Ilioinguinal- Iliohypogastric N. Superior Cluneal N. Obturator N.

Lateral Femoral Cutaneous

Origin L1 T10-L2 L2-4 L2-3

Course Across QL, psoas, inguinal Passes through psoas, Forms in psoas, passes through Runs across iliacus towards
ligament posterior to QL and courses obturator foramen, divides into ASIS- emerges distal lateral
distally to iliac crest via ant and post branches to medial aspect of psoas and
fibrous tunnel 7m lateral to thigh inguinal ligament-
midline Pierces TFL and terminates
at lateral thigh
Entrapment site QL, psoas, inguinal canal, hernia TLJ and osteofibrosous Fascia at ADD brevis Distal psoas, TFL, inguinal
tunnel inferior to IC ligament
Symptoms/ Restricted thoracolumbar jct., QL Restricted TLJ, QL, psoas, Groin/inner thigh pain Pain at ASIS, paresthesia
Clinical Findings and psoas and hip flexor distal crossed sx. Exercise induced medial knee anterior lateral thigh
restrictions Painful trigger point 7cm pain, ADD weakness Meralgia paresthetica
Pain in inguinal region, genitals lateral to midline at IC Pain with passive ABD
Pain c palpation to medial ASIS
Muscle weakness None None ADD longus and brevis and None
magnus, gracilis, pectineus
Sensory loss Inguinal region and genitals Sensory to lower lumbar Medial thigh and medial knee Anterior lateral thigh
and IC
Differential L1 radiculopathy L3/L4 radiculopathy L3 radiculopathy
diagnosis
 Femoral Nerve Saphenous Nerve Sciatic Nerve Common Peroneal Nerve
Origin L2-4 L3-4 L4-S3 L4-S2

Course Forms in psoas- descends Branches off femoral nerve Passes through sciatic foramen Arises from sciatic nerve at
between psoas and iliacus deep inferiorly to inguinal underneath piriformis, ischial popliteal fossa distal/lateral
to inguinal ligament, femoral ligament, add canal, pieces tuberosity- distally underneath to biceps femoris and
triangle, terminates quads and fascia at sartorius- travels hamstrings where it divides into lateral to head of gastroc-
saphenous nerve distal to supply medial leg the common peroneal and tibial goes around fibular head
and medial arch of foot nerve at the popliteal fossa deep to the peroneus
longus and divides into
deep and superficial
branches
Entrapment site Inguinal ligament with hip Knee joint where nerve Piriformis, ischial tuberosity at Fibular head d/t braces or
extension, psoas pierces fascia at ADD biceps femoris origin casts.
canal/sartorius just superior Trauma to lateral leg
to knee prolonged squatting
Symptoms/ Parasthesia ant/medial thigh, Burning, ache, pain at + SLR, posterior thigh pain Foot slap, pain at fibular
Clinical Findings quad weakness medial knee/leg/foot Hamstring weakness, TTP head or popliteal fossa,
Knee buckling Night pain/sleeping with piriformis, achilles tendon reflex P&N anterior lateral leg
knee flexion/hip ADD and in between 1st 2 toes
TTP distal sartorius
Muscle weakness Quads, pectineus, sartorius None Hamstrings Superficial branch:
peroneals
Deep: tib anterior
Sensory loss Anterior medial thigh Medial lower leg and medial Posterior thigh Superficial branch:
foot/arch anterior-lateral leg and
dorsum of foot
Deep branch: sensory
between 1/2nd toes
Differential L4 radiculopathy L4 radiculopathy S1 radiculopathy L5/S1 radiculopathy
diagnosis
 Sural Nerve Medial Plantar Nerve Tibial Nerve Lateral Plantar Nerve
Origin S1-2 L4-5 L4-S3 S1-2

Course Lateral branch arises from
common peroneal nerve and
Medial branch from tibial nerve
Travels distally on top of gastroc
– the 2 nerves converge to form
sural n. at the distal 1/3 of
gastroc
Entrapment site Gastroc-soleus complex at distal
1/3 of leg
Symptoms/ Achilles region pain
Clinical Findings P&N over the posterolateral leg
Muscle weakness NONE
Sensory loss Posterior-lateral leg and lateral
heel
Lateral foot along 5th ray
Special tests SLR test with foot bias- inversion
Tibial n. divides into medial
and lateral plantar nerves at
the medial malleolus
Medial plantar n. runs to
the base of the metatarsals-
deep to the transverse
ligament and divides into
interdigital n.
At the flexor digit. Longus
and flex. Hallucis longus
tendons at the medial foot
Overpronation and
calcaneal eversion
Compression from arch
supports
Toe flexors
FHB
Medial half of the plantar
foot
Branches off sciatic n. at the
popliteal fossa – deep to the
soleus – crosses knee joint and
descend between superficial and
deep compartments – crosses
posterior to medial malleolus and
divides into lateral and medial
plantar n.
Origen of soleus mm at popliteal
fossa, tarsal tunnel
Chronic heel pain
Paresthesia of plantar surface of
foot, Aching calf
Weak PF and INV
Burning of toes and plantar foot
Overpronation, Pain with walking
Gastroc + soleus
Posterior tibialis
Flexor digitorum long. FHL
Medial sural n. - skin on lower
half back of leg and skin of foot
laterally to the little toe.
Medial calcaneal n.- skin on
post-inferior calcaneus
Branch of the tibial n. at
the medial malleoli
Runs laterally to the 5th ray
and divides into superficial
and deep branches
Between flex digit. Brevis
and quadratus plantae
Between the ABD hallucis
and quadratus plantae
P&N in the lateral foot
4th and 5th toe weakness
ADD hallucis, all interossei,
4th/5th lumbricals
Skin of the lateral aspect of
the 5the toe

dDifferential S1 radiculopathy L4/5 radiculopathy

diagnosis Achilles tendonopathy