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Branches:
1. Muscular
a. semitendinosus
b. semimembranosus
c. Adductor Magnus (rest of adductors are supplied by obturator)
d. biceps femoris
2. Articular
a. Hip joint
3. Terminal
a. Common peroneal
b. tibial
Branches are:
1. cutaneous
a. sural communicating arises in the popliteal fossa and crosses lateral gastroc to join sural nerve
b. lateral cutaneous nerve of calf supplies skin over the anterolateral and posterolateral upper calf
2. articular
a. to the knee
3. terminal
a. deep peroneal (anterior tibial)
b. superficial peroneal
DEEP PERONEAL NERVE
Mainly a motor nerve
Originates from the common peroneal nerve between the fibular head and peroneus longus
Goes deep to extensor digitorum longus and runs along the interosseous membrane
Branches are:
1. muscular
a. tibialis anterior (dorsiflexion)
b.
Branches:
1. muscular
a. peroneus longus (evertors)
b. peroneus brevis
2. cutaneous
a. lower outer aspect of the leg
3. terminal branches
a. medial supplies sensation to the medial aspect of the dorsum of the foot and toes (lateral 2nd and medial 3rd
toes) second web space
b. lateral supplies sensation to the lateral aspect of the dorsum of the foot and toes (lateral 3 rd , 4th and medial 5th
toes)
NL15 [u] Which nerve is NOT from L2? See diag below
A. Femoral L2.3.4
B. Obturator L2.3.4
C. Genitofemoral L1.2
D. Lateral cutaneous nerve of the thigh L2.3
E. Ilioinguinal nerve L1, along with iliohypogastric (superficial to ilioinguinal) Rob Franz and the inguinal hernia
LUMBAR PLEXUS
Made up of anterior primary rami of the L1-L4, some individuals also receive contribution from T12 and L5
Relationship of lumbar plexus nerves to iliopsoas important obturator is medial, genitofemoral pierces it from behind, and the rest
emerge seratim (in series) from its lateral border.
NL05 S2 to S4:
A. Supplies upper inner third of thigh
B. Medial to nerve to obturator internus
C. ?
D. ?
NL07 [:] Sciatic nerve is located midway between the greater trochanter and:
A. Sacral hiatus
B. Ischial tuberosity just medial to the mid point
C. Anus
D. Coccyx
E. ? ischial spine
NL11 [d] Nerves that supply the skin immediately below the inguinal ligament:
A. Genitofemoral n.
B. Subcostal n.
C. Ilioinguinal n.
D. Iliohypogastric n.
TIBIAL NERVE
Originates at the apex (femoral side) of the popliteal fossa, along with the common peroneal nerve.
Consider the foot as the hand in the non anatomical position, palm down, and the analogy between the medial plantar and median nerves
is good. Median normally supplies the lateral 2 lumbricals (first and second), and the medial plantar supplies the first lumbrical.
SURAL NERVE (L5,S12) branch of the tibial
Receives the sural communicating branch of the common peroneal
Descends behind the lateral malleolus and runs along the lateral side of the foot to the 5 th toe
Supplies the posterolateral part of the lower third of the calf, as well as the lateral side of the foot and the 5 th toe.
Lower Limb
RL01 For a skin graft to the anterolateral aspect of the thigh you would block:
A. 2 f-breadths medial and above the anterior superior iliac spine
B. 2 f-breadths medial and below the anterior superior iliac spine 2 cm inferomedial to the ASIS (similar to
where the ilioinguinal nerve is blocked)
C. 2cms ?lateral?medial to the femoral artery
D. Caudal to L5
E. At the internal inguinal ring
RL02 For the taking of a skin graft on the lateral aspect of the thigh, it is necessary to block:
A. Femoral nerve
B. Sciatic nerve
C. A 2" line along the tope of the iliac crest anteriorly
D. At a point 1/2 - 1" medial to the anterior superior iliac spine
E. ?
RL07 [<] Resection of the great toe nail bed. Anaesthesia by blocking:
1. Superficial peroneal n
2. Sciatic n. most correct?
3. Femoral n.
4. Digital nerves
RL09 [=+>c] Anaesthesia for amputation of great and second toes requires block of:-
A. Saphenous n.
B. Posterior tibial n.
C. Deep peroneal n.
D. Sural nerve little toe and lateral foot branch of the tibial. Tibial nerve supplies all of the sole of the foot, peroneal nerve
supplies all of the dorsum (except the distibution of the saphenous)
RL05 [s] (type A) Effective local anaesthesia for removal of a skin lesion from the medial aspect
of the midcalf would require blockade of:
A. Sciatic nerve
B. Femoral nerve
C. Obturator nerve
D. Saphenous nerve
E. Posterior medial (something) nerve
SAPHENOUS NERVE
Largest cutaneous branch of the femoral nerve and the only cutaneous branch to cross the knee joint. Other cutaneous branches
include intermediate and medial cutaneous nerves of the thigh. It arises in the femoral triangle from the posterior division of the femoral
nerve, and descends the leg with the femoral artery on its lateral side, goes through the canal of Hunter and emerges between sartorius
and gracilis. It then runs down the medial border of the tibia, crosses with the vein in front of the medial malleolus and reaches as far as
the base of the big toe. Supplies an extensive cutaneous area over the medial side of the knee, leg, ankle and foot.
n.b lateral aspect of the mid calf would require block of lateral cutaneous nerve of the calf, which is a cutaneous branch of the common
peroneal nerve.
OBTURATOR NERVE (L2-4) adductors (look for this twitch on femoral nerve block)
Emerges from the medial border of psoas at the pelvic brim, which it crosses in its downward and forward passage to the obturator canal
(the hole between pubic rami). In this course it passes along the side wall of the pelvis, lateral to the internal iliac vessels and the ureter. It
enters the obturator canal above and anterior to the obturator vessels which are derived from the internal iliacus.
Within the canal, the nerve divides into its anterior and posterior branches.
Anterior branch: Passes into the thigh above obturator externus, descends on adductor brevis to end as a filament which runs along the
femoral artery.
Supplies adductor longus
Gracilis
Adductor brevis (usually)
Articular branch to the hip
Posterior branch: pierces and supplies obturator externus. It descends on adductor magnus behind adductor brevis, which separates it
from the anterior branch of the obturator nerve. Then it descends along the adductor canal to the popliteal fossa, to supply the knee joint.
Supplies adductor magnus (also receives a supply from the sciatic)
Adductor brevis (if not supplied by the anterior branch).
RL05b [r] What dermatome to block for lesion removal on medial aspect of calf?
A. L3 see posterior view
B. L4
C. L5
D. S1
RL06 [q] The medial side of the foot/lower leg can be blocked by:
A. Saphenous nerve block can be blocked subcutaneously either between superior to the medial malleolus from the mid line to
the medial malleolus, or on the anteromedial surface of the tibial tuberosity. Best answer
B. Femoral nerve block
C. Sacral block of L5
RL10 [jr] (type A) For femoral hernia repair under regional need all of the following
blocked EXCEPT:
A. Ilioinguinal.
B. Iliohypoglossal. no such nerve (could this be iliohypogastric?)
C. Femoral
D. Genitofemoral
E. Cutaneous branches of T11 & T12.