Neurology of Lower Limb

MED121
Neurology of Lower Limb (A)
Lecture 1
 Lecture Objectives
• Explain the origin, course, innervations of following
nerves and its clinical applied anatomy
– Lumbosacral plexus
• Femoral nerve
– Saphenous nerve
• Obturator nerve
• Sciatic nerve
– Tibial nerve
» Sural nerve
» Medial plantar nerve
» Lateral plantar nerve
– Common fibular nerve
» Superficial fibular nerve
» Deep fibular nerve
– Superficial and deep terminal branches
– Cutaneous innervation of lower limb
Figure I.30

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 Lower Limb Nerves
• Lumbosacral plexus
– often divided into lumbar(L1-L4) and sacral(L4-S4)
plexuses
• Femoral nerve
– anterior, can be seen in femoral triangle (anterior thigh)
• Obturator nerve
– passes through obturator foramen (medial thigh)
• Sciatic nerve
– posterior, deep to gluteus maximus and hamstrings
– Tibial nerve
• branch of sciatic (posterior thigh, leg and foot)
– Common fibular nerve
• branch of sciatic, travels laterally (posterior thigh anterior and
lateral leg and foot) 4
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https://somepomed.org/articulos/contents/mobipreview.htm?14/40/14985
Figure 2.19

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Figure
5.26B

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Figure 5.42

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Figure 5.38A

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Figure 5.50

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 Obturator Nerve
• Origin: Lumbosacral plexus, L2-L4
• Muscles innervated and movement
– Rotates thigh laterally
• Obturator externus
– Adducts thigh
• Adductor magnus (adductor part)
• Adductor longus
• Adductor brevis
– Adducts thigh and flexes knee
• Gracilis
• Course:
– Descends posteromedial to the psoas
major
– Through the obturator canal and
divides to anterior and posterior
division
• Cutaneous and sensory innervation:
– Superior medial side of thigh

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 Femoral Nerve
• Origin: Lumbosacral plexus, L2-L4
• Muscles innervated and movement
– Flexes hip
• Psoas major
• Iliacus
• Pectineus
– Flex hip and flexes knee
• sartorius
– Extends knee
• Vastus lateralis
• Vastus intermedius
• Vastus medialis
– Extends knee and flexes hip
• Rectus femoris
• Course:
– Descend between psoas major and iliacus
– Deep to the inguinal ligament into the
anterior compartment of thigh and divides
– Deep to sartorius the cutaneous branch of
femoral nerve traverses adductor canal and
crosses to the medial side of the knee
• Cutaneous and sensory innervation:
– Anterior and lateral branches supply the
anterior and lateral thigh
– Saphenous branch supplies the medial leg
and foot 12
 Tibial Nerve
• Origin: Lumbosacral plexus, L4-S3
• Muscles innervated and movement
– Extends hip and flexes knee
• Biceps femoris long head
• Semitendinosus
• Semimembranosus
– Extends hip and adducts thigh
• Adductor magnus (hamstring part)
– Plantarflexes foot
• Plantaris
• Gastrocnemius
• Soleus
• Tibialis posterior
– Flexes knee
• Popliteus
– Flexes toes
• Flexor digitorum longus
• Flexor hallucis longus
• Course:
– Bifurcation from sciatic nerve at the level of
middle posterior thigh
– Runs through the middle of the popliteal
surface and into the posterior leg deep to
the gastrocnemius
– Branches in the planter surface
• Cutaneous and sensory innervation: 13
– None
 Common Fibular
Nerve
• Origin: Lumbosacral plexus,
L4-S2
• Muscles innervated and
movement
– Extends hip and flexes knee
• Biceps femoris short head
• Course:
– Descends on the lateral side
of the popliteal surface and
over the head of fibular to
divide into 2 branches
• Cutaneous and sensory
innervation:
– Lateral surface of knee 14
 Lower Limb Nerves
• Deep fibular nerve
– branch of common, anterior compartment
• Superficial fibular nerve
– branch of common, lateral compartment
• Medial plantar nerve
– branch of tibial, plantar surface of foot
• Lateral plantar nerve
– branch of tibial, plantar surface of foot

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Figure 5.57

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Deep Fibular Nerve
• Origin: Common fibular (peroneal)
nerve
• Muscles innervated and movement
– Dorsiflexes foot
• Tibialis anterior
• Fibularis tertius
– Extends toes
• Extensor digitorum longus
• Extensor hallucis longus
• Extensor digitorum brevis
• Course:
– Becomes anterior through the
interosseous membrane
– Pierces deep fascia superior to the
heads of 1st and 2nd metatarsals
• Cutaneous and sensory innervation:
– Great and 2nd toe

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 Superficial Fibular
Nerve
• Origin: Common fibular
(peroneal) nerve
• Muscles innervated and
movement
– Plantar flexes and everts foot
• Fibularis longus
• Fibularis brevis
• Course:
– Stay on the lateral
compartment
– Perforates deep fascia of leg
• Cutaneous and sensory
innervation:
– Dorsal anterior third of leg
– Dorsum of foot
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 Sural nerve
• Origin: Tibial nerve
• Muscles innervated and
movement
– None
• Course:
– Cutaneous branch of tibial
descends between the 2 heads of
the gastrocnemius
– Merging of the medial and lateral
sural cutaneous nerves
• Cutaneous and sensory
innervation:
– Lateral and posterior one third of
leg and lateral side of the foot

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 Medial and lateral
plantar nerves
• Origin: Tibial nerve
• Muscles innervated and
movement
– Flex and adduct toes
• Plantar muscles of the foot
• Course:
– Pass between the 1st and
2nd layers of plantar muscles
• Cutaneous and sensory
innervation:
– Sole of the foot
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Cutaneous innervation of Lower limb

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Figure 5.72

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Motor innervation of Lower limb

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 References
• Moore, K. L., Dalley, A. F., & Agur, A. M. R.
(2010). Clinically Oriented Anatomy (6th ed.).
Philadelphia: Lippincott Williams & Wilkins.
• VanPutte, C. L., & Seeley, R. R. (2014). Seeley's
anatomy & physiology. New York, NY:
McGraw-Hill

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ANY QUESTIONS???

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