The obturator nerve originates from l24 and is the only motor nerve of the lumbar plexus to pass through the pelvis without innervating any pelvic structures. The anterior division exits from the obturator canal to. Obturator neuropathy is caused by entrapment of the obturator nerve and this can occur at several points along its course. Hn20 autonomic nerve supply to the eye and principles of pupil control. Spasm in the obturator internus muscle is most often caused by irritation or entrapment of the nerve to the obturator internus. Obturator nerve article about obturator nerve by the.
The obturator nerve extends from the lower lumbar spine through the anterior hip and into the groin and medial thigh. 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. The obturator nerve originates from the ventral divisions of the second, third, and fourth lumbar nerves in the lumbar plexus. Neuropathic pain is usually the result of an injury or malfunction of the peripheral or central nervous system. Radiological anatomy of the obturator nerve and its articular branches. Obturator nerve definition of obturator nerve by the. Mar 18, 2020 the classic description of the anatomic course of the obturator nerve comes from grays anatomy. The nerve to obturator internus originates in the sacral plexus. The nerve to the obturator internus and gemellus superior arises from the ventral divisions of the fifth lumbar and first and second sacral nerves.
With an aim to improve the accuracy of diagnosis and to prevent complications, we performed a cadaveric morphometric study to investigate the anatomical features and relationships between the obturator nerve and its surrounding anatomical landmarks. 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. Information and translations of obturator nerve in the most comprehensive dictionary definitions resource on the web. 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. The accessory obturator nerve and the innervation of the. The major contribution to the obturator nerve is from l3 and the least contribution is usually from l2. The nerve supplies the obturator internus and superior gemellus muscles as well as the fascia of the lateral side wall of the ischioanal fossa gross anatomy origin. The sciatic nerve is the major nerve arising from the lumbosacral plexus.
Conversely, unless immediate repair is made, functional recovery on sensory and motor nerves is quite poor. For anterior obturator nerve entrapment, treatment may consist of electrical stimulation of the adductor and hip flexor muscles, stretching, and. The obturator nerve is supplied by l2l4 nerve roots and innervates the medial thigh and hip joint. Mar 08, 2012 preventing the obturator nerve reflex the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Locher s, burmeister h, bohlen t, eichenberger u, stoupis c, moriggl b, et al. The obturator nerve course motor sensory teachmeanatomy. Gross anatomy course pelvis the nerve descends medi. Obturator nerve injury is an infrequent complication of. The pubis apparently also developed so as to isolate the accessory obturator nerve as it hooked around the obturator. The nerve then descends through the psoas muscle to emerge from its medial border at the. Localised neuropathic pain is where the pain occurs in a specific nerve or trigger point. In the pelvis, the obturator nerve can mimic pudendal neuralgia, hip pathology, groin strain, and claudication. The nerve is also responsible for the motor innervation of the adductor muscles of the lower limb external obturator.
This nerve exits the greater sciatic notch between the sciatic nerve and the pudendal nerve and then branches in the retrosciatic space, sending most of its descendant elements through the lesser sciatic notch to. The classic description of the anatomic course of the obturator nerve comes from grays anatomy. Its fibers originate from the l4 to s3 spinal roots. Obturator nerve block will be performed after induction of general anesthesia. Nerve to the obturator internus and superior gemellus a branch of the sacral plexus l5, s1 arterial supply. Preventing the obturator nerve reflex full text view. The fibers of obturator nerve arise from ventral divisions of 2 nd, 3 rd and 4 th lumbar nerves. Oct 25, 2011 how to test the obturator nerve using neurodynamic testing. How to test the obturator nerve using neurodynamic testing. The nerve path continues by following along the lateral wall of the pelvis, passing through the obturator.
Course substance of psoas the obturator decends through the substance of the psoas and exits medially near pelvic brim. Behind the pectineus, it distributes branches to the adductor longus and gracilis, and usually to the adductor brevis, and in rare cases to the pectineus. Obturator nerve is a branch of the lumbar plexus that emerges from the medial border of the psoas muscle in the abdomen. It passes into the thigh through the obturator foramen of the pelvic bones and innervates the adductor longus, adductor brevis, gracilis, pectineus, obturator externus, and adductor magnus muscles. Obturator externus muscular, musculoskeletal anatomyzone. Medial surface of greater trochanter of femur, in common with superior and inferior gemelli action. A 4 cm insulated stimulating needle will be used to verify location of the obturator nerve by contraction of the thigh adductor group. Accessory obturator nerve was observed on the right side in 2 cases 4% and on the left side in 2 cases 4%. Piriformis syndrome, obturator internus syndrome, pudendal. The nerve to obturator internus arises from the anterior divisions of the. Ul10 palpable structures and vulnerable nerves in the upper limb. The inside of psoas major from anterior sections of the ventral rami of l2 to l4 spinal nerves.
The obturator nerve is the biggest nerve in the front lumbar plexus, which is a group of nerves in the lower back region. It leaves the pelvis through the greater sciatic foramen below the piriformis, and gives off the branch to the gemellus superior, which enters the upper part of the posterior surface of the muscle. Critical sites of entrapment of the posterior division of the. The medical illustrations contained in this online atlas are ed.
Anatomi fot, study flashcards on anatomi muskler underben. In the buttock, it passes close to the posterior capsule of the hip joint. Internal surface of obturator membrane and posterior bony margins of obturator foramen insertion. In this article, we shall look at the anatomy of the obturator nerve its anatomical course, functions and clinical correlations. The sciatic nerve leaves the pelvis through the greater sciatic foramen sciatic notch passing below the piriformis muscle and over the obturator internus muscle fig. Original research article anatomical variations of. Anatomy, abdomen and pelvis, obturator nerve statpearls ncbi. Ul10 palpable structures and vulnerable nerves in the upper limb ul11 arteries. It is formed from the l5s2 nerve roots and exits the pelvis via the greater sciatic foramen inferior to the piriformis muscle and typically between the posterior cutaneous nerve of the thigh and the pudendal nerve. Because the adductors are innervated by the obturator nerve, an animal adopts a basewide stance or, in recumbency, a sitting position with both hindlimbs extended forward.
Obturator nerve entrapment description femoral head. Internal pudendal and superior and inferior gluteal arteries. The motor portion innervates a portion of the adductors while the sensory supplies the medial thigh. Apr 07, 2015 the obturator nerve begins at the medial border of the psoas major muscle. Early treatment of injured obturator nerve often results in complete motor recovery as in our patient 11, 12. Listing a study does not mean it has been evaluated by the u. 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. In all obturator nerve pathology, a sound knowledge of anatomy is the. 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. The nerve path continues by following along the lateral wall of the pelvis, passing through the obturator canal, to enter the medial compartment of the thigh. The muscles of the medial compartment generally serve to adduct the thigh at the hip joint.
A cause of groin pain in athletes article pdf available in the american journal of sports medicine 253. S sartorius g gracilis t semitendinosus from medial to lateral f femoral nerve o obturator nerve t tibial nerve. It arises from the anterior divisions of l24 in the lumbar plexus gross anatomy course pelvis. Nerve to internal obturator and superior gemellus radiology. A motor nerve originating in the lumbar plexus and composed of axons from spinal cord segments l2l4. Given the importance of the relationship between the posterior division and the obturator externus muscle as one of the possible causes of posterior division neuropathy, we identified the following classes of variations. She said that it is not a common neuropathy, but can occur in athletes or.
There appears to be no unanimity among comparative morphologists in interpreting the origin and position of the pectineus muscle. The obturator nerve is a large nerve arising from the lumbar plexus and the nerve of the medial compartment of the thigh. 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. Instant anatomy is a specialised web site for you to learn all about human anatomy of the body with diagrams, podcasts and revision questions.
What are the treatment options for obturator nerve entrapment. Critical sites of entrapment of the posterior division of the obturator. Nerve to the obturator internus and superior gemellus a branch of the sacral plexus l5, s1. The nerve descends medial to psoas major to the obturator canal where it divides into anterior and posterior divisions. Over 6 million healthcare students and professionals a year rely on teachmeanatomy to help them study. Knowledge of the obturator nerve anatomy is essential for adequate surgical planning and success. It is bounded by a thin, uneven margin, to which a strong membrane is attached, and presents, superiorly, a deep groove, the obturator. Cutaneous branch innervates the skin of the medial thigh. The nerve to obturator internus arises from the anterior divisions of the sacral plexus. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. The sciatic nerve itself cannot technically innervate anything because it is merely the designation for the common sheath that encases the tibial and common fibular nerves. 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.
It runs through the upper anterior part of the obturator foramen to the medial adductor compartment of the thigh while descending along the. 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. The obturator nerve arises from the lumbar plexus on the posterior abdominal wall and descends within the psoas. Obturator nerve belongs to the adductor compartment of the thigh. The obturator nerve arises from the lumbar plexus on the posterior abdominal wall and descends within the psoas muscle, emerging from the medial margin of the muscle to enter the pelvis. It arises from the anterior divisions of l24 in the lumbar plexus. It travels through the obturator foramen an opening in the pelvic bone before entering the thigh, where it branches. The obturator nerve is a principal peripheral nerve of the lower limb. An accessory obturator nerve supplies the pectineus muscle of the thigh and is sensory to the hip joint. Ultrasoundguided onb techniques and unresolved issues regarding these procedures are also discussed.
Obturator nerve injuries are a direct result of nerve sectioning, stretching, crushing, electrocoagulating, or ligating. Ll10 developmental internal rotation femoral and obturator nerves. Near the obturator foramen the nerve gives off an articular branch to the hipjoint. You may not embed one of our images on your web page without a link back to our site. The obturator nerve arises from the lumbar plexus and provides sensory and motor innervation to the thigh. Entrapment of the obturator nerve is a little recognized and rarely taught cause of pelvic and grointhighknee pain.
The obturator nerve in human anatomy arises from the ventral divisions of the second, third, and fourth lumbar nerves in the lumbar plexus. Anatomy any of the cordlike bundles of fibres that conduct sensory or motor impulses between the brain or spinal cord and another part of the body. A morphometric study of the obturator nerve around the. All the muscles of the medial compartment are innervated by the obturator nerve except for the pectineus femoral nerve and the hamstring part of the adductor magnus tibial division of sciatic. Obturator paralysis in cattle merck veterinary manual. I memorized the pathways of each nerve and was completely set for the exam.
This is a technique taught in the diploma in orthopaedic massage and manipulation, advanced massage techniques school, scotland. Obturator nerve blocks for the treatment of hip pain. The nerve to obturator internus and superior gemellus is formed from the anterior ventral divisions of the l5, s1 and s2 nerve roots of the sacral plexus. Upon exiting the canal, it then divides into two parts with the anterior division. Aug 08, 2018 obturator nerve belongs to the adductor compartment of the thigh. The nerve goes down in psoas major and issues from its medial border at the ala of the sacrum.
The obturator nerve is responsible for the sensory innervation of the skin of the medial aspect of the thigh. The knowledge of anatomy of accessory obturator nerve is important for orthopaedicians to plan an effective hip surgery to relieve coxalgia. Obturator nerve block atlas of pain medicine procedures. The obturator nerve should not be confused with the nerve to obturator internus. The close association of the obturator nerve with the origin of the ischiatic nerve can complicate interpretation of clinical signs. Nerve to the obturator internus and superior gemellus a branch of the sacral plexus l5, s1 l5, s1 arterial supply internal pudendal and superior and inferior gluteal arteries.
If you would like a large, unwatermarked image for your web page or. For anterior obturator nerve entrapment, treatment may consist of electrical stimulation of the adductor and hip flexor muscles, stretching, and massage. Critical sites of entrapment of the posterior division of. Obturator internus muscle an overview sciencedirect topics. Containing over vibrant, fullcolour images, teachmeanatomy is a comprehensive anatomy encyclopaedia presented. It arises from the ventral divisions of the fifth lumbar and first and second sacral nerves it leaves the pelvis through the greater sciatic foramen below the piriformis muscle, and gives off the branch to the gemellus superior, which enters the upper part of the posterior surface of the muscle.1096 711 1117 36 865 1175 1479 622 717 40 118 304 1230 755 951 1139 599 1204 1257 274 146 212 35 1305 1441 404 1422 1141 563 668 1565 1127 1165 1265 472 1568 1096 1329 651 41 1097 502 1405 1037 32 1279