LUMBOSACRAL PLEXUS 3.

Nn to Obturator Internus (L5-S2) ant

- Gemellus Superioris = re-enters
Lumbar Plexus
Formed by: Ant. Rami of L1-L4 (+T12)=> 6 nn 4. Nn to Quadratus Femoris (L4-S1) ant
At: Ant of Piriformis, Surface of Posterior Pelvic Wall - Mm: Quadratus Fem & G. Inferior; Pure motor
In: Psoas Major (I 2x Get Laid On Fridays)
Ilioing, Iliohypogastric , GenitoFem (psoas maj), LFCN, Obt, Fem 5. Sciatic Nn (L4-S3)
All arise fr: Lat. aspect of Psoas Major (exc G&O) - Largest nn in the body; lower medial of gluts
Ant: Genitofemoral :: Medial: Obturator Injection Palsy: should be at upper lat
*2 fr 1, 2 fr 2, 2 fr 3* Piriformis Syndrome: spasm of mm d/t impingement
L1 rt: Ilihypogastric & Ilioinguinal Leads to sciatica; aka fatwallet/thickwallet syndrome
L1 & L2 rt: Genitofemoral 5.1 Tibial nn (L4-S3)
L2 & L3 rt: LFCN Mm: HS, PF, foot mm
L2,3,4: Obturator & Femoral Branches: Sural nn lat side of leg & foot
-Principal nn of LP; bec I largest mm groups Med. Calcaneal nn heel
Med & Lat Plantar nn sole of foot
Additional:
Subcostal Nn: brach fr T12 5.2 Common Peroneal (L4-S2)
Accessory Obturator (not always present): fr L3-4 braches nn Mm: ant & lat compartment of leg
Muscular branches to the psoas muscle & Iliacus mm: fr femoral nn Branches: Sural Comunicating &Lat. Sural Cutaneous nn of calf
Motors: Superficial (Lat), Deep (ant)
1. Iliohypogastric nn (L1)
- Mm: Ant. Abdominal wall mm: TIE (-R) 6. Pudendal nn
- S: over lower ant abd wall & buttock - Mm: Perineum; if inj: incontinence
- S: M: Penis & Scrotum :: F: Clitoris, Labia Maj/Min
2. Ilioinguinal nn (L1) - MOI: entrapment of nn to bikers, cyclist
- Mm: Ant. Abd wall mm: TIE (-R)
- S: Groin (Upper Med of thigh), 7. Nn to Piriformis
F: Mons Pubis & Labia Majora :: M: root of penis & scrotum - Pure motor

3. Genitofemoral nn (L1-L2) Additional Smaller Branches (Direct)

- Mm: Cremaster for reflex Perforating Cutaneous Nn : Skin of Inf Gluts or fold (S2-3)
- S: over ant surface of thigh
CUTANEOUS DISTRIBUTION
4. Lat. Femoral Cutaneous nn (L2-L3)
- Mm: none I. Anterior Leg
- S: Anterolat thigh Lat. Cutaneous nn of Calf UAL or upper ant lat
- D/O: Meralgia Paresthetica, Saphenous nn medial leg
MOI-TOP: Tight belt & U/W, Obesity, Pregnancy Superficial Peroneal nn - LAL or lower ant lat

5. Obturator nn (L2-L4) II. Posterior Leg

- Mm: of medial compartment of thigh (adductors) Post. Cutaneous nn of thigh
- S: Inner medial thigh Post. Cutaneous nn of calf
- D/O: weak in hip ADER => x: cross leg, (-add) reflex Sural & Saphenous

6. Femoral nn (L2-L4) III. Dorsal Foot

- Largest nn in lumbar plexus; aka Ant. Crural nn Superficial Peroneal
- Mm: Hip flexors, knee extensors Deep Peroneal
- S: anteromedial side of leg & foot Sural & Saphenous
- D/O: (-) patellar knee jerk
- Gait: Ant. Lurching/ ant. Trunk bending IV. Sole Foot
- Femoral (L-M): NAVL Med. Calcaneal
- Branches: Medial FCN medial distal thigh Med. Plantar
Saphenous FCN med leg & foot Lat. Plantar
Intermediate FCN ant surface of thigh Med & Plantar nn

Sacral Plexus
Formed By: Ant. Rami of L4-S4 (SIOQSPP)
*if lumbosacral trunk: L4-S5
On the: Ant Piriformis (PosLat border of Pelvic Wall)
Emerges: Ant. Sacral Foramina
5 Major Peripheral Nn: S/I Gluteal, Sciatic, PFC, Pudendal Nerve
Descends to:
- Leave pelvis via Greater Sciatic Foramen
to enter gluteal reg (most)
- Loop around the sacral spinous ligament and re-enter via lesser sciatic
foramen to supply lat. pelvic and peroneal structures
- Remain inside to innervate pelvic mm organs and perineum

1. Superior Gluteal Nerve (L4-S1) post

- Mm: G. Med, Min & TFL; pure motor
- Gait: Trendelenburg/G. Med Lurch- if weak, stand at affected leg

2. Inferior Gluteal Nerve (L5-S2) post

- Mm: G. Max; pure motor
- Gait: Post. Lurching weak h/k extensors
 LOWER LIMB
BLOOD SUPPLY

Ascending >
Brachiocephalic+Common
Carotid + Subclavian
In
Arch of Aorta (T4-T5)
At Sternal /A of Louis
>Descending Aorta
= Diaphragm =
Lm: T12; Phrenic nn
Piston Action: Vertical (Inhale:
out & down)

Abdominal Aorta
R/L Common Iliac Artery
3.B Internal Iliac Artery
3.A External Iliac Artery
- main BS of pelvic organs
- larger; LM: pelvic brim
- LM: ant. Sacrum
- Piriformis divides it to
Sup/Inf Gluteal Artery
LM: GSF
4. Femoral Artery
- LM: Inguinal/Pouparts/Groin Lig
- MBS of LE; Sf or Deep*, terminates as perforating A
- LM: Adductor/Subsartorial/Hunters Canal
Cont: Obt. Nn & Saphenous nn

*Deep FA or Femoral Profunda

Med. Circumflex A Lat. Circumflex A
MBS (adult) Femoral Head Trochanteric
(child) Obturator A Anastomosis

5. Popliteal Artery
- UL: Biceps Fem; LL: Lat. Head of Gastrocs + Plantaris
- UM: Semimem/ten; LM: Med. Head of Gastrocs
Ends at Popliteus to become

6.A Anterior Tibial A. 6.B Posterior Tibial A.

-direct cont of Dorsalis Pedis > Fibular/Peroneal A.
-thru IOM 6.B.1 Med. Plantar A: big toe
-palpation: TA, EHL, EDL 6.B.2 Lat. Plantar A: lat four toes