CLINICAL ANATOMY CASESLOWER LIMB

Kaan Yücel M.D., Ph.D.

.

20.March.2013 Wednesday

CASE 1

Weakness of hip flexion & knee extension on the left side

Difficulty in walking & climbing stairsNumbness, 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 groinAbsent patellar reflexSweating 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.

IATROGENIC FEMORAL NERVE INJURY

CASE 2

MRI lumbar spine showing vertebral fractures at first presentation to clinic

L4

L2

CASE 2

L5

L3

L1

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 L1& L2lateral femoral cutaneous nerve L2 & L3femoral & obturator nerves L2-L4lumbosacral trunk 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 S1superior gluteal nerve

(L5-S2 inf. gluteal nerve)

genitofemoral nerve L1& L2lateral femoral cutaneous nerve L2 & L3femoral & obturator nerves L2-L4lumbosacral trunk L4+L5

Obturator nerveCollectively, 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

skin of the middle anterior thigh; male scrotum and cremaster muscle; female labia majora

Genitofemoral nerve

Tensor fascia lataeassists 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

SUPERIOR GLUTEAL NERVE