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Femoral n.

• The femoral nerve is the largest branch of the lumbar plexus.

• Femoral nerve is created from contributions from L2, L3, and L4.

• The femoral nerve enters into the thigh under the inguinal ligament, between the psoas and iliacus mucle.

• Nerve of anterior compartment of thigh

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Femoral Nerve “block”

1. Locate the anterior superior iliac spine and the pubic tubercle.

2. Just below this line is the femoral nerve.

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3. Palpate the femoral artery4. The femoral nerve should be

located 1 cm lateral to the palpation

5. Medial to lateral the structures are femoral vein, artery, and nerve (VAN).

IL = inguinal ligament

IC = inguinal crease (a natural skin fold 4–6 cm below the inguinal ligament),

FA = femoral artery

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femoral nerve block

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Femoral Nerve Block• Indications:• 1. Knee surgery• 2. Vascular surgery• • Complications:• 1. Intravascular injection causing systemic toxicity• 2. Hematoma• • Technique:• • Patient Position: Supine• • Landmarks: Insert needle 1cm lateral to the femoral artery. Two “pops” can be felt when

needle passes through fascia lata and fascia iliaca.• • Endpoints: Patellar movement should be detected.

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FEMORAL NERVE INJURY

• Injured by stab or gunshot wound• Motor loss• Loss of knee extension• Sensory loss• On anterior and medial aspect of thigh• Medial side of lower leg• Medial border of foot up to ball of great toe

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INJURY OF LATERAL CUTANEOUS NERVE OF THIGH

• CausesCompression or inflammation • PresentationSharp pain in the course of distribution

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Obturator n.

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Landmark

Cerebral palsy

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OBTURATOR NERVE INJURY• Causes• Penetrating wounds• Anterior dislocation of hip joint• Obturator hernia or tumors• Muscles paralyzed • All the adductor muscles except for hamstring part of adductor

magnus• Motor loss• adduction of thigh• Sensory loss• Medial side of thigh

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Sup. Gluteal n.Infer. Gluteal n.

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INJURY TO SUPERIOR GLUTEAL NERVE

• Loss of abduction of hip• Unilateral injury:

shows positive trendelenberg,s sign• Bilateral injury:

shows waddling gait

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INJURY TO INFERIOR GLUTEAL NERVE

• Impairment of hip extension and lateral rotation

• Difficulty in raising the body from sitting position

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Sciatic n.

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Your homework:

Sciatic Nerve “block”?

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SCIATIC NERVE INJURY

• Commonly injured in following conditions:• I.V.Disc Prolapse• Dislocation of hip joint• Piriformis syndrome• Intramuscular injection

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I.V.Disc Prolapse

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Intramuscular injection

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Dislocation of hip joint

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SCIATICA

• Pain along the sensory distribution of sciatic nerve

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Gluteal Region

Muscles

Arterial Supply

Nerve Supply

Superficial:Gluteus MaximusGluteus MediusGluteus MinimusDeep:PiriformisGemelus SuperiorObterator InternusGemelus InferiorQuadratus Femoris

Superior Gluteal ArteryInferior Gluteal Artery(branches of Internal Iliac a.)

Branches of Sacral Plexus

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Ant. Compartment

Muscles

Arterial Supply

Nerve Supply

SartoriusQuadriceps

Femoral Artery

Femoral nerve

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Post. Compartment

Muscles

Arterial Supply

Nerve Supply

Hamstring:1. Semitendinosus2. Semimembranosus3. Biceps femoris

Profonda femoris:Branch of femoral artery

Sciatic nerve

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Med. Compartment

Muscles

Arterial Supply

Nerve Supply

PectineusAdductorsGracilis

Obturator artery:Branch of internal iliac artery Femoral artery

Obturaror nerve:Branch of Lumbar plexus