Nerves and Injuries of Lower Limb

Hello everyone, this is Dr. Adel Bandek, professor of anatomy and neuroscience. Today I will talk about the nerves of the lower limb. The lower limb is supplied by the lumbar plexus and the sacral plexus. The lumbar plexus gives two nerves. the femoral nerve, it supplies the anterior compartment of the thigh, and it arises from L2, 3, and 4. Second branch is the obturator nerve, it supplies the medial compartment of the thigh, and it arises from L2. 3 and 4. Femoral nerve arises from the posterior divisions and the ulterior nerve arises from the anterior divisions. The sacral plexus gives gluteal nerves, superior and inferior gluteal nerves. The superior gluteal nerve supplies gluteus medius, gluteus minimus and tensor fasciae latae. The inferior gluteal nerve supplies the gluteus maximus. Second branch is the sciatic nerve. The sciatic nerve arises from L4, L5 and S1, S2 and S3. The sciatic nerve divides into two terminal branches, the common peroneal nerve and the tibial nerve. Start by the femoral nerve. This is the femoral nerve. We'll talk about the origin. The course and the branches. Regarding the origin, it arises from the posterior divisions of Ili II, III, and IV. Regarding the course, it lies between the psoas muscle and iliacus muscle. It is outside the femoral sheath. It is lateral to the femoral artery. This is the femoral artery. Regarding the branches, any nerve gives cutaneous branches to the skin, muscular branches to the muscles and the articular branches to the joints. Regarding the cutaneous branches, it gives us three cutaneous branches, medial cutaneous nerve of the thigh, this one, intermediate cutaneous nerve of the side this is the medial this is the intermediate and the longest one is the saphenous nerve then muscular branches muscular branches quadriceps Arturias, Iliacas and Epictenias. Regarding the quadriceps, this is the Rictus Femuris, this is Vastus Medialis, Vastus Lateralis and Vastus Intermedias. the articular branches to the hip joint and the knee joint. Regarding the obturator nerve, this is the obturator nerve. It arises from the anterior divisions of ILLI 2, 3 and 4. It is divided by the adductor brevis, this is the adductor brevis, into anterior division and posterior division. This is the anterior division anterior to the adductor brevis and this is the posterior division posterior to the adductor griffis. Regarding the branches, also remember, cutaneous, muscular, articular. So, cutaneous branches. Only the anterior division. The anterior division gives the cutaneous branch to the middle Third of the medial side of the thigh. Muscular branches. Anterior division supplies three muscles. Adductor longus, adductor brevis, and gracilis. Number four. The posterior division supplies two muscles. Adductor magnus, the pubic part of adductor magnus, and obturator externus. Articular branches. Each division supplies a joint. The anterior division supplies a hip joint. The posterior division supplies the knee joint. Then the sciatic nerve. This is the sciatic nerve. Talk about the origin, course, termination. Here is the termination of the sciatic nerve and the branches. Regarding the origin, it arises from L4, L5, S1, 2 and 3. Regarding landmarks in the course, this is the piriformis muscle. It enters the gluteal region through the greater sciatic foramen below the piriformis. It is covered by the gluteus maximus and hamstring muscle. muscles it may be injured by intramuscular injection by wrong intramuscular injection regarding the termination here is the termination in the middle of the back of the side by dividing into two branches tibial nerve the medial one common peroneal nerve the lateral one so the branches muscular branches to the hamstring, biceps, semityndinosus, semimembranosus, and the ischial part of the adductor magnus. It gives the articular branches to the hip joint and knee joint, and the two terminal branches the tibial nerve and the common peroneal nerve. Regarding sciatica, what is sciatica? Sciatica is pain along the sensory distribution of the sciatic nerve. What is the cause of sciatica? It is due to compression of the nerve. nerve root by prolapsed or herniated intervertebral disc. So regarding sciatic nerve injury, what are the causes of sciatic nerve injury? Of course the first one. the commonest one is round intramuscular injection the second one it may be compressed by the piriformis muscle regarding the effect of sciatic nerve injury motor paralysis and sensory loss, loss of sensation so it causes paralysis of muscles hamstring muscles in the back of the thigh and the muscles of the lip and foot which are supplied by the tibial and common peroneal nerves. Loss of sensation below the knee joint except the medial side of the leg and foot. Why not the medial side of the leg and foot? Because these areas are supplied by the saphenous nerve. What is the deformity caused by sciatic nerve injury? Due to paralysis of the muscles of the leg it will cause foot drop. drop of the foot. This is the gluteal region and this is the safest site of intramuscular injection the upper outer quadrant Then we'll talk about the two terminal branches of the sciatic nerve, tibial nerve and the common peroneal nerve. This is the tibial nerve, the medial one. This is the common peroneal nerve, the lateral one. So the origin, they are two terminal branches of the sciatic nerve where in the middle of the back of the side termination the tibial nerve terminates deep to the flexor retinaculum by dividing into medial and lateral plantar nerves the common peroneal nerve terminates on the lateral side of the neck of the fibula by dividing into deep peroneal nerve and superficial peroneal nerve regarding the landmark the tibial nerve is the most superficial structure in the pubic and the leg is discovered by gastrocnemius and the psori. The common peroneal nerve, the landmark, is the lateral side of the neck of the fibula. Regarding the branches, cutaneous branches, muscular branches, cutaneous branches, the tibial nerve gives a very long nerve, this one, the sural nerve. Common prurineal nerve gives the two branches. This one communicates with the sural nerve. So this is the sural communicating nerve. And this one is the lateral cutaneous nerve of the calf. Actually, the common prurineal nerve lies on the medial side of the tendon of the biceps. So compare between tibial nerve and the common peroneal nerve. They are the two terminal branches of the sciatic nerve. Termination. The tibial nerve terminates deep to the flexor retinaculum by dividing into medial plantar and lateral plantar nerves. The common peroneal nerve terminates on the lateral side of the neck of the fibula by dividing into deep peroneal and superficial peroneal nerves. The landmarks. The tibial nerve is the most superficial structure in the human body. the popliteal fossa, then in the leg it is covered by gastrocnemius and the soleus. The common peroneal nerve lies on the medial border of the biceps, then on the lateral side of the neck of the fibula. Regarding the branches, cutaneous branches, the tibial nerve gives a sural nerve, the common peroneal nerve gives sural communicating nerve and lateral cutaneous nerve was a calf. Tibial nerve supplies muscles of the back of the leg, all the muscles of the back of the leg, superficial muscles and deep muscles. Common prurineal nerve doesn't supply any muscles. I mean common prurineal nerve trunk itself. Articular branches, tibial nerve supplies the knee joint and ankle joint. Common prurineal nerve supplies only the knee joint. What is the commonest site of injury of the common peroneal nerve? The commonest site of injury of the common peroneal nerve is the lateral side of the neck of the fibula. That's why fracture neck of the fibula might... injured the common peroneal nerve. If the common peroneal nerve is injured, then the deep peroneal nerve and superficial peroneal nerve are paralyzed. It will lead to paralysis of the anterior compartment and lateral compartment of the leg. will cause deformity called foot drop this foot drop is due to paralysis of the dorsiflexors and the foot will be inverted due to paralysis of the lateral compartment Then the deep peroneal nerve. This is the deep peroneal nerve. It is one of the two terminal branches of the common peroneal nerve on the lateral side of the neck of the fibula. It terminates in front of the ankle joint. by dividing it into medial branch and lateral branch. Regarding the branches, the deep peroneal nerve supplies the anterior compartment of the leg. So muscular branches to the anterior compartment, TPL is anterior. extensor digitorum longus, extensor hallucis longus and peroneus tertius articular branch to the ankle joint and joints of the foot and then cutaneous branch this is the deep peroneal nerve it supplies the adjacent sides of the victim and second toe this area and the lesion of the deep peroneal nerve it will lead to paralysis of the torsiflexors so the foot will be dropped the sofa. foot drop. Regarding the superficial peroneal nerve, this is a superficial peroneal nerve. Superficial peroneal nerve, it is one of the two terminal branches of the common peroneal nerve on the lateral side of the neck of the fibula. supplies, ok, it's called the musculo-cutaneous, supplies muscles and skin. The muscles, lateral compartment of the leg, pruneus longus and pruneus brevis, cutaneous branches, it supplies the middle of the dorsum of the foot the medial side of the dorsum of the foot supplied by the softness nerve femoral the lateral side of the foot is supplied by the tibia by the sural nerve from the tibial nerve and the adjoining sides of the big toe and second toe by the deep peroneal nerve so this area is supplied by the superficial peroneal nerve lesion of the superficial peroneal nerve causes only paralysis of the pruneus longus and pruneus brevis, so loss of aversion. No foot drop, because the torsiflexors are intact. Regarding the dermatomes of the lower limb, dermatomes of the thigh, dermatomes of the leg and the foot, remember the thigh, front and the medial side, 1, 2, 3. upper part L1, middle part L2, lower part L3, regarding the back of the side it is S2 the leg, middle side, lateral side and back, middle side L4, lateral side L5 and the back, upper part S2, lower part S1, the foot, big toe L5 and little 2s1. So these are the dermatomes of the lower limb. They are very important in neurological examination to examine the sensory system. And thank you very much. Best wishes and good luck.

the femoral nerve, it supplies the anterior compartment of the thigh, and it arises from L2, 3, and 4. Second branch is the obturator nerve, it supplies the medial compartment of the thigh, and it arises from L2. 3 and 4. Femoral nerve arises from the posterior divisions and the ulterior nerve arises from the anterior divisions. The sacral plexus gives gluteal nerves, superior and inferior gluteal nerves.

The superior gluteal nerve supplies gluteus medius, gluteus minimus and tensor fasciae latae. The inferior gluteal nerve supplies the gluteus maximus. Second branch is the sciatic nerve.

The sciatic nerve arises from L4, L5 and S1, S2 and S3. The sciatic nerve divides into two terminal branches, the common peroneal nerve and the tibial nerve. Start by the femoral nerve. This is the femoral nerve. We'll talk about the origin.

The course and the branches. Regarding the origin, it arises from the posterior divisions of Ili II, III, and IV. Regarding the course, it lies between the psoas muscle and iliacus muscle.

It is outside the femoral sheath. It is lateral to the femoral artery. This is the femoral artery. Regarding the branches, any nerve gives cutaneous branches to the skin, muscular branches to the muscles and the articular branches to the joints.

Regarding the cutaneous branches, it gives us three cutaneous branches, medial cutaneous nerve of the thigh, this one, intermediate cutaneous nerve of the side this is the medial this is the intermediate and the longest one is the saphenous nerve then muscular branches muscular branches quadriceps Arturias, Iliacas and Epictenias. Regarding the quadriceps, this is the Rictus Femuris, this is Vastus Medialis, Vastus Lateralis and Vastus Intermedias. the articular branches to the hip joint and the knee joint. Regarding the obturator nerve, this is the obturator nerve.

It arises from the anterior divisions of ILLI 2, 3 and 4. It is divided by the adductor brevis, this is the adductor brevis, into anterior division and posterior division. This is the anterior division anterior to the adductor brevis and this is the posterior division posterior to the adductor griffis. Regarding the branches, also remember, cutaneous, muscular, articular.

So, cutaneous branches. Only the anterior division. The anterior division gives the cutaneous branch to the middle Third of the medial side of the thigh. Muscular branches.

Anterior division supplies three muscles. Adductor longus, adductor brevis, and gracilis. Number four. The posterior division supplies two muscles.

Adductor magnus, the pubic part of adductor magnus, and obturator externus. Articular branches. Each division supplies a joint. The anterior division supplies a hip joint.

The posterior division supplies the knee joint. Then the sciatic nerve. This is the sciatic nerve.

Talk about the origin, course, termination. Here is the termination of the sciatic nerve and the branches. Regarding the origin, it arises from L4, L5, S1, 2 and 3. Regarding landmarks in the course, this is the piriformis muscle. It enters the gluteal region through the greater sciatic foramen below the piriformis.

It is covered by the gluteus maximus and hamstring muscle. muscles it may be injured by intramuscular injection by wrong intramuscular injection regarding the termination here is the termination in the middle of the back of the side by dividing into two branches tibial nerve the medial one common peroneal nerve the lateral one so the branches muscular branches to the hamstring, biceps, semityndinosus, semimembranosus, and the ischial part of the adductor magnus. It gives the articular branches to the hip joint and knee joint, and the two terminal branches the tibial nerve and the common peroneal nerve. Regarding sciatica, what is sciatica?

Sciatica is pain along the sensory distribution of the sciatic nerve. What is the cause of sciatica? It is due to compression of the nerve. nerve root by prolapsed or herniated intervertebral disc.

So regarding sciatic nerve injury, what are the causes of sciatic nerve injury? Of course the first one. the commonest one is round intramuscular injection the second one it may be compressed by the piriformis muscle regarding the effect of sciatic nerve injury motor paralysis and sensory loss, loss of sensation so it causes paralysis of muscles hamstring muscles in the back of the thigh and the muscles of the lip and foot which are supplied by the tibial and common peroneal nerves.

Loss of sensation below the knee joint except the medial side of the leg and foot. Why not the medial side of the leg and foot? Because these areas are supplied by the saphenous nerve.

What is the deformity caused by sciatic nerve injury? Due to paralysis of the muscles of the leg it will cause foot drop. drop of the foot.

This is the gluteal region and this is the safest site of intramuscular injection the upper outer quadrant Then we'll talk about the two terminal branches of the sciatic nerve, tibial nerve and the common peroneal nerve. This is the tibial nerve, the medial one. This is the common peroneal nerve, the lateral one. So the origin, they are two terminal branches of the sciatic nerve where in the middle of the back of the side termination the tibial nerve terminates deep to the flexor retinaculum by dividing into medial and lateral plantar nerves the common peroneal nerve terminates on the lateral side of the neck of the fibula by dividing into deep peroneal nerve and superficial peroneal nerve regarding the landmark the tibial nerve is the most superficial structure in the pubic and the leg is discovered by gastrocnemius and the psori. The common peroneal nerve, the landmark, is the lateral side of the neck of the fibula.

Regarding the branches, cutaneous branches, muscular branches, cutaneous branches, the tibial nerve gives a very long nerve, this one, the sural nerve. Common prurineal nerve gives the two branches. This one communicates with the sural nerve.

So this is the sural communicating nerve. And this one is the lateral cutaneous nerve of the calf. Actually, the common prurineal nerve lies on the medial side of the tendon of the biceps.

So compare between tibial nerve and the common peroneal nerve. They are the two terminal branches of the sciatic nerve. Termination. The tibial nerve terminates deep to the flexor retinaculum by dividing into medial plantar and lateral plantar nerves.

The common peroneal nerve terminates on the lateral side of the neck of the fibula by dividing into deep peroneal and superficial peroneal nerves. The landmarks. The tibial nerve is the most superficial structure in the human body.

the popliteal fossa, then in the leg it is covered by gastrocnemius and the soleus. The common peroneal nerve lies on the medial border of the biceps, then on the lateral side of the neck of the fibula. Regarding the branches, cutaneous branches, the tibial nerve gives a sural nerve, the common peroneal nerve gives sural communicating nerve and lateral cutaneous nerve was a calf.

Tibial nerve supplies muscles of the back of the leg, all the muscles of the back of the leg, superficial muscles and deep muscles. Common prurineal nerve doesn't supply any muscles. I mean common prurineal nerve trunk itself. Articular branches, tibial nerve supplies the knee joint and ankle joint. Common prurineal nerve supplies only the knee joint.

What is the commonest site of injury of the common peroneal nerve? The commonest site of injury of the common peroneal nerve is the lateral side of the neck of the fibula. That's why fracture neck of the fibula might...

injured the common peroneal nerve. If the common peroneal nerve is injured, then the deep peroneal nerve and superficial peroneal nerve are paralyzed. It will lead to paralysis of the anterior compartment and lateral compartment of the leg.

will cause deformity called foot drop this foot drop is due to paralysis of the dorsiflexors and the foot will be inverted due to paralysis of the lateral compartment Then the deep peroneal nerve. This is the deep peroneal nerve. It is one of the two terminal branches of the common peroneal nerve on the lateral side of the neck of the fibula. It terminates in front of the ankle joint. by dividing it into medial branch and lateral branch.

Regarding the branches, the deep peroneal nerve supplies the anterior compartment of the leg. So muscular branches to the anterior compartment, TPL is anterior. extensor digitorum longus, extensor hallucis longus and peroneus tertius articular branch to the ankle joint and joints of the foot and then cutaneous branch this is the deep peroneal nerve it supplies the adjacent sides of the victim and second toe this area and the lesion of the deep peroneal nerve it will lead to paralysis of the torsiflexors so the foot will be dropped the sofa. foot drop. Regarding the superficial peroneal nerve, this is a superficial peroneal nerve.

Superficial peroneal nerve, it is one of the two terminal branches of the common peroneal nerve on the lateral side of the neck of the fibula. supplies, ok, it's called the musculo-cutaneous, supplies muscles and skin. The muscles, lateral compartment of the leg, pruneus longus and pruneus brevis, cutaneous branches, it supplies the middle of the dorsum of the foot the medial side of the dorsum of the foot supplied by the softness nerve femoral the lateral side of the foot is supplied by the tibia by the sural nerve from the tibial nerve and the adjoining sides of the big toe and second toe by the deep peroneal nerve so this area is supplied by the superficial peroneal nerve lesion of the superficial peroneal nerve causes only paralysis of the pruneus longus and pruneus brevis, so loss of aversion. No foot drop, because the torsiflexors are intact. Regarding the dermatomes of the lower limb, dermatomes of the thigh, dermatomes of the leg and the foot, remember the thigh, front and the medial side, 1, 2, 3. upper part L1, middle part L2, lower part L3, regarding the back of the side it is S2 the leg, middle side, lateral side and back, middle side L4, lateral side L5 and the back, upper part S2, lower part S1, the foot, big toe L5 and little 2s1.

So these are the dermatomes of the lower limb. They are very important in neurological examination to examine the sensory system. And thank you very much. Best wishes and good luck.

Transcript for:Nerves and Injuries of Lower Limb

Transcript for:
Nerves and Injuries of Lower Limb