. 20.March.2013 Wednesday

Weakness of hip flexion & knee extension on the left side Difficulty in walking & climbing stairs Numbness, parasthesiae, and hyperesthesia over the anteromedial aspect of the thigh, medial side of lower part of the leg, along the medial border of the foot as far as the ball of the big toe, and pain in the thigh and groin Absent patellar reflex Sweating in the autonomous cutaneous distribution of the nerve Weakness of hip flexion & knee extension on the left side Difficulty in walking & climbing stairs Numbness, parasthesiae, and hyperesthesia over the anteromedial aspect of the thigh, medial side of lower part of the leg, along the medial border of the foot as far as the ball of the big toe, and pain in the thigh and groin Absent patellar reflex Sweating in the autonomous cutaneous distribution of the nerve Inguinal canal above the medial half of the inguinal ligament on the anterior wall of abdomen

Moore AE, Stringer MD. Iatrogenic femoral nerve injury: a systematic review. Surg Radiol Anat. 2011;33: Moore AE, Stringer MD. Iatrogenic femoral nerve injury: a systematic review. Surg Radiol Anat. 2011;33:

CASE 2 MRI lumbar spine showing vertebral fractures at first presentation to clinic L4 L2

CASE 2 L3 L1 iliohypogastric & ilioinguinal nerves L1 iliohypogastric & ilioinguinal nerves genitofemoral nerve L1 + L2 genitofemoral nerve lateral femoral cutaneous nerve L2 + L3 lateral femoral cutaneous nerve femoral and obturator nerves L2 + L3 + L4 femoral and obturator nerves L4 + L5 lumbosacral trunk joins sacral nerves to form the sacral plexus.

genitofemoral nerve L1& L2 lateral femoral cutaneous nerve L2 & L3 femoral & obturator nervesL2-L4 lumbosacral trunkL4+L5 Dorsal divisions of L4, L5, S1, and S2 carried in common fibular nerve tibial nerve Ventral divisions of L4, L5, S1, S2, and S3 carried in tibial nerve Dorsal divisions of L4 to S1 superior gluteal nerve (L5-S2 inf. gluteal nerve)

genitofemoral nerve L1& L2 lateral femoral cutaneous nerve L2 & L3 femoral & obturator nervesL2-L4 lumbosacral trunkL4+L5 Obturator nerve Collectively, all these muscles except the obturator externus mainly adduct the thigh at the hip joint; the adductor longus and magnus may also medially rotate the thigh. Obturator externus is a lateral rotator of the thigh at the hip joint. All adductor muscles, except the “hamstring part” of the adductor magnus and part of the pectineus are supplied by the obturator nerve (L2-L4). The hamstring part of the adductor magnus is supplied by the tibial part of the sciatic nerve (L4). minimal sensory loss on the medial aspect of the thigh skin of the middle anterior thigh; male scrotum and cremaster muscle; female labia majora Genitofemoral nerve

Tensor fascia latae assists the gluteus maximus muscle in maintaining the knee in the extended position. stabilizes stabilizes the hip joint by holding the head of the femur in the acetabulum. Gluteus medius & Gluteus minimus abduct the lower limb at the hip joint and reduce pelvic drop over the opposite swing limb during walking by securing the position of the pelvis on the stance limb SUPERIOR GLUTEAL NERVE