Femoral n.

1. Femoral n. • The femoral nerve is the largest branch of the lumbar plexus. • Femoral nerve is created from contributions from L2, L3, and L4. • The femoral nerve enters into the thigh under the inguinal ligament, between the psoas and iliacusmucle. • Nerve of anterior compartment of thigh

3. Femoral Nerve “block” Locate the anterior superior iliac spine and the pubic tubercle. Just below this line is the femoral nerve.

4. IL = inguinal ligament IC = inguinal crease (a natural skin fold 4–6 cm below the inguinal ligament), Palpate the femoral artery The femoral nerve should be located 1 cm lateral to the palpation Medial to lateral the structures are femoral vein, artery, and nerve (VAN). FA = femoral artery

5. femoral nerve block

6. Femoral Nerve Block • Indications: • 1. Knee surgery • 2. Vascular surgery • Complications: • 1. Intravascular injection causing systemic toxicity • 2. Hematoma • Technique: • Patient Position: Supine • Landmarks: Insert needle 1cm lateral to the femoral artery. Two “pops” can be felt when needle passes through fascia lata and fascia iliaca. • Endpoints: Patellar movement should be detected.

9. FEMORAL NERVE INJURY • Injured by stab or gunshot wound • Motor loss • Loss of knee extension • Sensory loss • On anterior and medial aspect of thigh • Medial side of lower leg • Medial border of foot up to ball of great toe

10. INJURY OF LATERAL CUTANEOUS NERVE OF THIGH • Causes Compression or inflammation • Presentation Sharp pain in the course of distribution

11. Obturator n.

12. Cerebral palsy Landmark

14. OBTURATOR NERVE INJURY • Causes • Penetrating wounds • Anterior dislocation of hip joint • Obturator hernia or tumors • Muscles paralyzed • All the adductor muscles except for hamstring part of adductor magnus • Motor loss • adduction of thigh • Sensory loss • Medial side of thigh

15. Sup. Gluteal n. Infer. Gluteal n.

16. INJURY TO SUPERIOR GLUTEAL NERVE • Loss of abduction of hip • Unilateral injury: showspositive trendelenberg,ssign • Bilateral injury:shows waddling gait

17. INJURY TO INFERIOR GLUTEAL NERVE • Impairment of hip extension and lateral rotation • Difficulty in raising the body from sitting position

18. Sciatic n.

19. Your homework: SciaticNerve “block”?

20. SCIATIC NERVE INJURY • Commonly injured in following conditions: • I.V.DiscProlapse • Dislocation of hip joint • Piriformis syndrome • Intramuscular injection

21. I.V.DiscProlapse

22. Intramuscular injection

25. Dislocation of hip joint

27. SCIATICA • Pain along the sensory distribution of sciatic nerve

28. Superficial: Gluteus Maximus Gluteus Medius Gluteus Minimus Deep: Piriformis Gemelus Superior ObteratorInternus Gemelus Inferior QuadratusFemoris Gluteal Region Muscles Superior Gluteal Artery Inferior Gluteal Artery (branches of Internal Iliac a.) Arterial Supply Nerve Supply Branches of Sacral Plexus

29. Ant. Compartment Sartorius Quadriceps Muscles Arterial Supply Femoral Artery Nerve Supply Femoral nerve

30. Post. Compartment • Hamstring: • Semitendinosus • Semimembranosus • Biceps femoris Muscles Arterial Supply Profondafemoris: Branch of femoral artery Nerve Supply Sciatic nerve

31. Med. Compartment Pectineus Adductors Gracilis Muscles Obturator artery: Branch of internal iliac artery Femoral artery Arterial Supply Nerve Supply Obturaror nerve: Branch of Lumbar plexus