Obturator nerve entrapment description femoral head. A small cutaneous zone on the internal thigh is supplied by sensory fibers. The obturator nerve is responsible for the sensory innervation of the skin of the medial aspect of the thigh. The superior gemellus, inferior gemellus, and obturator internus muscles were once regarded as a single muscle judging from their insertion and function. A morphometric study of the obturator nerve around the. This would typically involve a three nerve block femoral, obturator and lateral.
Ll10 developmental internal rotation femoral and obturator nerves. The obturator nerve supplies the obturator externus and adductor muscles of the thigh, the hip and knee joints, and occasionally the skin of the thigh and leg. The obturator nerve is a major peripheral nerve of the lower limb. Femoral triangle and gluteal region instant anatomy. During a routine gross anatomy dissection class for undergraduate students at the all india institute of medical sciences, new delhi, india, in 2016, a rare unilateral variation in the obturator vasculature was found in a female cadaver of approximately 55 years. Sciatic nerve adductor magnus 1 gemellus superior, obturator internus, gemellus inferior 2 obturator externus 3 quadratus femoris for action of the muscles please see section on hip movements. The obturator nerve is clinically relevant in certain pathologic conditions.
The aim of the present study was to define a rational surgical approach for radiofrequency denervation of the articular branches of the obturator nerve that could be tested in clinical trials. Entrapment of the obturator nerve is a little recognized and rarely taught cause of pelvic and grointhighknee pain. The obturator nerve should not be confused with the nerve to obturator internus. Critical sites of entrapment of the posterior division of. The obturator nerve originates from the anterior division of the ventral rami of the second, third, and fourth lumbar spinal nerves within the psoas major muscle. Paul rea mbchb, msc, phd, mimi, rmip, fhea, frsa, in essential clinically applied anatomy of the peripheral nervous system in the limbs, 2015.
Radiological anatomy of the obturator nerve and its. The obturator nerve originates from the ventral divisions of the second, third, and fourth lumbar nerves in the lumbar plexus. Quadrangular space syndrome manual therapy by cambridge osteopath upper limb anatomy, axillary nerve. It also supplies a cutaneous sensory zone on the inner thigh insert. The obturator nerve results from the unification of the rami and descends through the psoas muscle to emerge from its medial border at the pelvic brim. Ul10 palpable structures and vulnerable nerves in the upper limb. Current knowledge regarding the functional anatomy of the oe muscle is limited. It arises from the anterior primary rami of l2, l3 and l4 in the lumbar plexus. It is a large nerve, which descends vertically within the psoas major muscle, before emerging from the inner border of the muscle in the abdomen. The obturator nerve arises from the anterior division of l2l4 ventral rami. Cutaneous branch innervates the skin of the medial thigh.
Similar to other injuries of the lumbar plexus see chapter 54, obturator nerve injury is infrequent and most commonly iatrogenic but may be due to. However, current textbooks of anatomy do not treat them as one muscle. The nerve goes down in psoas major and issues from its medial border at the ala of the sacrum. The obturator nerve is a mixed sensory and motor branch of the lumbar plexus and derives from the anterior divisions of the ventral rami of l2, l3, and l4 figure 631. Critical sites of entrapment of the posterior division of the obturator. From here the nerve divides into the anterior and posterior branch which are separated by the adductor brevis muscle. Obturator nerve injuries are a direct result of nerve sectioning, stretching, crushing, electrocoagulating, or ligating. The double innervation in more than 90% of the am3s is especially noteworthy. Accessory obturator nerve was observed on the right side in 2 cases 4% and on the left side in 2 cases 4%. It is bounded by a thin, uneven margin, to which a strong membrane is attached, and presents, superiorly, a deep groove, the obturator. The obturator artery normally originates from the internal iliac artery while the obturator vein drains into the internal iliac vein. It travels through the obturator foramen with the obturator artery and vein into the thigh. Am2, am3, and am4 received innervation from both the posterior branch of the obturator nerve and the tibial nerve portion of the sciatic nerve in 2 9.
Instant anatomy abdomen areasorgans bowel stomach blood supply. Original research article anatomical variations of. Distal to the obturator canal, the obturator nerve. See more ideas about anatomy, triangle, nerve anatomy. In this article we shall look at the anatomy of the oculomotor nerve its anatomical course, functions and clinical correlations. The inside of psoas major from anterior sections of the ventral rami of l2 to l4 spinal nerves. Before it divides into an anterior and posterior branch, which run distally in front of or. Variation in the obturator vasculature during routine. The anatomy and clinical implications of the obturator. Its different course and innervation by the posterior branch of the obturator nerve compared to the other short external rotators suggested it may serve a different role 6, 7. It arises from the anterior divisions of l24 in the lumbar plexus gross anatomy course pelvis. Figure 371 the obturator nerve supplies the pectineus, adductor longus, brevis, and magnus, gracilis, and external obturator muscles.
It runs through the upper anterior part of the obturator foramen to the medial adductor compartment of the thigh while descending along the. Anatomy the femoral nerve, formed by the dorsal divisions of the anterior rami of l2l4, is the largest terminal branch of the lumbar plexus. In this study, we explored the special characteristics of the. The obturator nerve arises from the lumbar plexus and provides sensory. The anterior division exits from the obturator canal to. Obturator nerve is a branch of the lumbar plexus that emerges from the medial border of the psoas muscle in the abdomen. A cadaveric study of ultrasoundguided subpectineal injectate spread around the obturator nerve and its hip articular branches thomas d. Pdf typically obturator nerve blockade is used to relieve hip pain.
A cadaveric study of ultrasoundguided subpectineal. A cause of groin pain in athletes article pdf available in the american journal of sports medicine 253. Obturator internus lateral boundary levator ani, radiology. Instant anatomy learn human anatomy online select an. It typically emerges from the medial border of the psoas muscle at the level of the pelvic brim, and divides in the obturator canal into anterior and posterior branches figure 632, although variations are common with a. It arises as 3 branches from the second, third, and fourth lumbar nerves.
Anatomy, abdomen and pelvis, obturator nerve statpearls ncbi. The internal obturator muscle may cause sciatic pain article pdf available in pain 10412. It courses medial to the psoas major muscle, along the sidewall of the pelvis, with the internal iliac vessels. The nerve is also responsible for the motor innervation of the adductor muscles of the lower limb external obturator. For this purpose, the anatomy of the obturator nerve and its branches was studied by cadaver dissection. Instant anatomy is a specialised web site for you to learn all about human anatomy of the body with diagrams, podcasts and revision questions. The classic description of the anatomic course of the obturator nerve comes from grays anatomy. A lesion of the obturator nerve results in weakness of adduction of the thigh and a tendency to abduct the thigh in walking. Pdf the sensory innervation of the hip joint an anatomical study.
Pdf the internal obturator muscle may cause sciatic pain. It exits the pelvis through the obturator canal in the upper part of the obturator foramen, where it divides into anterior and posterior divisions. In this article, we shall look at the anatomy of the obturator nerve its anatomical course, functions and clinical correlations. The obturator nerve is a large nerve arising from the lumbar plexus and the nerve of the medial compartment of the thigh. The accessory obturator nerve arises from the ventral branches of the third and fourth lumbar. It sometimes only has a minor effect in resolving symptoms. The obturator nerve is a mixed nerve with motor and sensory fibers. Obturator nerve block atlas of pain medicine procedures.
Ultrasoundguided onb techniques and unresolved issues regarding these procedures are. The knowledge of anatomy of accessory obturator nerve is. The fibers of obturator nerve arise from ventral divisions of 2 nd, 3 rd and 4 th lumbar nerves. Instant anatomy is a free web site for you to learn all about human anatomy of the body with diagrams, lectures, podcasts, questions, mcqs and apps.
In gross anatomy, the classification of muscles depends largely upon the nerve supply, so that the present author re. Obturator nerve belongs to the adductor compartment of the thigh. The obturator nerve is derived from l24 and travels along the medial border of the psoas muscle. This nerve controls adduction and rotation of the thigh. The obturator nerve arises from the lumbar plexus on the posterior abdominal wall and. The nerve descends medial to psoas major to the obturator canal where it divides into anterior and posterior divisions. In the pelvis, the obturator nerve can mimic pudendal neuralgia, hip pathology. Ultrasoundguided onb techniques and unresolved issues regarding these procedures are also discussed. In the present study, it was observed to have the described origin in 70%, while braithwaite found it in 41. Identifying an isolated obturator nerve lesion can be difficult based on history and physical examination alone, because other nerve injuries in the lower abdomen and pelvic region also present with groin and thigh pain. The oculomotor nerve cn iii course motor teachmeanatomy. Innervates the muscles of the medial compartment of the thigh obturator externus, adductor longus, adductor brevis, adductor. The obturator foramen latin foramen obturatum is the large opening created by the ischium and pubis bones of the pelvis through which nerves and blood vessels pass.
Download product flyer is to download pdf in new tab. The first seven chapters describe blood vessels, lymphatics, nerves, and the autonomic nervous system. The nerve then descends through the psoas muscle to emerge from its medial border at the. The obturator nerve moves behind the psoas major muscle distally leans against the wall of the pelvis, and together with the obturator artery, enters through the obturator canal to move to the inner thigh. The knowledge of anatomy of accessory obturator nerve is important for orthopaedicians to plan an effective hip surgery to relieve coxalgia. The text for each chapter comprises a short, precise. Manual muscle tests may further reveal weakness of the peroneus longus, peroneus brevis. Anatomy obturator nerve 8232017 368 views topic comments 2 please. The obturator nerve is a principal peripheral nerve of the lower limb. The obturator nerve can be anesthetized, or blocked, for pain control after knee surgery, for example, total knee replacement. An onb is performed to prevent thigh adductor jerk during transurethral resection of bladder tumor, provide analgesia for knee surgery, treat hip pain, and improve persistent hip.
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