Plexus lumbalis L1-L4 Sensory innervation skin of the lumbar area and skin of anterior and medial surface of thigh and crus Motor innervation posterior and partly lateral group of abdominal muscles, anterior group of hip muscles and anterior and medial group of thigh muscles The branches of lumbar plexus • Rr. musculares (m. psoas major, m. psoas minor, m. quadratus lumborum) 1. Branches arising laterally to m. psoas major 2. Branches passing through m. psoas major 3. Branches passing medially to m. psoas major Nervus iliohypogastricus Th12-L1 • rr. musculares (m.obliquus internus and externus, m. transversus abdominis) • r. cutaneus lateralis skin around hip joint and lig. inguinale • r. cutaneus medialis skin above lig. inguinale and pubical region Nervus ilioinguinalis L1 • rr. musculares (mm. obliqus internus, m. transversus abdominis, m. cremaster) • it passes through the inguinal canal • nn. scrotales (labiales anteriores) • skin of inguinal region and of external genital organs Nervus cutaneus femoris lateralis L2-L3 • Purely sensory • through lacuna musculorum, close to spina iliaca anterior superior • Skin of the lateral side of thigh Meralgia parestetica Nervus femoralis L2-L4 • rr. musculares (m. iliopsoas, m. quadriceps femoris, m. articularis genus, m. sartorius a m. pectineus) • rr. cutanei anteriores anterior surface of thigh • n. saphenus skin on the medial side of crus and in front of malleolus medialis • Palsy: inability to extend the knee and flex the hip, disorders of sensitivity in the area of innervation, patelar reflex is missing Nervus genitofemoralis L1-L2 • r. genitalis (through canalis inguinalis), m. cremaster, skin of medial side of thigh • r.femoralis – (through lacuna vasorum,skin of the anterior surface of thigh (below the inguinal ligament) Nervus obturatorius L2-L4 • r. anterior – r. cutaneus (m. pectineus, m. adductor longus, m. gracilis) • r. posterior – r. articularis (m. obturatorius externus, m. adductor magnus, m. adductor brevis) Palsy: inability to adduct Plexus sacralis L4-S4 (S5+Co) Sensory innervation skin of the gluteal region, skin of the posterior surface of thigh and crus and skin of external genital organs Motor innervation muscles of posterior group of pelvis and thigh and muscles of crus and foot Branches of plexus sacralis • rr. musculares: m. piriformis, m. obturatorius int., m. quadratus femoris, mm. gemelli Nervus gluteus superior L4-S1 • m. glutaeus medius et minimus, m. tensor fasciae latae • foramen suprapiriforme Nervus gluteus inferior L5-S2 m. glutaeus maximus, posterior part of articular capsule of hip joint foramen infrapiriforme Nervus cutaneus femoris posterior S1-S3 skin of the posterior side of thigh, popliteal fossa and proximal part of crus • rr. perineales – skin of perineum and scrotum (labia majora) • nn. clunium inf. – skin of inferior part of gluteal region • rr. cutanei- skin of regio femoris posterior Nervus ischiadicus L4-S3 The thickest nerve of human body • rr. musculares (posterior part of thigh + m. adductor magnus) • rr. articulares (art. coxae) Terminal branches: • n. fibularis communis • n. tibialis Nervus tibialis • Direct continuation of n. ischiadicus (fossa poplitea, below arcus tendineus m. solei and further behind the malleolus medialis– canalis malleolaris – into planta pedis) n. cutaneus surae medialis → r. communicans fibularis n. suralis- adjacent skin of crus, behind malleolus lateralis rr.musculares muscles of posterior group of crus rr. calcanei mediales • Terminal branches: • n. plantaris medialis • rr. musculares: m. abductor hallucis, m. flexor hallucis brevis, m. flexor digitorum brevis, 1st and 2nd m. lumbricalis • n. plantaris lateralis • rr. musculares: m. guadratus planteae, m. flexor dig. Min., m. abductor digiti minimi, m. opponens and flexor dig. min. brevis, mm. interossei, 3rd, 4th m. lumbricalis, m. adductor hallucis • Motor innervation: posterior group of crural muscles, muscles of planta • Sensory innervation: majority of posterior surface of crus, foot and plantar surface of fingers • It can be injured within fossa poplitea or within sulcus malleolaris • Palsy - pes calcaneus (predominance of extensors) •pes calcaneus •Congenital deformity Nervus fibularis communis • rr. articulares • n. cutaneus surae lat.-skin of lateral side of calf - r. communicans fibularis → into n. suralis Nervus fibularis superficialis • rr. musculares - for mm. fibulares • n. cutaneus dorsalis medialis • n. cutaneus dorsalis intermedius Nervus fibularis profundus • Sensory innervation of a small part of skin of dorsum pedis • rr. musculares for long and short extensors of the foot Nervus pudendus S1-S5 • Through foramen infrapiriforme (along with artery) it turns around spina ischiadica → foramen ischiadicum minus → into fossa ischiorectalis → through canalis pudendalis and reaches to the symphysis • For the muscles of pelvic diaphragm, perineum and muscles of genital organs • For skin of perineum and scrotum (labia majora) • n. dorsalis penis (clitoridis) – for skin of penis (clitoris) and mucosa of urethra Plexus coccygeus Rami ventrales nn. spinalium S4-5, Co is located on anterior surface of m. coccygeus, nn. anococcygei – for adjacent skin and to posterior part of diaphragma pelvis rr. musculares- m. levator ani, m. coccygeus • Thank you for your attention!