Lumbo sacral plexus

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Transcript of Lumbo sacral plexus

  • 1. LUMBOSACRALPLEXUSDr. Khadija Iqbal

2. Lets revise and then go ahead 3. Muscles Muscles of the thigh are arranged inthree compartments separated byintermuscular septa 4. medial compartment of thigh six muscles Gracilis-obturator nerve pectineus- femoral nerve adductor longus, adductor brevis adductor magnus-sciatic nerve obturator externus 5. anterior compartment of thigh sartorius four large quadriceps femoris muscles(rectus femoris, vastus lateralis, vastusmedialis, and vastus intermedius). the terminal ends of the psoas major and iliacus muscles pass into the upperpart of the anterior compartment fromsites of origin on the posterior abdominalwall. 6. The posterior compartment of thighcontains three large muscles termed thehamstrings. All are innervated by thesciatic nerve. 7. Adductor canal Laterally vastus medialis Anteromedially sartorius Posteriorly adductor longus 8. 15.Anterior rami ofupper 4 lumbarspinal nerves (+L5)and from thecontribution ofsubcostal nerve(T12)in the lumbarregion, withinthe psoas majormuscle. 9. Latfemoralobturator 10. 20.(L2-L4)largest branchboth motor and sensory.Emerges from the lateralborder of the psoas majorFlexors of the hip andextensors of the kneeSkin of the anterior andlateral thigh, medial legand foot 11. 21.largest cutaneousbranch of the femoralnervecontinuation of thefemoral nerveSkin of medial aspectsof leg and foot 12. 22.Emerges from the medialborder of the psoasmajorLeaves the lesserpelvis throughthe obturator canalSkin on the superiormedial thighAdductor muscles of theleg 13. Gluteal regiondeep group of small muscles, piriformis, obturator internus, gemellussuperior, gemellus inferior, and quadratusfemoris;superficial groupgluteus minimus, gluteus medius, andgluteus maximus- the tensor fasciae latae, 14. Second lecture24.4.13 15. 31.Sensory and motor innervation of the wholelower limbarises from the spinal roots L1-S4Lumbal plexusSacral plexus 16. 32.Descending part ofthe L4 nerve uniteswith the anteriorramus of the L5nerve to form thelumbosacral trunk.Participates in theformation of thesacral plexus withthe anterior ramiof S1-S4 nerves. 17. 33 18. 34 19. 43 20. 44.o Leaves thegluteal region bypassing deep tothe long head ofthe bicepsfemoris,at thelower margin ofthe quadratusfemoris muscleo Divides into thecommon peronealand tibialnerves, at avariable siteabove thepopliteal fossa 21. 45 22. 46 23. L4L5S1S2S3SemitendinosisBiceps femorissemimembranosusHamstringsGastrocnemiusand posteriorcompartment ofthe leg and footTibialnerveCommonperonealnerve Deep peronealnerveAnteriorcompartment oflegLateralcompartment of legSuperficial peronealnerveMotor Branches of theSciatic Nerve 24. 48 25. Greater sciatic foramen The greater sciatic foramen is formed on the posterolateral pelvic wall and is the major route forstructures to pass between the pelvis and the gluteal region of the lower limb . The margins of theforamen are formed by: the greater sciatic notch; parts of the upper borders of the sacrospinous and sacrotuberous ligaments; the lateral border of the sacrum. The piriformis muscle passes out of the pelvis into the gluteal region through the greater sciaticforamen and separates the foramen into two parts, a part above the muscle and a part below: the superior gluteal nerve and vessels pass through the greater sciatic foramen above thepiriformis; the sciatic nerve, inferior gluteal nerves and vessels, pudendal nerve and internal pudendal vessels,posterior cutaneous nerve of thigh, nerve to the obturator internus and gemellus superior and thenerve to the quadratus femoris and gemellus inferior pass through the greater sciatic foramenbelow the muscle.49 26. 50 27. Lesser sciatic foramen The lesser sciatic foramen is inferior to the greater sciatic foramenon the posterolateral pelvic wall .It is also inferior to the lateralattachment of the pelvic floor to the pelvic wall and thereforeconnects the gluteal region with the perineum: the tendon of obturator internus passes from the lateral pelvic wallthrough the lesser sciatic foramen into the gluteal region to inserton the femur; the pudendal nerve and internal pudendal vessels, which first exitthe pelvis by passing through the greater sciatic foramen below thepiriformis muscle, enter the perineum below the pelvic floor bypassing around the ischial spine and sacrospinous ligament andmedially through the lesser sciatic foramen.51 28. 52 29. Trendelenburgs Test assesses functioning of hip abductors Stand behind patient and ask to stand onone leg for 30 seconds Pelvis should tilt up on side of unsupportedleg = Trendelenburg negative (normal) If pelvis tilts down towards unsupported leg =Trendelenburg positive (pathological) Repeat for other leg53 30. A 51-year-old man experiences a loss ofskin sensation along the medialcompartment of the thigh. No otherareas of skin are affected. Which of thefollowing best describes the area of deficit?A. L2 dermatomeB. L3dermatomeC. L4 dermatomeD. Cutaneous field of the femoral nerveE. Cutaneous field of the obturator nerveF. Cutaneous field of the saphenous nerve 31. 27. A 55-year-old man has difficultyextending his hip while walking up a flightof stairs.He experiences no cutaneousdeficits. Which damaged nerve is mostlikely responsiblefor causing this mans symptoms?A. Inferior gluteal nerveB. S1 nerve rootC. S2 nerve rootD. Superior gluteal nerve 32. 28. A 33-year-old mans pelvis drops onthe right side whenhe steps with his right foot. He has nocutaneous deficits.Which nerve lesion is most likely causingthis problem?A. Femoral nerveB. Inferior gluteal nerveC. Obturator nerveD. Superior gluteal nerveE. Tibial nerve