PowerPointHandout_AandMThigh.pdfby soham shende

Anterior and medial thigh

1. Slide TitleSlide Number
Pelvis OsteologySlide 2
Thigh Fascia: Fascia Lata and Iliotibial BandSlide 3
Thigh Fascia: Iliotibial BandSlide4
Thigh CompartmentsSlide 5
Thigh Fascia: Saphenous Opening & Saphenous VeinSlide 6
Femoral TriangleSlide 7
Inguinal Ligament & SubinguinalSpaceSlide 8
Femoral SheathSlide 9
Femoral Ring and Femoral HerniaSlide 10
Femoral Artery & Vein CannulationSlide 11
Anterior Compartment Muscles: Flexors of the HipSlide 12
Psoas AbscessSlide 13
Anterior Compartment Muscles: Extensors of the
Knee Slide 14
Avulsion Fracture: AIISSlide 15
Slide TitleSlide Number
Medial Compartment MusclesSlide 16
Adductor Muscles: Clinical AnatomySlide 17
Obturator Artery and Nerve Slide 18
Adductor CanalSlide 19
Femoral ArterySlide 20
Deep Femoral ArterySlide 21
Medial Femoral Circumflex ArterySlide 22
Lumbar Plexus: OverviewSlide 23
Lumbar Plexus: Iliohypogastric n. and
Ilioinguinal n.Slide 24
Lumbar Plexus: Genitofemoral n.Slide 25
Lumbar Plexus: Lateral Femoral Cutaneous n.Slide 26
Lumbar Plexus: Femora n., Obturator n., and
Lumbosacral Trunk Slide 27
PowerPoint Handout: Lab 3, Anterior and Medial Thigh

2. Pelvis Osteology
To adequately review the learning objectives covering osteology of the pelvis,
make sure you view the Lower Limb Osteology and Medical Imaging Guide.

3. The deep fascia enveloping the thigh is called fascia lata.
•It is a stocking-like fascial layer extending from the osseous pelvis and gluteal
fascia superiorly to the bony prominences of the tibia inferiorly.
•At the tibia, the fascia latacontinues inferiorly as the deep fascia of the leg
(cruralfascia). (Cruralis a Latin term that means pertaining to the leg. In
anatomy, the “leg” refers to the region of the body between the knee and
ankle.) There are 3 important specializations of the fascia lata.
•The iliotibial band (tract)is a lateral thickening of the fascia lata.
•Intermuscular septa separate the thigh muscles into 3 compartments.
•The saphenous opening is a perforation in the fascia latathat allows for
the passage of the great saphenous vein to join with the femoral vein.
Thigh Fascia: Fascia Lata and Iliotibial Band

4. CLINICAL ANATOMY:Iliotibial tract (band) syndrome (ITBS)is one of the most common causes of lateral knee pain in endurance athletes. In this
condition, inflammation occurs in the iliotibial tract where it rubs against the lateral epicondyle of the femur.
PALPATION ANATOMY: The primary distal attachment site of the IT band is on the lateral tibial condyle. In the clinical environment, the eponym
Gerdy’stubercle is used to describe this specific site of the tibial condyle that is an easily palpated osseous landmark.
Thigh Fascia: Iliotibial Band
https://3d4medic.al/2gCnPVQC
The lateral aspect of the the fascia latais thickened into a 1.5 inch wide band called the iliotibial (IT) band (tract) that extends from the ilium to
the tibia. The gluteus maximus and the tensor fascia latamuscle both insert onto the iliotibial band. In addition, the tensor fascia latamuscle is
enclosed by the IT band.

5. The fascia lataextends inward toward the femur in three places. These extensions
are called septa (Latin for fence/enclosure) because they divide the thigh muscles
into three distinct compartments.
•Anterior compartment
•Medial compartment
•Posterior compartment
•The lateral intermuscular septum (separating the anterior from the posterior
compartment) is the thickest and strongest of the intermuscular septa
because it is a continuation of the IT band that attaches to the lineaaspera of
the femur.
https://3d4medic.al/6JcJWjjY
NOTE: There are testable exceptions to these generalizations! However,
these generalizations can be used clinically in many situations.
Muscles in theanterior compartment
•Actions: flex the hip and extend the knee
•Innervation: femoral nerve
Muscles in themedial compartment
•Actions: primarily adduct thigh
•Innervation: obturator nerve
Muscles in the posterior compartment (next lab)
•Actions: extend the hip and flex the knee
•Innervation: tibialnerve
Thigh Compartments

6. •Saphenous opening (ring) is an aperture in the fascia
latathrough which the great saphenous vein passes to
drain into the femoral vein.
•The great saphenous vein is a superficial vein that arises
on the medial side of the foot where it receives blood
from the dorsal venous arch. It ascends the lower
extremity on the medial leg and medial thigh. The details
of the great saphenous vein’s path are listed below. We
will revisit its path as we progress with our dissections
distally along the lower extremity
•It ascends the leg by passing anterior to the
medial malleolus of the ankle and continues
superior along the medial aspect of the tibia.
•It then winds a path around the medial condyle of
the knee and continues to ascend along the
medial aspect of the thigh.
•Ultimately it drains into the femoral vein within
the femoral triangle by passing through an
aperture in the the fascia latacalled the
saphenous opening (ring).
Thigh Fascia: Saphenous Opening & Saphenous Vein

7. The femoral triangle is a space in the superior
region of the anterior thigh through which
important neurovascular structures pass. The
boundaries of the femoral triangleare listed
below.
•Superior (base): inguinal ligament
•Lateral:sartorius muscle
•Medial:adductor longus muscle
•Apex:formed by the intersection of
thesartorialand adductorlongus muscles
•Floor:laterally formed by theiliopsoas
muscle and medially by thepectineus
muscle
Femoral Triangle
Contents of the femoral triangle
•Femoral nerve
•Femoral artery
•Femoral vein
•Lymphatics
The the mnemonic NAVEL (Nerve, Artery, Vein,
Empty Lymphatics) can be use to remember the
contents (and order) of structures within the
femoral triangle.
Femoral Triangle
https://3d4medic.al/LIffrV3F

8. The the sheet-like tendon of the abdominal oblique muscle (aponeurosis) attaches to both the anterior superior iliac spine (ASIS) and the
pubic tubercle. This dense fibrous connective tissue spans the distance between these two bony landmarks like a bridge to form astrong
ligament called the inguinal ligament.
Theinguinal ligament forms the superior boundary of the femoral triangle (base) and is the physical separation between the abdomen and
the thigh, which means that structures passing between the abdomen and the thigh must pass deepto the inguinal ligament (between the
inguinal ligament and the pelvic bone). The space deep to the inguinal ligament is informally known as the subinguinal(retroinguinal) space,
which can be divided into two compartments (lacunae) separated by a fascial septum derived from the iliopsoas fascia (iliopectineal arch).
•The muscular lacuna is the lateral compartment and contains the following structures.
•Iliopsoas muscle
•Femoral nerve
•The vascular lacuna is the medial compartment and contains the structures within the femoral sheath.
•Femoral artery
•Femoral vein
•Lymphatic vessels
and nodes
Inguinal Ligament & SubinguinalSpace
https://3d4medic.al/t4wGQGBa

9. The femoral sheath is a funnel-shaped fascia that extends from the inferior abdomen into the thigh by passing deep to the inguinal ligament.
•It begins in the abdomen as the transversalis fascia and the psoas fascia. These two fascia layers pass deep to the inguinal ligament to enter the thigh where
they blend with the connective tissue coverings (tunica adventitia) of the femoral vessels.
•The formal sheath It consists of two septa that divide it into three separate compartments.
•The lateral compartmentcontains thefemoral arteryand some of itsbranches.
•The intermediate compartment contains thefemoral vein, and some of itstributaries, notably the termination of the great saphenous vein.
•The medial compartment contains lymphatics(lymphatic vessels and sometimes a prominentdeep inguinal lymphnode known as theCloquet node).
•The medial compartment is also called the femoral canal.
•The proximal opening ofthe femoral canal that communicates with the abdomen is known as thefemoral ring.
Thefemoral nerve,and its branches,
areNOTlocated within the femoral sheath
nor the vascular lacuna. However, the
femoral nerve IS located within the femoral
triangle.
Femoral Sheath

10. Femoral Ring and Femoral Hernia
CLINICAL ANATOMY: Femoralherniascan occur through the femoral canal. When the loop of bowel is within the canal, it may not be obvious under
the skin. However, if the loop extends through the saphenous opening, it will emerge from the fascia lataand a lump will be visible on the anterior
thigh. Femoral hernias can be distinguished from inguinal hernias because femoral hernias are located inferior to the inguinal ligament, and
inferolateral to the pubic tubercle. Note that the medial border of the femoral canal is the lacunar ligament. Femoral hernias can easily become
strangulated by the sharp edge of the lacunar ligament.

11. CLINICAL ANATOMY: The femoral triangle is important clinically because it contains the femoral vessels, which are often cannulated in the triangleto perform
diagnostic procedures (Figure 1). When ultrasound is available, it can be used to easily identify the exact location of femoral artery and vein. If ultrasound isn’t
available, the practitioner must rely upon anatomical landmarks to identify the location of the femoral artery and vein (Figure 2).
•The femoral artery access site is located approximately 1 1/2 to 2 fingerbreadths (3 cm) below the inguinal ligament and directly over the femoral artery
pulsation (“X” in Figure 2). This location can also be determined by first palpating the pubic tubercle. From that location, the palpating fingers can be
moved laterally until the femoral pulse is located. If the patient lacks cardiac activity, the femoral pulsations should match in time with the compressions
from cardiopulmonary resuscitation (CPR).
•The femoral access site for the vein is at the same level as the access site for the artery, but approximately one fingerbreadthmedial.
Femoral Artery & Vein Cannulation
Figure 1Figure 2

12. Anterior Compartment Muscles: Flexors of the Hip
MUSCLEINNERVATIONBLOOD SUPPLYACTION
Tensor fasciae
lataeSuperior gluteal nSuperior gluteal a
Abducts, medially rotates and flexes thigh; helps
to keep the knee extended by tensing the IT
tractflexes thigh and trunk
PectineusFemoral nerve
(sometimes obturatorn.)Femoral aAdducts and flexes thigh
SartoriusFemoral n
Flexes, abducts and laterally rotates thigh; flexes
leg
Rectus femorisFemoral a and
Deep femoral aFlexes hipand extends leg
Iliopsoas Psoas: ventral rami L1-L3
Iliacus: femoral nAdducts and flexes thigh
The anterior compartment of the thigh is bounded by the medial and lateral intermuscular
septa of the fascia lata. It contains muscles that flex the thigh at the hip and/or extend the
leg at the knee. All of the muscles in the anterior compartment are innervated by branches
of the femoral nerve.
The tensor fascia latais enclosed within the iliotibial tract.
Although it is discussed with the anterior thigh because of
its anterior location, it is actually a gluteal muscle based on
its innervation. It acts to flex and medially rotate the hip,
and to extend the knee.
Pectineusis located between the anterior and medial
compartments of the thigh. It is grouped with the anterior
thigh muscles based on its innervation and its ability to flex
the thigh. However, it also adducts the thigh, and is
sometimes innervated by the obturator nerve. For these
reasons some textbooks group it with the medial
compartment muscles.
https://3d4medic.al/KUB2wt4J

13. CLINICAL ANATOMY: Apsoas abscessis the collection a purulent
infectious material within thepsoas muscle. The infection can be
primary or secondary.
•Primary psoas abscess occurs as a result of hematogenous or
lymphatic seeding from a different site. Primary psoas abscesses
tend to occur in children and young adults and are more
common in tropical and developing countries.It is most
commonly caused by S. aureus.
•Secondary psoas abscess occurs as a result of direct spread of
infection to the psoas muscle from an adjacent structure, such as
vertebrae. Historically, secondary psoas abscess was most often
the result of aMycobacterium tuberculosisinfection that spread
to the psoas from infected vertebral bodies (Pott's disease of the
spine). (This is probably still important to know for Step 1.) With
the decline in tuberculosis in the developed world, psoas
abscesses now more commonly occur fromgenitourinary or
gastrointestinal infections, especially inimmunocompromised
patients. Secondary psoas abscesses arising from intra-
abdominal infection are likely to be polymicrobial and to involve
enteric species such asE. coli,Enterobacter,Salmonella,
andKlebsiella, as well as anaerobic species.
Figure 1: Both psoas muscles appear
bulky. Left psoas muscle is much
bulkier than right and shows a
hypodense lesion which have well
defined outer margins (red arrow). Few
nodular hyperdense areas representing
small bony chips are also noted within
the substance of the muscle.
Destruction of whole of lower end
plate of L3 noted (green arrow).
Figure 2: C.T. showing coronal view of
abdomen at level of L3 and L4
vertebrae. The intervertebral disc space
between L3-4 vertebral body is lost
along with destruction and collapse of
L3 vertebra (green arrow). Both psoas
muscles are bulky and shows well
defined hypodense areas suggestive of
bilateral abscess. (red arrows).
Rare case of secondary tubercular psoas abscess from from infected vertebrae.
Psoas Abscess

14. Anterior Compartment Muscles: Extensors of the Knee
MUSCLEINNERVATIONBLOOD SUPPLYACTION
Quadriceps femoris muscle group
Rectus femoris
Femoral nerveFemoral artery and
Deep femoral artery
Flexes hipand extends leg
Vastus lateralis
Extends legVastus medialis
Vastus intermedius
https://3d4medic.al/hdKv2xaD

15. CLINICAL ANATOMY:During growth, the proximal attachment of the rectus femoris (anterior inferior iliac spine) is separated from the remainder of the
ilium by a growth plate of cartilage. Because of this, violent contraction of the quadriceps femoris in adolescents can result in anavulsion fracture of the
anterior inferior iliac spine.
Avulsion Fracture: AIIS

16. Medial Compartment Muscles
Most of the muscles in the medial compartment of the thigh insert on, or near, the lineaaspera, which is a prominentcrest on the posterior femur.
MUSCLEINNERVATIONBLOOD SUPPLYACTION
Adductor longus
Obturator nerveObturator artery
Adducts thigh
Adductor brevis Adducts thigh
Gracilis Adducts and flexes thigh
Obturator externus•Adducts thigh
•Laterally rotates thigh
Adductor Magnus•Obturator nerve
•Tibial portion of sciatic nerveDeep femoral arteryAdducts and extends thigh
https://3d4medic.al/n2Hr13zx

17. CLINICAL ANATOMY:The gracilisis a relatively weak member of the adductor
group that can be removed without noticeable loss of actions.In light of this,
surgeons can transplant parts or all of the muscle, along with its blood
supply, to other parts of the body.
CLINICAL ANATOMY:”Groin pull” refers to a strain injury to the adductor
group of muscles. Adductor strain is a common cause of medial thigh and
groin pain, especially among athletes. The musculotendinous junction is the
most common site of injury in strains. The adductor tendons have a small
area of attachment to the pelvis. This attachment site is characterized by a
poor blood supply and rich nerve supply, which explains the degree of
perceived pain in these injuries. The adductor longus is the most commonly
injured muscle and accounts for 62% to 90% of cases. It is hypothesized that
this occurs due to its low tendon to muscle ratio at the origin.
(https://www.ncbi.nlm.nih.gov/books/NBK493166/)
https://3d4medic.al/n2Hr13zx
Adductor Muscles: Clinical Anatomy

18. Both the obturator nerve and obturator artery arise in the
pelvis and gain access to the lower extremity by passing
through the opening in the superior aspect of the obturator
membrane (obturator foramen).
•Theobturator artery branches from the internal iliac
artery, which will be explored in further detail when we
study pelvic anatomy in the Endocrine/Reproductive
System. Two other arteries to note that branch from the
internal iliac artery that also supply the lower extremity
are the superior gluteal artery and inferior gluteal artery.
•The obturator nerve is formed by the nerve roots L2-L4
and branches from the lumbar plexus.
Obturator Artery and Nerve
https://3d4medic.al/7n59LB7V

19. Theadductor canal(subsartorialcanal, Hunter canal) begins at the apex of the femoral triangle and ends at theadductor hiatus. The adductor hiatus is an opening
in the tendon of the adductor magnus that allows the femoral artery and vein to pass from the anterior thigh into the popliteal fossa. Theadductor canalprovides
anintermuscular passageway for thefemoral vessels,saphenous nerve, andnervetovastusmedialis. Not all of these structures traverse the entire adductor canal.
Structures that DO course through the entire adductor
canal and exit the canal by passing through the
adductor hiatus to enter the popliteal fossa (region
posterior to the knee).
•Thefemoral artery and vein
Structures that DON’Tcourse through the entire
adductor canal. In other words, don’t exit the canal by
passing through the adductor hiatus.
•Thesaphenous nervecourses within the canal
with the femoral artery and vein but exits the
canal by piercing the fascia lataon the medial side
of the knee between thesartorius and gracilis
muscles. On the medial side of the tibia, the nerve
meets up with the great saphenous vein, and as
companions they descend to the medial side of
the foot. Along its path in the superficial fascia, it
provides sensory innervation to the skin of the
medial aspect of the leg, ankle, and foot.
•Thenerve to vastus medialism.courses within
the proximal canal parallel to the saphenous
nerve. Ultimately, it exits the canal to enter the
vastus medialis muscle in the midthigh region.
Adductor Canal

20. •The abdominal aorta bifurcates into the right and left
common iliac arteries. The common iliac arteries
branch into the internal and external iliac arteries.
Each external iliac artery becomes the (common)
femoral artery when it enters the thigh by passing
deepto the inguinal ligament.
•Each femoral artery courses through the femoral
triangle. Within the femoral triangle, the femoral
artery is located in the femoral sheaths’ lateral
compartment. In the femoral triangle, the (common)
femoral artery bifurcates into the (superficial) femoral
artery and the (deep) femoral artery.
•At the apex of the femoral triangle the femoral artery
enters the adductor canal.
•It courses through the adductor canal, and exits the
adductor canal by passing through the adductor
hiatus, which is an opening formed by the tendon of
the adductor magnus muscle.
•After passing through the adductor hiatus, the artery
enters the popliteal fossa and is now called the
popliteal artery.
Femoral Artery
The blood supply to the anterior compartment of the
thigh is provided by the (common) femoral artery. The
femoral artery gives off small cutaneous and muscular
branches, but only has one major branch, the deep
femoral artery. The path of the (superficial) femoral artery
is described below. Typically we refer to the common
femoral artery and the superficial artery simply as the
“femoral artery,” but you should be prepared to hear the
names of each during surgical clerkships.
https://3d4medic.al/vQTFwmDQ

21. Deep Femoral Artery
The deep femoral artery arises from the (common) femoral artery within
the femoral triangle. It provides the majority of the blood supply to the
thigh. The following vessels branch from the deep femoral artery.
•It immediately gives off medial and lateral circumflex arteries. These
arteries supply muscles in the thigh, gluteal region, and the hip joint.
•The medial circumflex artery branches from the medial side of
the deep artery and passes posteriorly through a gap between
iliopsoasandpectineusmuscles.
•The lateral circumflex artery courses in a lateral direction on
the anterior surface of the iliacus muscle. It divides into an
ascending, descending, and transverse branches.
•Ascending branch ascends deep to the tensor fascia lata
muscle. It forms an anastomosis with a branch from the
medial femoral circumflex artery, which encircles the
neck of the femur.
•The transverse branch passes through the vastus
lateralis and wraps around the proximal shaft of the
femur to anastomose with other vessels (medial femoral
circumflex, inferior gluteal, and first perforating artery)
•The descending branch connects distally with the
popliteal artery near the knee.
•The deep femoral artery exits the femoral triangle to enter the
medial compartment of the thigh by coursing deep to adductor
longus muscle. Within the medial compartment, it gives off
perforating arteries. The perforating arteries supply muscles in the
medial compartment, and ultimately pierce the adductor magnus
muscle to supply muscles located within the posterior compartment.
https://3d4medic.al/MF7rMYhy

22. CLINICAL ANATOMY: The medial circumflex femoral artery is clinically important
because it is the primary source of blood to the head and neck of the femurand is
often torn in fractures of the femoral neck.
Medial Femoral Circumflex Artery
https://3d4medic.al/tTyEAIzj

23. Lumbar Plexus: Overview
The L1-L3 ventral primary rami and a portion of
the L4 ventral primary ramus form thelumbar
plexus.Branches of the lumbar plexus include
the nerves that innervate structures of the
ventrolateral body wall and lower extremity.
The nerves of the lumbar plexus are listed
below.
•Iliohypogastric(L1)
•Ilioinguinal (L1)
•Genitofemoral (L1-L2)
•Lateral femoral cutaneous (L2-L3)
•Femoral (L2-L4)
•Obturator (L2-L4)
•Lumbosacral trunk

24. •The iliohypogastric (L1) nervebranches from the common trunk it shares with the ilioinguinal
nerve at the lateral edge of the psoas major muscle. It then courses along the anterior surface
of the quadratus lumborum on its path to pass through the transversus abdominis muscle. The
nerve then courses between the transversus abdominis muscle and the internal abdominal
oblique muscle where it branches above the iliac crest into the lateral cutaneous branch and the
anterior cutaneous branch.
•The lateral cutaneous branch passes through the internal abdominal oblique and external
abdominal oblique muscles to enter the skin where it provides sensory innervation to a
small area of the gluteal region.
•The anterior branch continues in an anterior direction between the internal abdominal
oblique and external abdominal oblique muscles. Ultimately, it passes through the
aponeurosis of the external abdominal oblique to enter the skin where it provides
sensory innervation to the pubic region.
•The ilioinguinal nerve (L1) nerve branches from the common trunk it shares with the
iliohypogastric nerve at the lateral edge of the psoas major muscle. It crosses the iliacus muscle
as it courses parallel, but inferior to iliohypogastric nerve. It pierces both the transversus
abdominis muscle and the internal abdominal oblique muscle to pass between the internal
abdominal oblique and the external abdominal oblique muscles where it enters the inguinal
canal from the side (not through the deep ring). It exits the inguinal canal at the superficial ring
to enter the skin where it provides innervation to the following areas: upper middle thigh.
•In males, it also supplies the skin over the root of the penis and anterior scrotum.
•In females, it supplies the skin over mons pubis and labia majora.
NOTE: For completeness, the path of the ilioinguinal and iliohypogastric nerves is described in
detail. At this point in time, identification of each nerve branching from the lumbar plexus, the nerve
root that contributes fibers to each nerve, and each nerve’s sensory distribution is the emphasis.
Lumbar Plexus: Iliohypogastricn. and Ilioinguinaln.

25. Genitofemoral nerve (L1-2):The genitofemoral nerve courses along the anterior surface of
thepsoas majormuscle.
•Thefemoral branchenters the femoral region by passing posterior to the inguinal
ligament. It is a sensory nerve that supplies theskin in the upper anterior thigh
•Thegenital branchpasses through the deep inguinal ring to enter the inguinal canal, and
exits the inguinal canal at the superficial ring.
•In men, it innervatesthe cremaster muscle and terminates in the skin of the
upper anterior scrotum.
•In women, it accompanies the round ligament of the uterus and terminates in the
skin of the mons pubis and labiamajora.
CLINICAL ANATOMY:Contraction of the cremaster muscle can be elicited via a
reflex arc, which is called thecremaster reflex.To elicit this reflex, the examiner
strokes the superior and middle aspects of the inner thigh, which results in
contraction of the cremaster muscle and an elevation of the testes within the
scrotum.
•The afferent limb of the reflex is the ilioinguinalnerve and the femoral branch
of the genitofemoral nerve.
•The efferent limb is the genital branch of the genitofemoral nerve, which
supplies the cremaster muscle.
Lumbar Plexus: Genitofemoral n.

26. The lateral femoral cutaneous (L2-3)passes obliquely across theiliacusmuscle, in the
direction of the anterior superior iliac spine, on its way to the subinguinalspace.The
nerve enters the lateral thigh by passing posterior to theinguinal ligamentand anterior
to thesartoriusmuscle.
CLINICAL ANATOMY:The lateral femoral cutaneous nerve can be compressed where
it passes between the inguinal ligament and the sartorius muscle of the anterior
thigh.Such compression results in a condition calledmeralgia paresthetica,which
manifests as numbness, tingling, and burning pain along the lateral aspect of the
thigh.
Lumbar Plexus: Lateral Femoral Cutaneous n.

27. •The femoral nerve (L2-4)courses along the anterior surface of theiliacusmuscle
lateral to the psoas major muscle. It passes through thesubinguinalspaceto enter
the anterior thigh.
•The obturator nerve (L2-4) is located medial to the psoas major muscle and
courses along the lateral wall of the pelvis toward theobturator foramento enter
the medial compartment of the thigh.
•Thelumbosacral trunkis a large nerve bundle, formed by a portion of the L4
ventral ramus and all of the L5 ventral ramus, joins the S1 ventral ramus and
portions of the S2-3 ventral rami to form thelumbosacral plexus. Branches of
thelumbosacral plexusinnervate structure/regions of the lower extremity not
innervated by branches of the lumbar plexus.This includes structures in the
gluteal region, posterior thigh, most of the leg and all of the foot.
Lumbar Plexus: Femora n., Obturator n., and Lumbosacral Trunk