Last edited: 9/9/2021

1. SACRAL PLEXUS
Sacral Plexus Medical Editor: Dr. Sarah Abimhamed

OUTLINE

I) BRANCHES OF SACRAL PLEXUS

II) HILTON’S LAW POSTERIOR DIVISION OF S1-S3
III) SCIATICA Forms the Posterior Cutaneous Nerve
IV) APPENDIX
V) REVIEW QUESTIONS
VI) REFERENCES Cutaneous supply:
- Inferior buttocks
- Posterior thigh
- Popliteal region
- Posterior calf
I) BRANCHES OF SACRAL PLEXUS
- Skin around heel

The sacral plexus is located on the posterolateral wall of the

lesser pelvis. The two main nerves arising from the sacral
plexus, the sciatic and pudendal nerves.

ROOTS OF THE SACRAL PLEXUS

The sacral plexus originates from L4-L5, S1-S5 and Co1

FIBERS FROM L4, L5 AND S1

Forms the Superior Gluteal Nerve

Figure 2. Branches that supply the obturator internus and

Motor supply: posterior cutaneous nerve
- Gluteus medius
- Gluteus minimus
L4, L5, S1-S3 BRANCHES
FIBERS L5, S1 AND S2 (DORSAL DIVISION) Forms the Sciatic Nerve
Forms the inferior gluteal nerve
BRANCHES OF THE SCIATIC NERVE

Motor supply:
At the knee it splits into:
- Gluteus maximus
Extension and lateral rotation of the hip Anterior division: Tibial nerve

Cutaneous supply:
o Posterior Leg Limb Thigh
o Popliteal Region
o Sole of the Foot

Motor supply:
o Hamstring Muscles
 Biceps Femoris (Long head)
Figure 1. Branches that form the superior and inferior gluteal  Semitendinosus
nerves  Semi Membranous
o Adductor Magnus
L5, S1 AND S2 (VENTRAL DIVISION) o Popliteus
Forms the Obturator Internus Nerve o Plantaris
o Tibialis Posterior
o Flexor Digitorum Longus
Motor supply: o Flexor Hallucis Longus
o Triceps Surae (gastrocnemius and soleus)
- Superior Gemellus Muscle
o Intrinsic Muscles Of The Foot
- Obturator Internus Muscle
If there is compression of the sciatic nerve  pain and lack
of function of all muscles

Sacral Plexus NEURO PHYSIOLOGY: Note #1. 1 of 4

Posterior division: Common Fibular Nerve
S2-S4
Forms the Pudendal nerve
Cutaneous supply:
- Lateral aspect of the leg
Cutaneous supply:
Female and male perineum
Motor supply: o Scrotum
o Biceps femoris (short head) o Penis
Extension of the hip/flexion of the knee o Anus
o Fibularis brevis o Perineum
o Fibularis longus o Clitoris
Evert the ankle o labia majora
o Extensor halluces longus o mons pubis
Extends big toe
Motor supply:
o Extensor digitorum longus
Dorsiflexion, inversion of the ankle, o External Anal Sphincter
extend the digits. o External Urethral Sphincter
o Tibilas anterior
Inversion and dorsiflexion of the ankle

Figure 5. Fibers forming the pudendal nerve

S4, S5 AND CO1:

Forms the coccygeal plexus

Cutaneous supply:
o Supplies skin around the coccygeal
region

Figure 3. Sciatic Nerve and its branches (follow dark blue line)

S1-S2
Posterior division of sacral plexus

Forms the nerve to piriformis Figure 6. Coccygeal plexus

Motor supply:
- Piriformis muscle
Lateral rotator of the hip

II) HILTON’S LAW

“The nerve supplying the muscles

extending directly across and
acting at a given joint not only
supplies the muscle, but also
innervates the joint and the skin
overlying the muscle”

Figure 4. Fibers forming nerve to piriformis

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 III) SCIATICA

CAUSES OF SCIATIC NERVE COMPRESSION:

CLINICAL PRESENTATION:
- Sciatica is often caused by a herniated lumbar L4-
Shooting pain in the posterior and lateral aspect of the leg.
S3 disc that compresses and compromises
nerves of that region of the sciatic nerve
TREATMENT:
Note: - Rest
- The posterior division (common fibular nerve) gets - NSAIDs
its fibers mainly from L4-S2 - Physiotherapy
- The anterior division (tibial nerve) gets fibers - Surgery
mainly from L4-S3.

Therefore, if there is sciatica, it affects mostly the

anterior division than the posterior division.

IV) APPENDIX

Table 1. Summary of the Sacral Plexus

Nerve Segment Motor Supply Cutaneous Supply
Superior Gluteal
L4, L5, S1
Nerve
L5, S1, S2
Inferior Gluteal
(dorsal
Nerve
division)
L5, S1, S2
Obturator
(ventral
Internus Nerve
division)

S1-S3
Posterior
(posterior
Cutaneous Nerve
division)

Sciatic Nerve L4, L5, S1-S3

Nerve To
S1-S2
Piriformis

Pudendal Nerve S2-S4

Coccygeal Plexus S4, S5, Co1

Sacral Plexus NEURO PHYSIOLOGY: Note #1. 3 of 4

 V) REVIEW QUESTIONS

1) Which nerve supplies the Gluteus Minimus?

a) Sciatic Nerve
b) Pudendal Nerve
c) Superior Gluteal Nerve
d) Inferior Gluteal Nerve

2) Which nerve innervates the female and male

perineum?
a) Obturator Internus Nerve
b) Superior Gluteal Nerve
c) Nerve To Piriformis
d) Pudendal Nerve

3) The tibial nerve provides a motor supply to which of

the following?
a) Triceps Surae
b) Fibularis brevis
c) Piriformis muscle
d) External Anal Sphincter

4) What are the roots of the sciatic nerve?

a) L1-S4
b) L4-S3
c) L5-Co1
d) S1-S5
5) Why does sciatica affect mainly the structures of the
tibial nerve than the common fibular nerve?
a) Because the anterior division gets fibers mainly from
L4-S3
b) Because the posterior division gets fibers mainly
from L4-S3.
c) Because the anterior division gets fibers mainly from
L4-S2
d) Because the posterior division gets fibers mainly
from L4-S2

6) Which nerve does the ventral division of L5-S2?

a) Obturator Internus Nerve
b) Inferior Gluteal Nerve
c) Nerve To Piriformis
d) Pudendal Nerve

7) What are the roots of the coccygeal plexus?

a) S1-Co1
b) Co1
c) S3-Co1
d) S4-Co1

8) Which area of the spinal cord is most affected in

sciatica?
a) L3-S5
b) L4-S3
c) L1-L5
d) S1-S5

VI) REFERENCES
● Moore, Keith L. et al. (2010) Clinically Oriented Anatomy, 6th Ed

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