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Kaan Ycel M.D., Ph.D.22.February.2012 WednesdayLumbosacral plexus&Gluteal region1IN 25 QUESTIONS

2What do you think you will see about the lumbosacral plexus?Which muscles?

Which functions?

What is glutea?Gluteal region contents?

Guns Roses- Godfather theme- Live in Copenhagen-19913LUMBOSACRAL PLEXUSIN17 QUESTIONS41. What is lumbosacral plexus?. Sensory and motor innervation of the whole lower limb arises from the spinal roots L1-S3

Lumbal plexusSacral plexus

52. How is the lumbar plexus formed?. Anterior rami of upper 4 lumbar spinal nerves (+L5) and from the contribution of subcostal nerve (T12)

in the lumbar region, within the psoas major muscle.

63. Nerves of the lumbar plexus?. L1 gives rise to the iliohypogastric and ilioinguinal nerves L1 + L2 gives rise to the genitofemoral nerve L2 + L3 gives rise to the lateral femoral cutaneous L2 + L3 + L4 give rise to the femoral and obturator nerves L4 + L5 give rise to the lumbosacral trunk which joins sacral nerves to form the sacral plexus.

74. ...femoral nerve?. (L2-L4) largest branch both motor and sensory.

Emerges from the lateral border of the psoas major

Flexors of the hip and extensors of the knee

Skin of the anterior and lateral thigh, medial leg and foot

785. ...saphenous nerve?. largest cutaneous branch of the femoral nerve

continuation of the femoral nerve

Skin of medial aspects of leg and foot

896. ...obturator nerve?. Emerges from the medial border of the psoas major

Leaves the lesser pelvis throughthe obturator canal

Skin on the superior medial thigh

Adductor muscles of theleg

107. ...lumbosacral trunk?. Descending part of the L4 nerve unites with the anterior ramus of the L5 nerve to form the lumbosacral trunk.

Participates in the formation of the sacral plexus with the anterior rami of S1-S4 nerves.

118. ...ilioinguinal & iliohypogastric nerves?. Enter the abdomen and run obliquely across the quadratus lumborum muscle behind the kidney.

Abdominal muscles Skin of the inguinal and pubic regions.

129. ...genitofemoral nerve?uinal & iliohypogastric nervesPierces the psoas major and emerges on its anterior surface.

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

1310. ...lateral cutaneous nerve of the thigh?. Runs inferolaterally on the iliacus and enters the thigh deep to the inguinal ligament/iliopubic tract

Skin on the anterolateral surface of the thigh

1411....lumbar plexus & the sympathetic system?The lumbar plexus is also connected with the lumbar part of the sympathetic nervous system via two or three long communicating branches.

1512. How is the sacral plexus formed?. anterior rami of S1 to S4, and the lumbosacral trunk (L4 and L5).

formed in relation to the anterior surface of the piriformis muscle

located on the posterolateral wall of the lesser pelvis.

1613... sciatic nerve?. Largest nerve in the body.

The most lateral structure emerging through the greater sciatic foramen inferior to the piriformis and enters the gluteal region

Posterior aspect of the thigh and the entire leg and foot

1713... sciatic nerve?. Leaves the gluteal region by passing deep to the long head of the biceps femoris,at the lower margin of the quadratus femoris muscle

Divides into the common peroneal and tibial nerves, at a variable site above the popliteal fossa

1814... pudendal nerve ?. Main nerve of the perineum and the chief sensory nerve of the external genitalia

Enters the gluteal region through the greater sciatic foramen inferior to the piriformis muscle & medial to the sciatic nerve.

Passes through the lesser sciatic foramen to enter the perineum. no branches in the gluteal region.

1915....superior & inferior gluteal nerves?. Superior gluteal nerveleaves the pelvic cavity through the upper part of the greater sciatic foramen superior to piriformis muscle gluteus medius, gluteus minimus, and tensor fasciae lata

Inferior Gluteal Nervegluteus maximuspost. thigh,leg,footskin of the foot and lateral leg

2016....others?. Nerve to Quadratus Femoris

Nerve to Obturator Internus

Posterior Cutaneous Nerve of Thigh

Perforating cutaneous nerve

2117....cocygeal plexus?. A minor contribution from S4 and is formed mainly by the anterior rami of S5 and Co, which originate inferiorly to the pelvic floor.

Skin in the anal triangle of the perineum

22IN8 QUESTIONSGLUTEAL REGION231. What is gluteal region?. (G. gloutos, buttocks) transitional region between trunk & lower limbs

242. How are the muscles of the gluteal region organized?. DeepSuperficial253...deep muscles of the gluteal region?.

264...superficial muscles in the gluteal region?.

Ilium posterior to posterior gluteal line; dorsal surface of sacrum and coccyx; sacrotuberous ligamentIliotibial tract & gluteal tuberosity of femur

External surface of ilium between anterior and posterior gluteal linesLateral surface of greater trochanter of femur

External surface of ilium between anterior and inferior gluteal linesAnterior surface of greater trochanter of femur

275...functions of the gluteal region muscles?. Muscles in the gluteal region mainly abduct, extend, and laterally rotate the femur relative to the pelvic bone.

286....innervation of the gluteal region muscles?. Superior gluteal nerveGluteus minimus & mediusTensor fascia lataeInferior gluteal nerveGluteus maximusNerve to the quadratus femorisQuadratus femorisGemellus inferior Nerve to the obturator internusObturator internusGemellus superior

Nerve to the piriformisPiriformis

297...arteries in the gluteal region?.

308...lymphatics in the gluteal region?. Lymph from deep tissuesuperior & inferior gluteal lymph nodes

internal,external,common iliac lymph nodes

lateral lumbar (aortic/caval) lymph nodesLymph from superficial tissue

superficial inguinal lymph nodes

external iliac lymph nodesGodfather Theme(gnrworld.com) Guns N' RosesLive In Copenhagen (Aug. 19th)1991Rock159354.67eng - www.gnrworld.com