lumbar plexus coccygeal plexus sacral plexus anatomy clinical anatomy nerves and its courses diagramm flowcharts

1. LUMBOSACRAL PLEXUS

2. The anterior divisions
of the lumbar
nerves, sacral nerves,
and coccygeal
nerve form
the lumbosacral
plexus, the first lumbar
nerve being frequently
joined by a branch from
the twelfth thoracic. For
descriptive purposes
this plexus is usually
divided into three parts:
•lumbar plexus
•sacral plexus
•pudendal plexus

3. The spinal nerves L1 – L4 form the basis of the lumbar plexus. At each vertebral level, paired
spinal nerves leave the spinal cord via the intervertebral foramina of the vertebral column. Each
nerve then divides into anterior and posterior nerve fibres.
The lumbar plexus begins as the anterior fibres of the spinal nerves L1, L2, L3, and L4.
The spinal cord outflow at each vertebral level. The anterior rami of vertebral levels L1-L4 make up the roots of the
lumbar plexus

5. ILIOHYPOGASTRIC NERVE (L1)
PSOAS MAJOR UPPER BORDER
FRONT OF QUADRATUS LUMBORUM
ILIAC CREST
TRANSVERSUS
ABDOMINIS
INTERNAL
OBLIQUE
MUSCLE
ANTERIOR
CUTANEOUS
BRANCH
LATERAL
CUTANEOUS
BRANCH

7. SENSORY INNERVATION
•INTERNAL OBLIQUE MUSCLES
•EXTERNAL OBLIQUE MUSCLES
•TRANSVERSUS ABDOMINIS
•SUPRAPUBIC SKIN
•POSTEROLATERAL GLUTEAL SKIN
MOTOR INNERVATION
•TRANVERSUS ABDOMINIS
•INTERNAL OBLIQUE MUSCLES
•CONJOINT TENDON
CLINICAL SIGNIFICANCE
•BURNING PAIN IN SUPRAPUBIC AND INGUINAL REGION
SO INJECTION OF LOCAL ANAESTHESIA AND PHYSICAL THERAPY IS
GIVEN
•NERVE GETS INJURED DUE TO PELVIC , SPORTS , SURGICAL INJURIES
AND RARELY IN PREGNANCY DUE TO COMPRESSION
•THERE IS RARELY A CASE OF ISOLATED ILIOHYPOGASTRIC NERVE
INJURY., ILIOINGUINAL NERVE IS ALSO INVOLVED.

8. ILIOINGUINAL NERVE (L1)
QUADRATUS LUMBORUM
ILIACUS MUSCLE
TANSVERSUS ABDOMINIS
INTERNAL OBLIQUE MUSCLE
INGUINAL CANAL
SUPERFICIAL INGUINAL RING
MALES
SPEMATIC CORD
FEMALES
ROUND LIGAMENT

10. SENSORY INNERVATION
SKIN OF SUPERO- MEDIAL THIGH AND GROIN REGION
IN MALES-ANTERIOR ONE-THIRD OF SCROTUM
ROOT OF PENIS
IN FEMALES- ANTERIOR ONE-THIRD OF LABIA MAJORA
ROOT OF CLITORIS
MOTOR INNERVATION
TRANSVERSE ABDOMINIS MUSCLE
INTERNAL OBLIQUE
CLINICAL SIGNIFANCE
NERVE CAN GET DAMAGED THROUGH SURGERY OR INJURY TO
ABDOMINAL WALL
WEAKENED TRANSVERSUS ABDOMINIS AND INTERNAL OBLIQUE
INGUINAL HERNIA- STRECHES
NERVE ENTRAPMENT- PHYSICAL THERAPY/MANUAL THERAPY
INGUINODYNIA- CHRONIC PAIN IN GROIN REGION

11. GENITOFEMORAL NERVE(L1,L2)

12. PSOAS MAJOR
ANTERIOR SURFACE OF PSOAS MAJOR
GENITAL BRANCH
DOWNWARDS MEDIALLY IN DEEP INGUINAL
RING
INGUINAL CANAL
MALESCREMATUS MUSCLE
;SCROTAL SKIN
FEMALES
ROUND LIGAMENT OF UTERUS
INNERVATING SKIN OF MONS
PUBIS AND LABIA MAJORA
ANTERIOR LAYER OF FEMORAL SHEATH AND FASCIA
LATA
SKIN OF UPPER ANTERIOR THIGH
FEMORAL BRANCH
FEMORAL CANAL

14. MOTOR AND SENSORY INNERVATION
•Femoral branch is exclusively sensory in
nature
•While the genital branch is both sensory
and motor in nature
CLINICAL SIGNIFICANCE
Genitofemoral neuralgia
Lower abdomen and pelvic pain
Kinetic exercises

15. LATERAL CUTANEOUS NERVE OF THIGH(L2,L3)
LATERAL BORDER OF PSOAS MAJOR
ILIACUS MUSCLE OBLIQUELY
ASIS
LACUNA MUSCULORUM
SARTORIUS
ANTERIOR
BRANCH
KNEE
POSTERIOR
BRANCH
FASCIA LATA
LATERAL AND POSTERIOR
SURFACE OF THIGH

17. CLINICAL SIGNIFICANCE
MERALGIA PARASTHETICA
•NUMBNESS, TINGLING SOMETIMES
PAIN IN OUTER THIGH
COMPRESSION
•EXERCISES
•HEAT APPLICATION
•TRIGGER POINT THERAPY

18. OBTURATOR NERVE(L2,L3,L4)
MEDIAL BORDER OF
PSOAS MAJOR
PELVIC BRIM
DOWNWARDS AND FORWARDS ON LATERAL
WALL OF PELVIS
UPPER PART OF OBTURATOR FORAMEN
ANTERIOR
BRANCH
POSTERIOR
BRANCH

20. CLINICAL SIGNIFICANCE
Injury of the obturator nerve: The obturator nerve may be injured in the
anterior dislocation of the hip joint, or during radical retropubic
prostatectomy. The following are the characteristic clinical features:
(a) Motor loss: Loss of adduction of the thigh, due to paralysis of adductor
muscles of the thigh.
(b) Sensory loss: Sensory loss on the medial aspect of thigh, due to
involvement of the cutaneous branch of the anterior division of the
obturator nerve.
• Obturator nerve neuropathy: The syndrome of an obturator nerve
entrapment causing the medial thigh pain is described in athletes with large
adductor muscles.
• Surgical division of the obturator nerve: It is sometimes done to relieve the
spasm of adductor muscles in the spastic paralysis.
• Irritation of the obturator nerve: The inflammation of the ovary causes
localized peritonitis in the region of ovarian fossa which may cause irritation
of the obturator nerve. In such a case, the pain may be referred to the hip,
knee, and medial side of the thigh.
• Referred pain: In diseases of the hip joint, the pain may be referred to the
medial side of the thigh.

21. FEMORAL NERVE(L2,L3,L4)
LATERAL BORDER OF PSOAS
MAJOR
DOWNWARDS BETWEEN
ILIACUS AND PSOAS MUSCLE
BEHIND INGUINAL
LIGAMENT
END 2.5 CM BELOW THE
INGUINAL LIGAMENT
ANTERIOR
DIVISION
POSTERIOR
DIVISION

23. Femoral nerve neuropathy: The main
trunk of the femoral nerve is not subject
to an entrapment neuropathy but it may
be compressed by the retroperitoneal
tumors. A localized neuropathy of the
femoral nerve may occur in diabetes
mellitus. The following are the
characteristic clinical features:
(a) Wasting and weakness thigh extending
down along the medial aspect of the leg
and foot
Injury of the femoral nerve: It is rare but
may be injured by a stab, gunshot wounds,
or a pelvic fracture. The following are the
characteristic clinical features:
(a) Motor loss
– Weak flexion of the thigh, due to paralysis
of the iliacus and sartorius muscles.
– Inability to extend the knee, due to
paralysis of the quadriceps femoris.
(b) Sensory loss
– Sensory loss over the anterior and medial
aspects of the thigh, due to involvement of
the intermediate and lateral cutaneous
nerves of the thigh.
– Sensory loss on the medial side of the leg
and foot up to the ball of the great toe (first
metatarsophalangeal joint), due to
involvement of the saphenous nerve.
CLINICAL SIGNIFICANCE