Lumbosacral Plexus

Dr Zoya Moazzam
 Introduction
• The lumbosacral plexus is formed by
the anterior rami of the nerves (spinal
segments T12–S4) to supply the lower limbs.
The lumbosacral plexus can be divided into
• the lumbar plexus, which innervates the
ventral upper half, and
• the sacral plexus, which mainly innervates the
dorsal side
 Lumbar Plexus
• The lumbar plexus is composed of segments T12–L4 and is
located next to the lumbar spine behind the psoas
major muscle. In addition to the short nerves leading to
the hip muscles, the lumbar plexus includes the following
major nerves:
• Iliohypogastric nerve: Th12–L1
• Ilioinguinal nerve: Th12–L1
• Genitofemoral nerve: L1–L2
• Lateral cutaneous nerve of the thigh: L2–L4
• Femoral nerve: L2-L4
• Obturator nerve: L2–L4
 Iliohypogastric nerve

• The iliohypogastric nerve proceeds obliquely

laterally on the quadratus lumborum muscle and
runs ventrally. It supplies motor innervation to
the transverse abdominis and the internal oblique
muscles of the abdomen.
• It is further divided into the anterior
cutaneous branch and the lateral
cutaneous branch for sensory innervation of the
skin above and to the side of the inguinal ligament
 Ilioinguinal nerve

• This nerve runs below the iliohypogastric nerve; it leans

against the abdominal wall and pierces through it at a
spot that varies to finally run medially at the level of
the inguinal ligament and to pass through the external
inguinal ring to the pubic symphysis and the perineum
• The ilioinguinal nerve also provides motor innervation to
the caudal portions of the transverse
abdominis and internal oblique muscles of the
abdomen,
• as sensory branches, possess the femoral
branch supplying the upper and inner parts of the
anterior thigh
 Genitofemoral nerve

• After it pierces the psoas major muscle, the

genitofemoral nerve is divided into the genital
branch and the femoral branch.
• The purely sensory femoral branch passes
through the vascular lacuna in the area of the
saphenous opening and supplies the skin
below the inguinal ligament, whereas
the genital branch, enters the perineum.
 Lateral cutaneous nerve of the thigh

• The purely sensory lateral femoral cutaneous

nerve supplies the lateral skin of the thigh. It
passes the psoas major muscle to finally break
through the fascia lata.
 FEMORAL NERVE

 The femoral nerve is the chief

nerve of the anterior
compartment of the Thigh.
 It emerges at the lateral border of psoas
major muscle in abdomen .it passes
downwards between psoas major and
illiacus muscles.
 It gives branches to Pectineus muscle,
which passes behind the femoral sheath to
reach the muscle.
 (Note:- Pectineus muscle are supplied by
both are Femoral and Obturator nerve)*
 The nerve enter the thigh behind the
inguinal ligament , lateral to femoral
sheath.
 It is not content of femoral sheath as its
formation is behind fascia illiaca.
 It will divide 2.5cm below the inguinal
ligament
  ,
 The anterior division supplies the
Sartorius
 Posterior division supplies the,
i. Rectus femoris
ii. Vastus medialis, Intermediate and lateralis,
iii. Articular genu
 The Articular genu is supplied by a
branch from the nerve vastus
intermedius.
  The anterior division gives two cutaneous
branches. they are,
i. Medial cutaneous nerve of thigh
ii. Intermediate cutaneous nerve of thigh

•  The posterior division gives only one

cutaneous branch, the saphenous nerve.
Supplies hip joint and knee joint
• The saphenous nerve is the sensory terminal
branch of the femoral nerve that
courses along the femoral artery and vein and
moves into the adductor canal. Finally, it
follows the great saphenous vein to the
medial side of the lower leg. Thus, it
innervates the skin between the knee and the
foot on the medial side.
 Sacral Plexus

• The sacral plexus is composed of the segments L4–S4 and

sits on the piriformis muscle. It provides short motor
branches to supply the hip muscles and further consists of
the following major nerves:
• Superior gluteal nerve: L4–S1
• Inferior gluteal nerve: L5–S2
• Posterior femoral cutaneous nerve: S1–S3
• Sciatic nerve: L4–S3
– Common peroneal (fibular) nerve: L4–S2
– Tibial nerve: L4–S3
• Pudendal nerve: S1–S4
 Superior gluteal nerve

• The purely motor superior gluteal nerve follows the superior

gluteal vessels and moves through
the suprapiriform foramen to supply the gluteus medius,
gluteus minimus, and tensor fascia lata muscles.
• Because these three muscles are primarily responsible
for abduction of the hip joint and the stabilization of the pelvis
in the frontal plane, a lesion of the nerve (e.g., in the case of an
incorrectly performed intramuscular injection) causes the so-
called Trendelenburg’s sign. When walking or standing on one
leg, the pelvis tilts toward the healthy side, resulting in a
waddling gait called the ‘Trendelenburg gait’ or the ‘gluteal
gait.’
 Inferior gluteal nerve

• The purely motor inferior gluteal nerve moves

together with the inferior gluteal vessels, the sciatic
nerve, the posterior femoral cutaneous nerve, and
the pudendal nerves, as well as the pudendal
vessels, through the infrapiriform foramen and
innervates the gluteus maximus muscle. Damage to
this nerve is more rare than is damage to the
superior gluteal nerve, but this damage leads to
severe limitations when standing up, climbing stairs,
and jumping.
• Coccygeal nerve
• Nerves to levator ani and coccygeus (Sr, S4) >>
muscles of the pelvic floor
• Anococcygeal nerve >> skin between coccyx and anus
• Posterior femoral cutaneous nerve
• The purely sensory posterior femoral cutaneous
nerve passes through the foramen infrapiriform and
innervates the dorsal side of the thigh. To supply the
gluteal fold, it releases the inferior cluneal nerves.
 Sciatic nerve
• The sciatic nerve is the largest nerve of the human body and,
along with the saphenous nerve, supplies the skin of the lower
leg. After passing through the greater sciatic foramen below the
piriformis muscle, it moves along the back of the thigh to
the popliteal fossa. Above the popliteal fossa, it usually divides
itself into the tibial nerve and the common
fibular (or peroneal) nerve.
• Even before the division of the sciatic nerve, a fibular part (F) can
be distinguished from a tibial part (T). Each of them makes
branches for the following muscles:
• Semitendinosus muscle (T)
• Semimembranosus muscle (T)
• Biceps femoris muscle
– Long head (T)
– Short head (F)
• Adductor magnus muscle (T) (superficial part)
 Causes

• Disc herniation
• Osteophytes of lumbar spine
• Piriformis Syndrome
 Symptoms
• Pain in lumbar region
• Radiates to back of leg
• Sensation loss in posterior thigh and leg
 Injury to Sciatic Nerve
• A pain in the buttock may result from compression of the sciatic
nerve by the piriformis muscle (piriformis syndrome).
• Individuals involved in sports that require excessive use of the
gluteal muscles (e.g., ice skaters, cyclists, and rock climbers) and
women are more likely to develop this syndrome. In
approximately 50% of cases, the histories indicate trauma to the
buttock associated with hypertrophy and spasm of the
piriformis.
• In the approximately 12% of people in whom the common
fibular division of the sciatic nerve passes through the piriformis,
this muscle may compress the nerve.
•
• Complete section of the sciatic nerve is uncommon.When
this injury occurs, the leg is useless because extension of
the hip is impaired, as is flexion of the leg. All ankle and
foot movements are also lost.
• With respect to the sciatic nerve, the buttock has a side of
safety (its lateral side) and a side of danger (its medial
side). Wounds or surgery on the medial side of the buttock
may injure the sciatic nerve and its branches to the
hamstrings (semitendinosus, semimembranosus, and
biceps femoris) on the posterior aspect of the thigh.
 Anesthetic Block of Sciatic Nerve
• Sensation conveyed by the sciatic nerve can be
blocked by the injection of an anesthetic agent a
few centimeters inferior to the midpoint of the line
joining the posterior superior iliac spine (PSIS) and
the superior border of the greater trochanter.
• Paresthesia radiates to the foot because of
anesthesia of the plantar nerves, which are
terminal branches of the tibial nerve derived from
the sciatic nerve.