Nerve And Blood Supply_le

NERVE AND BLOOD SUPPLY OF THE LOWER EXTREMITY Mark David S. Basco, PTRP Department of Physical Therapy College of Allied Medical Professions University of the Philippines Manila

OBJECTIVES 

Describe the Lumbar and Sacral Plexus in terms of:  Roots,

Divisions, and Branches  Pathway  Motor and Sensory distribution

OBJECTIVES 

Describe the Arterial and Venous Circulation in terms of:  Vessels  Pathway  Distribution  Function



Decribe the lymphatic circulation of the lower extremity

NERVES OF THE LOWER EXTREMITY LUMBAR Plexus SACRAL Plexus

IMPORTANT FUNCTIONS Sensory innervation to the skin and joints  Motor innervation to the muscles  Autonomic innervation to the 

LUMBOSACRAL PLEXUS 

The nerves of the lower limb originate from the lumbar plexus and the sacral plexus

LUMBAR PLEXUS 

Formed by:  Anterior

rami of L1 to L4  May have contributions from T12 

Branches emerge from the anterior, lateral, and medial borders of the psoas muscle

ILIOHYPOGASTRIC NERVE T12, L1  MOTOR and SENSORY  MOTOR 

 Muscles

of the abdominal wall



SENSORY  Suprapubic

region  Lateral aspect of the buttocks

ILIOINGUINAL NERVE L1  MOTOR and SENSORY  MOTOR 

 Muscles

of the abdominal walll



SENSORY  Upper

medial part of

thigh  Anterior part of scrotum  Mons pubis and labium majus

GENITOFEMORAL NERVE L1, L2  MOTOR and SENSORY  MOTOR 

 Genital 



branch

Cremater muscle

SENSORY  Skkin

over femoral triangle

GENITOFEMORAL NERVE 

Cremasteric reflex  Efferent

stimulation of the skin of the upper medial thigh in males causes a reflex contraction of the cremaster muscle



RESPONSE  Drawing

upward of the ipsilateral testes within the scrotum

LATERAL FEMORAL CUTANEOUS NERVE L2, L3  SENSORY 

 Skin

over the Anterior and Lateral surface of the thigh and knee  Lower lateral quadrant of buttocks

LATERAL FEMORAL CUTANEOUS NERVE 

Meralgia Paresthetica  Entrapment

of the lateral femoral cutaneous nerve

 Commonly

at the level of the inguinal ligament

 Complains

of pain and paresthesia in the area supplied by the nerve

OBTURATOR NERVE L2, L3, L4  SENSORY and MOTOR  SENSORY 

 Cutaneous 



branch

Subsartorial plexus to supply the medial thigh

MOTOR  Gracilis  Adductor

longus  Adductor brevis  Adductor magnus  Pectineus  Obturator externus

OBTURATOR NERVE 

MOTOR  Gracilis  Adductor

longus  Adductor brevis  Adductor magnus  Pectineus  Obturator externus

FEMORAL NERVE L2, L3, L4  Largest branch of the lumbar plexus  Enters the thigh via the femoral triangle  Supplies all the mucles of the anterior compartment of the thigh  MOTOR and SENSORY 

FEMORAL NERVE Anterior Division  Cutaneous branch  Medial

cutaneous nerve of the thigh  Intermediate cutaneous nerve of the thigh 

Motor branch  Sartorius,



Iliacus, Pectineus

Other branch  Articular

branch to the knee joint

FEMORAL NERVE Posterior Division  Cutaneous branch  Saphenous

nerve supplies the medial surface of the leg, foot up to ball of big toe



Motor branch  Rectus

mm

femoris, Vastus

FEMORAL NERVE PATELLAR Plexus  Located in front of the knee  Formed by the terminal branches of the  LATERAL,

INTERMEDIATE,and MEDIAL cutaneous nerve of

the thigh  INFRAPATELLAR branch of saphenous nerve

FEMORAL NERVE SUBSARTORIAL Plexus  Found underneath the sartorius mm 

Formed by the cutaneous branches of:  FEMORAL  OBTURATOR

SACRAL PLEXUS Lies on the posterior wall (in front of the piriformis)  Formed by the: 

 Anterior 

rami of L4 – S3

Branches leave the pelvis through the greater sciatic foramen

BRANCHES TO PELVIC MUSCLES, PELVIC VISCERA, AND PERINEUM

PUDENDAL NERVE S2 – S4  MOTOR and SENSORY  MOTOR 

 External

anal / urethral sphincter and muscle



Cutaneous branch  Perineum

NERVE TO PIRIFORMIS S1 – S2  MOTOR 

 Piriformis

PELVIC SPLACHNIC NERVE S2 – S4  MOTOR and SENSORY 

 Pelvic 

Viscera

Erection, GI Mobility, Micturition, Pain from cervix, bladder, urethra

LUMBAR PLEXUS Iliohypogastric

T1 2 L1

ILIonguinal

L2

Genitofemoral

L3

Lateral Femoral Cutaneous

L4 Obturator Femoral

BRANCHES TO THE LOWER EXTREMITY

SUPERIOR GLUTEAL NERVE L4, L5, S1  Leaves the greater sciatic foramen above the piriformis  MOTOR  SUPERIOR branch 

 Gluteus

minimus

 TFL 

INFERIOR branch  Gluteus  TFL

medius

INFERIOR GLUTEAL NERVE L5, S1, S2  Leaves the greater sciatic foramen below the piriformis 

MOTOR  Supplies the gluteus maximus 

NERVE TO QUADRATUS FEMORIS L4, L5, S1  MOTOR 

 INFERIOR

GEMELLUS  QUADRATUS FEMORIS 

Articular branch to hip joint

NERVE TO OBTURATOR INTERNUS L5, S1, S2  MOTOR 

 SUPERIOR

GEMELLUS  OBTURATOR INTERNUS

POSTERIOR FEMORAL CUTANEOUS NERVE S1, S2, S3  SENSORY 

 Lower

medial aspect of buttock  Back of thigh and upper leg

SCIATIC NERVE L4, L5, S1, S2, S3  Largest branch of lumbosacral plexus  Largest peripheral nerve  Emerges from the piriformis and courses downward on the red carpet mm  Passess deep into the long head of the biceps femoris  Divides into tibial and common peroneal 

SCIATIC NERVE Sciatic nerve can be entrapped by the piriformis  PIRIFORMIS Syndrome, Fat wallet syndrome  Sciatic nerve can also be injured by injection at the wrong site 

TIBIAL NERVE Larger than the common peroneal nerve  Enters the popliteal fossa  Passes behind the medial malleolus  Divides into lateral and medial plantar nerves 

TIBIAL NERVE MOTOR and SENSORY  SENSORY 

 Sural

nerve – posterolateral leg  Medial calcaneal branch  Articular branch to knee joint 

MOTOR  Soleus  Gastrocnemius  Flexor

digitorum longus  Flexor hallucis longus  Tibialis posterior

MEDIAL AND LATERAL PLANTAR NERVES 

Medial plantar nerve  ABDuctor

hallucis  FLEXor hallucis brevis  1st lumbrical  Flexor digitorum brevis 

Lateral Plantar nerve

COMMON PERONEAL NERVE Winds around the neck of the fibula  MOTOR and SENSORY  MOTOR 

 Short 

head of Biceps femoris

SENSORY  Sural

communicating  Lateral cutaneous nerve of calf 

Articular branch to knee and proximal tibiofibular joint

SUPERFICIAL AND DEEP PERONEAL NERVE

SUPERFICIAL PERONEAL NERVE 

SENSORY and MOTOR



SENSORY  Dorsum



of the foot,

MOTOR  Peroneus

longus  Peroneus brevis

DEEP PERONEAL NERVE 

SENSORY and MOTOR



SENSORY  1st



dorsal webspace

MOTOR  TA  EHL  EDL  PT

BLOOD SUPPLY OF THE LOWER EXTREMITY Arterial Venous Lymphatic

FEMORAL ARTERY

ANTERIOR TIBIAL ARTERY

DORSALIS PEDIS ARTERY

POSTERIOR TIBIAL ARTERY

PLANTAR ARCH 

Composed of:  Lateral

Plantar Artery  Dorsalis pedis artery 

Gives off plantar digital arteries

TROCHANTERIC ANASTOMOSIS 

Main blood supply to femoral head



Composed of:  Superior

gluteal artery  Inferior gluteal artery  Medial femoral circumflex artery  Lateral femoral circumflex

CRUCIATE ANASTOMOSIS At the level of greater trochanter  Connects the internal and femoral arteries  Composed of: 

 Inferior

gluteal artery  Medial femoral circumflex artery  Lateral femoral circumflex artery  First perforating artery

VENOUS DRAINAGE Deep veins (venae commitantes)  Superficial veins  Perforating veins 

LYMPHATIC DRAINAGE

REFERENCES 

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Moore, K.L., & Dalley, A.F. (2006). Clinically oriented anatomy. Philadelphia: Lippincott Williams & Wilkins. Chung, K.W., & Chung, H.M. (). BRS Gross anatomy. Philadelphia: Lippincott Williams & Wilkins. Tank, P.W. (2005). Grant’s dissector. Philadelphia: Lippincott Williams & Wilkins. Moore, K.L., & Dalley, A.F. (2006). Clinically oriented anatomy. Philadelphia: Lippincott Williams & Wilkins. Drake, R.L., Vogl, W., & Mitchell, A.W.M. (2007). Gray’s anatomy for students. Philadelphia: Elsevier Standring, S. (ed.). (2008). Gray’s anatomy. London: Churchill Livingstone. Gomez, M.Z.A. (2008). OTPT102 Archives.