nerve and blood supply_le

8/14/2019 Nerve and Blood Supply_LE

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NERVE AND BLOOD SUPPLYOF THE

LOWER EXTREMITYMark David S. Basco, PTRP

Department of Physical Therapy

College of Allied Medical Professions

University of the Philippines Manila


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OBJECTIVES

Describe the Lumbar and Sacral Plexus interms of: Roots, Divisions, and Branches

Pathway

Motor and Sensory distribution


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OBJECTIVES

Describe the Arterial and Venous Circulationin terms of: Vessels

Pathway

Distribution

Function

Decribe the lymphatic circulation of the lowerextremity


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NERVES OF THE

LOWER EXTREMITYLUMBAR Plexus

SACRAL Plexus


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IMPORTANT FUNCTIONS

Sensory innervation to the skin and joints

Motor innervation to the muscles

Autonomic innervation to the


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LUMBOSACRAL PLEXUS

The nerves of the lowerlimb originate from thelumbar plexus and thesacral plexus


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LUMBAR PLEXUS

Formed by: Anterior rami of L1 to L4

May have contributionsfrom T12

Branches emerge fromthe anterior, lateral,and medial borders of

the psoas muscle


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ILIOHYPOGASTRIC NERVE

T12, L1

MOTOR and SENSORY

MOTOR

Muscles of theabdominal wall

SENSORY Suprapubic region

Lateral aspect of thebuttocks


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ILIOINGUINAL NERVE

L1

MOTOR and SENSORY

MOTOR

Muscles of theabdominal walll

SENSORYUpper medial part of

thigh

Anterior part of scrotum

Mons pubis and labiummajus


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GENITOFEMORAL NERVE

L1, L2

MOTOR and SENSORY

MOTOR

Genital branch Cremater muscle

SENSORY Skkin over femoral

triangle


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GENITOFEMORAL NERVE

Cremasteric reflex Efferent stimulation of the skin of the upper

medial thigh in males causes a reflex contractionof the cremaster muscle

RESPONSEDrawing upward of the ipsilateral testes within

the scrotum


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LATERAL FEMORAL CUTANEOUSNERVE

L2, L3

SENSORY Skin over the Anterior

and Lateral surface of

the thigh and knee

Lower lateralquadrant of buttocks


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LATERAL FEMORAL CUTANEOUSNERVE

Meralgia Paresthetica Entrapment of the

lateral femoralcutaneous nerve

Commonly at thelevel of the inguinalligament

Complains of pain andparesthesia in thearea supplied by thenerve


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OBTURATOR NERVE

L2, L3, L4

SENSORY and MOTOR

SENSORY

Cutaneous branch Subsartorial plexus to

supply the medial thigh

MOTORGracilis

Adductor longus

Adductor brevis

Adductor magnus

Pectineus

Obturator externus


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OBTURATOR NERVE

MOTORGracilis

Adductor longus

Adductor brevis

Adductor magnus

Pectineus

Obturator externus


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FEMORAL NERVE

L2, L3, L4

Largest branch of thelumbar plexus

Enters the thigh via thefemoral triangle

Supplies all the muclesof the anteriorcompartment of thethigh

MOTOR and SENSORY


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FEMORAL NERVE

Anterior Division

Cutaneous branchMedial cutaneous nerve of

the thigh

Intermediate cutaneousnerve of the thigh

Motor branch Sartorius, Iliacus, Pectineus

Other branch Articular branch to the

knee joint


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FEMORAL NERVE

Posterior Division

Cutaneous branch Saphenous nerve

supplies the medial

surface of the leg, footup to ball of big toe

Motor branch Rectus femoris, Vastus

mm


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FEMORAL NERVE

PATELLAR Plexus

Located in front of the knee

Formed by the terminal branches of the

LATERAL, INTERMEDIATE,and MEDIAL cutaneous nerve ofthe thigh

INFRAPATELLAR branch of saphenous nerve


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FEMORAL NERVE

SUBSARTORIAL Plexus

Found underneath the sartorius mm

Formed by the cutaneous branches of: FEMORAL

OBTURATOR


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SACRAL PLEXUS

Lies on the posterior wall(in front of the piriformis)

Formed by the: Anterior rami of L4 S3

Branches leave the pelvisthrough the greater sciaticforamen


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BRANCHES TO PELVICMUSCLES, PELVIC VISCERA,AND PERINEUM


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PUDENDAL NERVE

S2 S4

MOTOR and SENSORY

MOTOR

External anal / urethralsphincter and muscle

Cutaneous branch Perineum


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NERVE TO PIRIFORMIS

S1 S2

MOTOR Piriformis


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PELVIC SPLACHNIC NERVE

S2 S4

MOTOR and SENSORY Pelvic Viscera

Erection, GI Mobility,Micturition, Pain fromcervix, bladder,urethra


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LUMBAR PLEXUS

L2

L4

L1

L3

T12

Iliohypogastric

ILIonguinal

Genitofemoral

Lateral Femoral

Cutaneous

Femoral

Obturator


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BRANCHES TO THE LOWER

EXTREMITY


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SUPERIOR GLUTEAL NERVE

L4, L5, S1

Leaves the greater sciaticforamen above the piriformis

MOTOR SUPERIOR branchGluteus minimus

TFL

INFERIOR branchGluteus medius

TFL


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INFERIOR GLUTEAL NERVE

L5, S1, S2

Leaves the greatersciatic foramenbelow the piriformis

MOTOR

Supplies the gluteus

maximus


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NERVE TO QUADRATUS FEMORIS

L4, L5, S1

MOTOR INFERIOR GEMELLUS

QUADRATUS FEMORIS

Articular branch to hip joint


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POSTERIOR FEMORAL CUTANEOUSNERVE

S1, S2, S3

SENSORY Lower medial aspect of buttock

Back of thigh and upper leg


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SCIATIC NERVE

L4, L5, S1, S2, S3

Largest branch oflumbosacral plexus

Largest peripheral nerve

Emerges from thepiriformis and coursesdownward on the redcarpet mm

Passess deep into thelong head of the bicepsfemoris

Divides into tibial andcommon peroneal


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SCIATIC NERVE

Sciatic nerve can beentrapped by thepiriformis

PIRIFORMIS

Syndrome, Fat walletsyndrome

Sciatic nerve can alsobe injured by injection

at the wrong site


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TIBIAL NERVE

Larger than the commonperoneal nerve

Enters the popliteal fossa

Passes behind the medialmalleolus

Divides into lateral and medialplantar nerves


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TIBIAL NERVE

MOTOR and SENSORY

SENSORY Sural nerve posterolateral leg

Medial calcaneal branch

Articular branch to knee joint

MOTOR Soleus

Gastrocnemius

Flexor digitorum longus

Flexor hallucis longus

Tibialis posterior


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MEDIAL AND LATERAL PLANTARNERVES

Medial plantar nerve ABDuctor hallucis

FLEXor hallucis brevis

1st lumbrical

Flexor digitorum brevis

Lateral Plantar nerve


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COMMON PERONEAL NERVE

Winds around the neck of thefibula

MOTOR and SENSORY

MOTOR Short head of Biceps femoris

SENSORY Sural communicating

Lateral cutaneous nerve of calf

Articular branch to knee andproximal tibiofibular joint


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SUPERFICIAL AND DEEP PERONEALNERVE


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SUPERFICIAL PERONEAL NERVE

SENSORY and MOTOR

SENSORYDorsum of the foot,

MOTOR Peroneus longus

Peroneus brevis


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DEEP PERONEAL NERVE

SENSORY and MOTOR

SENSORY 1st dorsal webspace

MOTORTA

EHL

EDL

PT


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BLOOD SUPPLY OF THE

LOWER EXTREMITYArterialVenous

Lymphatic


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FEMORAL ARTERY


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ANTERIOR TIBIAL ARTERY


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DORSALIS PEDIS ARTERY


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POSTERIOR TIBIAL ARTERY


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PLANTAR ARCH

Composed of: Lateral Plantar Artery

Dorsalis pedis artery

Gives off plantar digital arteries


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TROCHANTERIC ANASTOMOSIS

Main blood supply to femoral head

Composed of: Superior gluteal artery

Inferior gluteal artery

Medial femoral circumflex artery

Lateral femoral circumflex


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CRUCIATE ANASTOMOSIS

At the level of greater trochanter

Connects the internal and femoral arteries

Composed of: Inferior gluteal artery

Medial femoral circumflex artery

Lateral femoral circumflex artery

First perforating artery


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VENOUS DRAINAGE

Deep veins (venaecommitantes)

Superficial veins

Perforating veins


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LYMPHATIC DRAINAGE


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REFERENCES

Moore, K.L., & Dalley, A.F. (2006). Clinically orientedanatomy. Philadelphia: Lippincott Williams & Wilkins.

Chung, K.W., & Chung, H.M. (). BRS Gross anatomy.Philadelphia: Lippincott Williams & Wilkins.

Tank, P.W. (2005). Grants dissector. Philadelphia: LippincottWilliams & Wilkins.

Moore, K.L., & Dalley, A.F. (2006). Clinically orientedanatomy. Philadelphia: Lippincott Williams & Wilkins.

Drake, R.L., Vogl, W., & Mitchell, A.W.M. (2007). Grays

anatomy for students. Philadelphia: Elsevier Standring, S. (ed.). (2008). Grays anatomy. London:

Churchill Livingstone.

Gomez, M.Z.A. (2008). OTPT102 Archives.

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