LUMBER PLEXUS

Presented by: Laraib Sohail 拉比

Roll No: 8020220005
Contents :
 learn about the structure , relationship and importance
 learn about the origin of lumbar plexus
 learn about the branches of lumbar plexus and some clinical points
 Lets solve Mcqs together
What is Lumber Plexus? And where
it is situated?

 The lumbar plexus is a network of nerve fibers that serves

the skin and muscles of the lower leg. It is situated in the
lumbar area, within the substance of the psoas major
muscle, and anterior to the transverse processes of the
lumbar vertebra.

The plexus is composed of the anterior rami (divisions) of

the lumbar spinal nerves L1, L2, L3, and L4. It also
receives input from thoracic spinal nerve 12. In this
presentation we will look at the anatomy of the lumbar
plexus, namely its development and primary branches.
Branches of Lumber Plexus
 Ilihypogastric L1
 Ilioinguinal L1
 Genitofumoral L1-2
 Lateral femoral cutaneous L2-3
 Femoral L2,3,4
 Obturator L2,3,4
 Iliohypogastric Nerve
 The iliohypogastric nerve is the primary branch of the lumbar plexus. It connects to the
iliac crest and crosses the posterior abdominal wall's quadratus lumborum muscle. It then
perforates the transversus abdominis, dividing into terminal branches. The iliohypogastric
nerve arises from the anterior ramus of the L1 spinal nerve root of lumbar plexus, along
with the ilioinguinal nerve.
 After it emerges from the upper lateral border of the psoas major muscle, the
iliohypogastric nerve passes inferolaterally, posterior to the lower pole of the kidneys and
in front of the quadratus lumborum muscle.
 As it runs toward the anterior abdominal wall, the iliohypogastric nerve pierces the
transversus abdominis muscle posteriorly, just above the iliac crest and continues
anteriorly between the transversus abdominis and the internal abdominal oblique muscles
.

 Roots: L1 (with contributions from T12).

 Motor functions include innervation of the internal obliques and transversus abdominis.

 Sensory Functions: Innervates the posterolateral gluteal skin in the pubic area.
 Ilioinguinal Nerve
 The ilioinguinal nerve has the same anatomical path as the bigger
iliohypogastric nerve. After innervating the muscles of the anterior
abdominal wall, it travels via the superficial inguinal ring to innervate the
genital skin and middle thigh. The ilioinguinal nerve is a continuation of the
anterior ramus of the spinal nerve L1. In some cases, it may also receive
contributions from the subcostal (T12) nerve or L2. Upon its origin, the
nerve passes posterior to the psoas major and then emerges to the anterior
surface of the quadratus lumborum. It continues obliquely downwards across
its surface, passing also over the anterior surface of the iliacus muscle.
Finally, at the level of the iliac crest, it pierces the transversus abdominis
muscle.
 Roots: L1.
 Motor functions include innervation of the internal obliques and transversus
abdominis.
 Sensory Functions: Innervates the skin of the upper anteromedial thigh. In
men, it also provides skin around the penis root and the anterior scrotum. In
females, it provides skin across the mons pubis and labia majora.
 Genitofemoral Nerve
 The genitofemoral nerve is a branch of the lumbar plexus that carries fibers from
the anterior rami of spinal nerves L1 and L2. The nerve originates in the substance
of the psoas major muscle and descends retroperitoneally towards the
inguinal ligament. After exiting the psoas major muscle, the genitofemoral nerve
separates into two branches: genital and femoral.
 Genital branch: Upon its origin, the genital branch courses inferiorly, crosses the
external iliac artery , and enters the inguinal canal via the deep inguinal ring. In the
inguinal canal, the genital branch is accompanied by the spermatic cord (in males)
or the round ligament (in females).
 Femoral branch: the femoral branch (also known as the lumboinguinal branch)
courses lateral to the external iliac artery towards the inguinal ligament. It then
travels underneath the inguinal ligament, pierces the femoral sheath and fascia lata,
and enters the thigh region.
 Roots: L1 and L2.
 Motor Functions: The vaginal branch innervates the cremasteric muscle.
 Sensory Functions: The genital branch innervates the skin of the anterior scrotum
(in men) or the skin of the mons pubis and labia majora (in women). The femoral
branch innervates the skin of the upper anterior thigh.
 Lateral Cutaneous Nerve of the Thigh
 The lateral femoral cutaneous nerve originates from the dorsal branches of the
second and third lumbar ventral rami. This nerve emerges from the lateral edge of
the psoas major muscle and travels diagonally across the iliacus muscle. It
then heads towards the anterior superior iliac spine. On its way, it provides
innervation to the parietal peritoneum that is located in the iliac fossa.
 The left nerve passes behind the lower section of the descending colon. Both left
and right nerves travel either behind or through the inguinal ligament.
 The anterior branch of the nerve becomes superficial a few centimeters below the
anterior superior iliac spine. This branch then proceeds to provide innervation to the
skin on the front and outer side of the thigh.
 he posterior branch penetrates the fascia lata at a higher position compared to the
anterior branch. It then splits to provide innervation to the skin on the outer side.
 Obturator Nerve
 The obturator nerve is a major peripheral nerve of the lower limb. Roots: L2, L3,
L4.
 Motor Functions: Innervates the muscles of the medial thigh – the obturator
externus, adductor longus, adductor brevis, adductor magnus and gracilis.
 After its formation, the obturator nerve descends through the fibres of the psoas
major and emerges from its medial border. It then travels posteriorly to the
common iliac arteries and laterally along the pelvic wall – towards the obturator
foramen of the pelvis.
 The obturator nerve enters the medial thigh via the obturator canal (formed within
the obturator foramen by the obturator membrane).

 In obturator groove it divides into:

 1- Anterior branch (anterior to adductor brevis)
 Sensory Functions: Innervates the skin over the medial thigh.

Femoral Nerve
The femoral nerve is one of the major peripheral nerves of the lower limb.
 Roots: L2, L3, L4.
 Branches of Femoral Nerve
 Muscular:
 In abdomen: to iliacus (flexor of hip joint)
 In lower limb: to the anterior compartment of the thigh:
 Flexors of hip joint:Sartorious and pectineous
 Extensors of knee joint:Quadriceps femoris
 Cutaneous brs:
 To antero-medial aspect of the thigh
 To medial side of knee, leg and foot ( saphenous nerve)
 Motor Functions: Innervates the muscles of the anterior thigh – the illiacus, pectineus,
sartorius and quadriceps femoris.
 Sensory Functions: Innervates the skin on the anterior thigh and the medial leg.
 Lets test your knowledge
1.What does the L stand for in nerves L1, L2, L3 and L4 ?
A.Lateral B. Limbic
C.Lumbar D.lion

2. Which of these is NOT a spinal nerve that forms part of

the lumbar plexus
A. L5 B. L2

C. L1 D. T3
3.Which of the following nerves has a contribution from the
L3 spinal nerve? (3 answers )
A.Iliohypogastric C.Genitofemoral
B.Ilioinguina D.Lateral Cutaneous
E.Obturator F.Femoral