Nerves of the

lower limb
 Lumbar plexus
• Sit: it lies inside the post of the substance of
psaos major Ms. in the abdomen.
• Formation: by the rami of the upper 4 lumbar
nerves (1, 2, 3, 4) each of which (except L1)
divides into ant (ventral) & post (dorsal)
divisions.
 :Branches of the plexus
Distribution of the root of the Small branches Large branches
plexus

L1 gives:
 iliohypogastric n
 ilioinguinal n
 1st root of genitofemoral n
L2 gives:
 2nd root of genitofemoral n
 1st root of lat cut n of thigh
 1st root of obturatorn
 1st root of femoral n.
L3 gives:
 2nd root of lat cut n of thigh
 2nd root obturator n
 2nd root of femoral n.
3. ilohypogastric (L1) 1. Femoral n.:
From post divisions of L2,3,4
4. ilioinguinal (L1)
5. genitofemoral (L1,2) 2. obturator n.:
6. lat. cut. n. of thigh From ant. divisions of L2, 3,
4
(Post. divisions of L2,3)
7. accessry obturator n.:
from the ventral divisions of
L3 & L4

L4 gives :
 3rd root of obturtor n
 3rd root of femoral n
 upoer root of lumrbosacrel
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Exit of the branches from the psoas major
:muscle
Emerge from the medial border of psoas major
• Obturator n.
• Accessory obturator n.
• Lumbosacral trunk.
Emerges from the ant. suface of psaas major.
• Iliohypogastric n.
• Ilioingunal nerve
• Lat. cut. n. of thigh
• Femoral never
• Genitofemoral nrver.
 Femoral nerve
• Origin: dorsal divisions of L 2, 3,
4 roots of lumbar plexus.
• Course: it emerges from the
lateral border of psoas (in the
abdomen) then descends
between psoas and iliacus and
passes behind the inguinal
ligament to enter the femoral
triangle lat. to the femoral
artery.
• Termination: it ends one inch below inguinal
ligament by dividing into number of terminal
branches
 :Branches
:Motor branches to Articular branches
Sensory branches
- Iliacus muscle (in - Intermediate cut. nerve of - Br. To hip joint.
abdomen) thigh. - Br. To knee joint
Sartorius - Medial cut. nerve of thigh.
-
- Saphenous nerve: to medial
- Pectineus
side of leg.
- Quadriceps
 :Injury of femoral nerves
Causes:
• Injury of femoral nerve is uncommon.
• It may be caused by stab wounds
• Gunshot wounds in the groin.
Motor effects:
• Paralysis of quadriceps muscle leads to
inability to extend the knee actively but it can
be extended passively by the iliotibial tract.
Sensory effects:
• Loss of sensation from the front and medial side
of thigh
• Loss of sensation of the medial side of leg and
foot.
 Obturator nerve
• Origin: ventral divisions of L2, 3, 4
roots of the lumbar plexus.
• Course: it emerges from the medial
border of psoas then descends on
the side wall of the pelvis to enter
the thigh through the obturator
canal.
• Termination: it ends on entering the
thigh by dividing into 2 divisions:
anterior and posterior. (infront and
behind adductor brevis muscle.
 :Branches
Motor: to muscles of Sensory branches Articular branches
medial side of thigh

- Gracilis To the skin of medial - To hip joint

- Add. Longus. side of thigh - To knee joint
- Add. Brevis.
- Pubic part of add.
Magnus.
 :Injury of obturator nerve
• Causes: penetrating wound, pressure on the
nerve by obturator hernia.
• Motor effects: inability of adduction and
external rotation of thigh (crossing leg is
difficult).
• Sensory effects: pain on the medial side of
thigh
 Sciatic nerve
• Origin: it is the largest branch of the sacral
plexus, and it is the thickest nerve in the body.
 :Course
• It leaves the pelvis through
greater sciatic notch below
piriformis muscle.
• It descends, first in the gluteal
region undercover of the
gluteus maximus then on the
back of thigh undercover of
long head of biceps.
• End: by dividing into medial and
lateral popliteal nerves at the
Branches:
• Motor: to hamstring muscles + ischial part of
adductor magnus muscle.
• Articular branch: to the hip joint.
 Medial popliteal nerve
• Origin: at the middle of back of
thigh as the larger of the 2
terminal branches of sciatic nerve.
• Course: it traverses the popliteal
fossa (from upper angle to lower
angle) crossing behind
(superficial) popliteal vessels from
lateral to medial.
• It ends: by becoming posterior
tibial nerve at the lower border of
popliteus muscle.
 :Branches
• Motor: to 4 muscles on the back of leg
(G.P.P.S).
• Cutaneous: sural nerve. Which runs on the
back of leg and lateral side of foot and
supplies the overlying skin.
• Articular: 3 genicular branches to the knee
joint.
Posterior tibial nerve (tibial nerve)
• Begins: as a continuation of
medial popliteal nerve at lower
border of popliteus.
• Course: it descends in the back
of leg accompanying posterior
tibial nerve (between the
superficial and deep calf
muscles).
• It ends: deep to the flexor retinaculum by
dividing into:
• Medial planter nerve.
• Lateral planter nerve.
Lateral popliteal nerve (common peroneal
nerve)
• Begins: as the smaller of the 2
terminal branches of sciatic
nerve at the back of thigh.

• Ends: inside peroneus longus

muscle, on the lateral aspect of
neck of fibula by dividing into 2
terminal brs: musculocutaneous
and anterior tibial nerves.
 Branches
• No muscular brs.
• 2 cutaneous brs:
 Sural communicating: joins sural nerve.
 Lat. cut. nerve of calf: upper lat. aspect of leg.
• 3 genicular brs. To knee.
 Musclo-cutaneous nerve: (superficial
peroneal nerve)
• Begins: as one of the 2 terminal
brs. Of lateral popliteal nerve (on
lateral aspect of neck of fibula).
• Course: in the upper 1/3 of leg, it
descends between peroneus
longus and brevis muscles then
becomes superficial in the lower
2/3.
• Ends: in the lower part of leg by
dividing into medial and lateral
terminal cut. brs.
Branches:
• Motor: to peroneus longus and brevis muscles
of lateral terminal cut. brs.
• Cutaneous: to lower 2/3 of anterolateral
aspect of leg + dorsum of foot except the cleft
between the 1st and 2nd toes.
 Anterior tibial nerve: (deep peroneal
nerve)
• Begins: as one of the 2 terminal brs. Of lateral
popliteal nerve on lateral aspect of neck of fibula.
• Course: it enters the anterior compartment of leg
and accompanies the anterior tibial artery lying
first on interosseous membrane then on anterior
surface of lower end of tibia.
• Ends: just below inferior extensor retinaculum
by dividing into medial and lateral terminal
brs.
 :Branches
Motor: to the 5 muscles of anterior compartment of leg
and dorsum of foot:
• Tibialis ant.
• Ext. hallucis longus.
• Ext. digit. Longus.
• Peroneus tertius.
• Ext. digit. Brevis.
Sensory: to the skin of the 1st cleft (between the 1st and
2nd toes).
• Articular: to the ankle joint and joints of the foot.
 Injury of sciatic nerve
Paralysis of all muscles supplied:
• Hamstrings: loss of flexion of knee.
• All muscles of leg and foot, leading to
steppage gait and foot drop.
• Loss of sensation below knee except on
medial side of leg and foot (supplied by
saphenous nerve).
 Injury of medial popliteal nerve or
:posterior tibial nerve
• Motor effects: paralysis of muscles of back of
leg + muscles of foot, leading to inability to
plantar flexion or invert foot.
• Sensory effects: loss of sensation over the
sole (except the medial border which is
supplied by saphenous nerve).
• Deformity: talipus-calcaneo-valgus deformity
(dorsiflexion and eversion of foot).
 Injury of the lateral popliteal nerve
Causes: wounds in popliteal fossa or fracture of neck of
fibula.
Motor effects:
• Paralysis of muscles of anterior compartment of leg,
leading to drop.
• Paralysis of muscles of lateral compartment of leg,
leading to inversion.
Deformity: talipus equino-varus (foot drop with inversion).
Sensory effects: loss of sensation from the anterolateral
aspect of leg and dorsum of foot.