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20.March.2013 Wednesday
Weakness of hip flexion & knee extension on the left side
Difficulty in walking & climbing stairs
Numbness, parasthesiae, and hyperesthesia over the
anteromedial aspect of the thigh, medial side of lower part of
the leg, along the medial border of the foot as far as the ball of
the big toe, and pain in the thigh and groin
Absent patellar reflex
Sweating in the autonomous cutaneous distribution of the nerve
Inguinal canal
above the medial half of the inguinal ligament on the anterior wall of abdomen
Moore AE, Stringer MD. Iatrogenic femoral nerve injury: a
systematic review. Surg Radiol Anat. 2011;33:649-658.
CASE 2
MRI lumbar spine showing
vertebral fractures at first
presentation to clinic
L2
L4
CASE 2
L1
L3
L1 iliohypogastric & ilioinguinal nerves
L1 + L2 genitofemoral nerve
L2 + L3 lateral femoral cutaneous nerve
L2 + L3 + L4 femoral and obturator nerves
L4 + L5 lumbosacral trunk
joins sacral nerves to form the sacral plexus.
genitofemoral nerve
lateral femoral cutaneous nerve
femoral & obturator nerves
lumbosacral trunk
L1& L2
L2 & L3
L2-L4
L4+L5
Dorsal divisions of L4, L5,
S1, and S2 carried
in common fibular nerve
Ventral divisions of L4,
L5, S1, S2, and S3 carried
in tibial nerve
Dorsal divisions of L4 to S1
superior gluteal nerve
(L5-S2 inf. gluteal nerve)
genitofemoral nerve
lateral femoral cutaneous nerve
femoral & obturator nerves
lumbosacral trunk
L1& L2
L2 & L3
L2-L4
L4+L5
Obturator nerve
Collectively, all these muscles except the obturator externus mainly adduct the thigh at
the hip joint; the adductor longus and magnus may also medially rotate the thigh.
Obturator externus is a lateral rotator of the thigh at the hip joint. All adductor
muscles, except the “hamstring part” of the adductor magnus and part of the pectineus
are supplied by the obturator nerve (L2-L4). The hamstring part of the adductor
magnus is supplied by the tibial part of the sciatic nerve (L4).
minimal sensory loss on the medial aspect of the thigh
Genitofemoral nerve
skin of the middle anterior thigh; male scrotum and cremaster muscle;
female labia majora
SUPERIOR GLUTEAL NERVE
Tensor fascia latae
assists the gluteus maximus muscle in maintaining the knee in the extended position.
stabilizes stabilizes the hip joint by holding the head of the femur in the acetabulum.
Gluteus medius & Gluteus minimus
abduct the lower limb at the hip joint and reduce pelvic drop over the opposite swing
limb during walking by securing the position of the pelvis on the stance limb