Femoral nerve

femoral nerve

1. Femoral nerve Dr Prashant Shringi Senior resident Neurology

2. Lumbar plexus

3. Formation: Ventral (anterior) rami of the upper 4 lumbar spinal nerves (L1,2,3 and L4) Within the substance of the psoas major muscle Main branches : Iliohypogastric & ilioinguinal : skin of the anterior abdominal wall Genitofemoral : skin of the thigh & cremaster muscle Obturator : to medial (adductor) group of the thigh Femoral : to anterior group of the thigh

4. FEMORAL NERVE Origin: From lumbar plexus ( L2,3,4) Course: Descends lateral to psoas major & enters the thigh behind the midpoint of the inguinal ligament Passes lateral to femoral artery, then divides into anterior & posterior divisions Muscular branches are first given off to the psoas and then to the iliacus muscles before the nerve runs beneath the inguinal ligament

5. MUSCULAR BRANCHES OF FEMORAL NERVE In abdomen : To iliacus , (flexor of hip joint). In lower limb : To the muscles of the anterior compartment of the thigh: Flexors of hip joint: Sartorius & Pectineus Extensors of knee joint: Quadriceps femoris . P S A R T

6. CUTANEOUS BRANCHES OF FEMORAL NERVE To antero -medial aspect of the thigh. To medial side of: Knee, Leg and Foot ( saphenous nerve ). Lateral thigh is not supplied by the femoral nerve but is innervated by the lateral femoral cutaneous nerve , which is derived directly from the lumbar plexus, receiving innervation from the L2–L3 nerve roots

7. MOTOR EFFECT Paralysis of Iliacus Sartorius Pectineus Quadriceps femoris Movement affected Flexion of the hip Flexion and abd uction of the hip Flexion and add uction of the hip Extension of the knee

8. SENSORY EFFECT: loss of sensation over areas supplied ( antero -medial) aspect of thigh & medial side of knee, leg & foot

9. How patient present in clinics? develop buckling of the knee (from quadriceps weakness) difficulty lifting up the thigh dragging of the leg Test : patient arise from the floor from the kneeling position Weakness of hip flexion is an important sign because it indicates involvement of the iliopsoas muscle, localizing the lesion proximal to the inguinal ligament

10. Thank you