Download Femoral n.

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 artery
4. 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
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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
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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
• Causes
Compression or inflammation
• Presentation
Sharp pain in the course of distribution
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Obturator n.
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Cerebral palsy
Landmark
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OBTURATOR NERVE INJURY
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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:
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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 Maximus
Gluteus Medius
Gluteus Minimus
Deep:
Piriformis
Gemelus Superior
Obterator Internus
Gemelus Inferior
Quadratus Femoris
Superior Gluteal Artery
Inferior Gluteal Artery
(branches of Internal Iliac a.)
Branches of Sacral Plexus
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Ant. Compartment
Muscles
Arterial Supply
Nerve Supply
Sartorius
Quadriceps
Femoral Artery
Femoral nerve
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Post. Compartment
Muscles
Arterial Supply
Hamstring:
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Semitendinosus
Semimembranosus
Biceps femoris
Profonda femoris:
Branch of femoral artery
Nerve Supply
Sciatic nerve
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Med. Compartment
Muscles
Arterial Supply
Nerve Supply
Pectineus
Adductors
Gracilis
Obturator artery:
Branch of internal iliac artery
Femoral artery
Obturaror nerve:
Branch of Lumbar plexus
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