OGAREV STATE MEDICAL

UNIVERSITY MEDICAL
INSTITUTE

ESSAY
SACRAL PLEXUS

SUBMITTED BY:
CHANDRAMOULI MONISHA
GROUP-223A
CHECKED BY ANATOMY PROFESSOR
A.G.RYBAKOV

SARANSK 2023
 REFERENCES
https://www.kenhub.com/en/library/ana
tomy/sacral-plexus
https://teachmeanatomy.info/lowerlimb/
nerves/sacral-plexus/
ORIGIN
The sacral plexus is a network of nerves formed by the
lumbosacral trunk (L4, L5) and sacral spinal nerves (S1 -
S4).
The sacral plexus is located on the posterior pelvic wall,
posterior to the internal iliac vessels and ureter, and
anterior to the piriformis muscle.

The plexus gives off numerous branches including the

anterior, posterior branches and one terminal branch).
These branches provide the motor and sensory
innervation for the posterior thigh, most of the lower leg,
the entire foot, and part of the pelvis.
Branches and supply
The sacral plexus provides a large number of branches
which can be divided into posterior, anterior and terminal
branches. The posterior branches are derived from
posterior divisions of the anterior rami of spinal nerves,
while the anterior branches are derived from the anterior
divisions. The largest and only terminal branch is the
sciatic nerve that provides two divisions: tibial nerve and
common fibular (peroneal) nerve.
Posterior branches
Superior gluteal nerve
The superior gluteal nerve is formed from the posterior
divisions of the anterior rami of L4, L5, and S1 spinal
nerves. It gains access to the gluteal region by coursing
over the superior border of piriformis muscle through the
greater sciatic foramen. Afterwards, the superior gluteal
nerve travels laterally underneath the gluteus medius
and innervates the tensor fasciae latae, gluteus medius
and gluteus minimus.

Inferior gluteal nerve

The inferior gluteal nerve receives contributions from the
posterior divisions of the anterior rami of the L5, S1, and
S2 spinal nerves. It takes a similar route through the
greater sciatic foramen, but inferior to piriformis muscle.
It travels superficial to the sciatic nerve and innervates
the gluteus maximus muscle.

Perforating cutaneous nerve

The perforating cutaneous nerve is also formed of purely
posterior divisions, this time originating from the fibers of
the anterior rami of spinal nerves S2 and S3. It passes
through the greater sciatic foramen, superior to the
gemelli and obturator internus, piercing the
sacrotuberous ligament and gluteus maximus. This
nerve provides cutaneous supply to a small area of skin
on the inferior medial part of the buttock.

Pelvic splanchnic nerves

The pelvic splanchnic nerves originate from the anterior
rami of spinal nerves S2, S3 and S4. They provide both
parasympathetic and motor innervation to muscles of the
pelvic cavity and pelvic floor. The parasympathetic
outflow joins the inferior hypogastric (pelvic) plexus. Its
motor component supplies the bladder and the distal
part of the large intestines (from the left colic flexure,
onwards). It also participates in clitoral (or penile)
erection.

Nerve to piriformis
The nerve to piriformis usually arises from the dorsal
branches of the
anterior rami of spinal nerves S1 and S2 (sometimes
only S2) and
enters the anterior surface of piriformis muscle and
supplies it.

Anterior branches
Nerve to quadratus femoris
The nerve to quadratus femoris originates from the
anterior divisions of the anterior rami of the spinal
nerves L4, L5 and S1. The nerve travels inferiorly
underneath the sciatic nerve and passes towards
the quadratus femoris. Along its course, it supplies
the inferior gemellus muscle and provides an
articular branch to the hip joint.
Nerve to obturator internus
The nerve to obturator internus arises from the anterior
divisions of the anterior rami of spinal nerves L5, S1 and
S2. The nerve travels inferior to piriformis leaves the
pelvis through the greater sciatic foramen, where it gives
off a branch to innervate the superior gemellus muscle.
It then courses around the ischial spine and reenters the
pelvis through the lesser sciatic foramen and pierces
obturator internus.
Posterior cutaneous nerve of the thigh The
posterior cutaneous nerve of the thigh (also known as
the posterior femoral cutaneous nerve) is the only
other branch of the sacral plexus that receives fibers
from both anterior and posterior divisions of anterior

rami.

Its fibers originate from:

• Posterior divisions of the anterior rami of spinal

nerves S1 and S2.
• Anterior divisions of the anterior rami of spinal
nerves S2 and S3.
The nerve enters the posterior thigh by way of the
greater sciatic notch, passing inferior to piriformis, deep
to the inferior gluteal artery and superior to the gemelli,
obturator internus and the sciatic nerve.
The nerve has an anteroposterior and superoinferior
range of cutaneous and fascial supply between the
anterior and posterior axillary lines from the buttock to
the middle of the calf muscles.

The posterior femoral cutaneous nerve also gives rise to

gluteal branches that provide cutaneous supply to the
contour of the buttock and perineal branches that
innervate skin of the lateral perineum (two thirds of the
posterolateral aspect of the scrotum in males, or labium
majus in females) and adjacent region of the upper
medial thigh.

Pudendal nerve
The anterior divisions of the anterior rami of spinal nerve
S2, S3 and S4 merge on the anterior surface of
piriformis (posterior to the inferior gluteal artery) to form
the pudendal nerve. The pudendal nerve travels
inferiorly around the sacrospinous ligament to enter the
pudendal canal with the pudendal vessels. The
pudendal nerve gives rise to:

• The inferior rectal nerve that innervates the external

anal sphincter, anal canal and perianal skin.
• The perineal nerve that provides cutaneous supply
to part of the posterior scrotum (vulva), mucus
membrane of the urethra and vagina, and motor
innervation to the muscles of the perineum.
• The dorsal nerve of the clitoris/penis that provides
cutaneous innervation to this region.

Nerve to levator ani and ischiococcygeus muscles

The last two branches of the sacral plexus are the nerve
to levator ani and ischiococcygeus muscle. It provides
motor innervation to the pelvic part of the muscles for
which they are named.
Sciatic nerve
The sciatic nerve is the terminal and largest branch of
the sacral plexus formed from both anterior and
posterior divisions of the anterior rami of spinal nerves
L4 to S3
.
The nerve exits the pelvic cavity by way of the greater
sciatic foramen. In the gluteal region, it travels deep to
gluteus maximus and the inferior gluteal artery. It
courses over the posterior surface of the gemelli,
piriformis, quadratus femoris and the ischial fibers of
adductor femoris. The sciatic nerve begins branching at
about the midpoint between the ischial tuberosity and
the greater trochanter to supply the hamstring muscles
and the ischial fibers of adductor magnus.
At the apex of the popliteal fossa, the nerve typically
divides into the common peroneal and tibial nerves.
These two nerves are responsible for innervating the
muscles and joints of the leg and foot. It is noteworthy
that the sciatic nerve receives vasa nervorum (small
artery providing arterial blood to peripheral nerves) from
the inferior gluteal artery.