does the common fibular nerve supply any muscle?

The branches DO supply muscles, but the common fibular nerve does NOT supply any muscle directly

As the common fibular nerve winds around the ______ of the fibula it divides into _________ and ___________ fibular nerves

neck of fibula

superficial and deep fibular nerves

common fibular nerve divides into

superficial fibular nerve and deep fibular nerve

superficial fibular nerve courses ____ in _____ of the leg

inferiorly in the lateral compartment

superficial fibular nerve courses between ____ and ____

fibularis longus and fibularis brevis

superficial fibular nerve innervates _______

fibularis longus

fibularis brevis

superficial fibular nerve supplies SKIN of _______

lateral leg and dorsum of foot

EXCEPT webspace between first and second toes

deep fibular nerve passes from ____ to ____

lateral to anterior compartment

deep fibular nerve innervates ________

entire anterior leg including:

tibialis anterior

extensor hallicus longus

extensor digitorum longus

fibular tertius

extensor digitorum brevis on dorsum of foot

deep fibular nerve supplies SKIN of _______

webspace between the first and second toes

abdominal aorta divides into _________

right and left common iliac arteries at the level of L4

abdominal aorta divides at level _______

L4

common iliac artery courses ____ and ____ for about _____ cm before dividing into _________along ________

inferiorly and laterally for about 5 cm

before dividing into internal and external iliac arteries

along pelvic brim

Internal iliac artery courses _________ along _________ giving off branches

inferiorly and posteriorly along wall of the pelvis

Branches of the internal iliac artery

multiple branches to pelvic organs including internal pudendal artery

and

2 branches that supply gluteal region

2 branches of internal iliac artery that supply gluteal region

superior and inferior gluteal arteries

superior gluteal artery exits the pelvis to enter gluteal region _____

above the piriformis

superior gluteal artery exits the pelvis with _______

superior gluteal nerve

superior gluteal artery exits the pelvis and courses between _____ muscles

gluteus medius and minimus

inferior gluteal artery leaves the pelvis to enter the gluteal region ______

below the piriformis

inferior gluteal artery exits the pelvis with _________

inferior gluteal nerve

the inferior gluteal artery lies deep to ________

gluteus maximus

external iliac artery continues _____ towards the ______

inferiorly towards the thigh

external iliac artery courses deep to ____, and then changes its name to _____

inguinal ligament in the femoral triangle

femoral artery

femoral artery lies _______ to femoral nerve and ______ to femoral vein in the _____

MEDIAL to femoral nerve

LATERAL to femoral vein

in the femoral triangle

femoral triangle located in ________

superior portion of anterior thigh

In ____ thigh. femoral artery gives off _______

proximal thigh

large profunda femoris artery

profunda femoris artery branches supply _______

adductor and hamstring muscles

hamstring muscles

biceps femoris, semitendinosus, semimembranosus

the femoral artery continues to course through the anterior thigh, and then passes to ________ through the _____ where it becomes _____

distal posterior thigh

adductor hiatus (opening)

popliteal artery

external iliac artery becomes

femoral artery

femoral artery becomes

popliteal artery

the femoral artery gives off a branch called _______

profunda femoris artery

popliteal artery courses ____ through _______, where it lies DEEP to ______

distally through popliteal fossa

deep to popliteal vein and tibial nerve

popliteal artery divides into ______ and ____ at the ________

anterior and posterior tibial arteries

at the LOWER portion of popliteal fossa

anterior tibial artery immediately passes through a _____ in the _______ as it courses from the _____ to _____ compartment of leg

gap in the interosseous membrane

posterior to anterior compartment

anterior tibial artery courses ____ in the _____ compartment of leg with _______ nerve

distally in the anterior compartment

deep fibular (peroneal) nerve