Femoral n The femoral nerve is the largest

Femoral n. • The femoral nerve is the largest branch of the lumbar plexus. • Femoral nerve is created from contributions from L 2, L 3, and L 4. • The femoral nerve enters into the thigh under the inguinal ligament, between the psoas and iliacus mucle. • Nerve of anterior compartment of thigh 1

2

Femoral Nerve “block” 1. Locate the anterior superior iliac spine and the pubic tubercle. 2. Just below this line is the femoral nerve. 3

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 4

femoral nerve block 5

Femoral Nerve Block • • • • Indications: 1. Knee surgery 2. Vascular surgery Complications: 1. Intravascular injection causing systemic toxicity 2. Hematoma Technique: Patient Position: Supine Landmarks: Insert needle 1 cm 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. 6

7

8

FEMORAL NERVE INJURY • • 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 9

INJURY OF LATERAL CUTANEOUS NERVE OF THIGH • Causes Compression or inflammation • Presentation Sharp pain in the course of distribution 10

Obturator n. 11

Cerebral palsy Landmark 12

13

OBTURATOR NERVE INJURY • • • 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 14

Sup. Gluteal n. Infer. Gluteal n. 15

INJURY TO SUPERIOR GLUTEAL NERVE • Loss of abduction of hip • Unilateral injury: shows positive trendelenberg, s sign • Bilateral injury: shows waddling gait 16

INJURY TO INFERIOR GLUTEAL NERVE • Impairment of hip extension and lateral rotation • Difficulty in raising the body from sitting position 17

Sciatic n. 18

Your homework: Sciatic Nerve “block”? 19

SCIATIC NERVE INJURY • Commonly injured in following conditions: • • I. V. Disc Prolapse Dislocation of hip joint Piriformis syndrome Intramuscular injection 20

I. V. Disc Prolapse 21

Intramuscular injection 22

23

24

Dislocation of hip joint 25

26

SCIATICA • Pain along the sensory distribution of sciatic nerve 27

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 28

Ant. Compartment Muscles Arterial Supply Nerve Supply Sartorius Quadriceps Femoral Artery Femoral nerve 29

Post. Compartment Muscles Arterial Supply Hamstring: 1. 2. 3. Semitendinosus Semimembranosus Biceps femoris Profonda femoris: Branch of femoral artery Nerve Supply Sciatic nerve 30

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 31