Femoral nerve

Dr Prashant Shringi
Senior resident
Neurology
Lumbar plexus
• 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
 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
MUSCULAR BRANCHES OF
FEMORAL NERVE
•In abdomen:
To iliacus, (flexor of hip joint).
•In lower limb:
•To the muscles of the anterior P
compartment of the thigh: S
Flexors of hip joint: A
Sartorius & Pectineus R
Extensors of knee joint: T
Quadriceps femoris.
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
 MOTOR EFFECT

Paralysis of Movement affected

• Iliacus • Flexion of the hip

• Sartorius
• Flexion and abduction of
the hip

• Pectineus
• Flexion and adduction of
the hip

• Quadriceps femoris • Extension of the knee

 SENSORY EFFECT:

• loss of sensation over areas supplied (antero-medial) aspect

of thigh & medial side of knee, leg & foot
 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
Thank you