Spasm in the obturator internus muscle is most often caused by irritation or entrapment of the nerve to the obturator internus. Issn 23214287 1124 figure 1 to figure 5 illustrates the sciatic nerve variations observed in this study. In most individuals, the nerve divides into an anterior branch and posterior branch before exiting the pelvis through the obturator foramen. Skin over lower part of medial aspect of thigh in diseases of hip joint pain is referred to knee joint and vice versa.
Ultrasoundguided onb techniques and unresolved issues regarding these procedures are also discussed. Paul rea mbchb, msc, phd, mimi, rmip, fhea, frsa, in essential clinically applied anatomy of the peripheral. It inserts into the trochanteric fossa of the femur. Posterior division of obturator nerve innervates most of the adductor magnus. Obturator internus muscle an overview sciencedirect topics. The obturator nerve is a major peripheral nerve of the lower limb. The inside of psoas major from anterior sections of the ventral rami of l2 to l4 spinal nerves. The anatomy and clinical implications of the obturator.
Persistent pain in the groin and thigh area is a difficult clinical problem to evaluate. Check out our resources for adapting to these times. In effect you are stealing something that belongs to someone else. It also supplies a cutaneous sensory zone on the inner thigh insert. The obturator nerve originates from the ventral divisions of the second, third, and fourth lumbar nerves in the lumbar plexus.
Types of activities reading physiopedia pages, journal articles, book chapters. Critical sites of entrapment of the posterior division of. Obturator nerve anatomy everything you need to know dr. The musculocutaneous nerve c57 is a terminal branch of the lateral cord. Obturator nerve definition of obturator nerve by medical. The obturator nerve is derived from l24 and travels along the medial border of the psoas muscle. The obturator nervel24 emerges from the medial aspect of the psoas and runs downwards and forwards, deep to the internal iliac vessels, to reach the superior part of the obturator foramen. This book is distributed under the terms of the creative commons. The double innervation in more than 90% of the am3s is especially noteworthy. 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. Nerves, blood vessels and lymph nerves, blood vessels and lymph of the gluteal region nerves of the gluteal region originating from the sacral plexus l4 s4, there are a number of significant nerves that either directly innervated the buttocks or pass through the gluteal region to innervate more inferior regions such as the perineum and thigh. Weak thigh adduction indicates obturator nerve injury.
Bones of the pectoral girdle and shoulder page 297. Obturator nerve injuries are a direct result of nerve sectioning, stretching, crushing, electrocoagulating, or ligating. The obturator nerve is the second major nerve that arises from l2, l3 and l4 ventral rami of the lumbar. Obturator nerve block atlas of pain medicine procedures. Innervates the muscles of the medial compartment of the thigh obturator externus, adductor longus, adductor brevis, adductor.
The obturator nerve divides into anterior and posterior branches. Bhanu prakash usmle, fmge and neet pg 43,919 views 2. The patient returned to sport and has remained symptom free. The fibers of obturator nerve arise from ventral divisions of 2 nd, 3 rd and 4 th lumbar nerves. The nerve is also responsible for the motor innervation of the adductor muscles of the lower limb external obturator. One possible cause of pain is due to fascial entrapment of the nerve. What is most important is to obtain complete block of obturator nerve, not to distinguish the two branches or provide local anesthetics to both branches. Download grays clinical anatomy pdf and study anatomy using your mobile, tablet or pc. Figure 371 the obturator nerve supplies the pectineus, adductor longus, brevis, and magnus, gracilis, and external obturator muscles. 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 principal peripheral nerve of the lower limb.
It arises from the obturator foramen and the obturator membrane. The nerve to obturator internus arises from the anterior divisions of the. Medial circumflex femoral artery, inferior gluteal artery, 1st 4th perforating arteries, obturator artery, and some superior muscular branches of popliteal artery. J, assistant professor, department of anatomy, sri siddhartha medical college, tumkur, karnataka, india. 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.
Redundant material has been eliminated to create a slimmer, easy to read text. Injury to the nerve is rare as it lies deep within the pelvis and medial thigh. Nerves, blood vessels and lymph advanced anatomy 2nd. Anatomy, abdomen and pelvis, obturator nerve statpearls ncbi. 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.
In case of injury to obturator nerve there will be. There are many entities that produce groin pain including tendonitis, bursitis, osteitis pubis, stress fracture, sports hernias or athletic pubalgia, nerve entrapment. 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. Diagnosis of obturator nerve entrapment was confirmed by emg and nerve block. Obturator neuropathy is a difficult clinical problem to evaluate. The obturator nerve is responsible for the sensory innervation of the skin of the medial aspect of the thigh. In some instances, a report of obturator nerve compression, specifically its anterior division, is one possible cause. Obturator nerve anatomy and clinical application medical animation dr bhanu prakash duration. Netters clinical anatomy, 3rd edition is a clinical anatomy textbook you will actually read. Muscles, blood vessels and nerves of the anterior and medial compartments of the thigh. This handbook makes it easy to acquire a rich understanding of complex clinical anatomical concepts. The obturator nerve should not be confused with the nerve to obturator internus. A cause of groin pain in athletes article pdf available in the american journal of sports medicine 253. Essential depictions of normal anatomy and embryology are paired with focused descriptions of a broad spectrum of corresponding clinical conditions commonly encountered across multiple medical specialties.
It runs through the upper anterior part of the obturator foramen to the medial adductor compartment of the thigh while descending along the. Motor blockade is most often not necessary for surgical patients receiving obturator nerve block. It courses medial to the psoas major muscle, along the sidewall. Obturator nerve belongs to the adductor compartment of the thigh. The obturator nerve arises from the lumbar plexus and provides sensory and.
The obturator nerve arises from the anterior division of l2l4 ventral rami. This nerve is formed by fibers from the 5th lumbar through the 2nd sacral spinal nerves. Access to the complete content on oxford medicine online requires a subscription or purchase. The bladder is a midline structure, supported by the pelvic floor levator ani and obturator internus muscles, and protected by the pubic bones anteriorly. The nerve descends medial to psoas major to the obturator canal where it divides into anterior and posterior divisions. A cadaveric study with proposed clinical implications archana b. It travels through the obturator foramen with the obturator artery and vein into the thigh. Obturator nerve is a branch of the lumbar plexus that emerges from the medial border of the psoas muscle in the abdomen. The technics that give us the opportunity to turn a map anatomy on to a road book and therefore allow us to answer, at all times, the three main questions related to safety during a surgical procedure. Obturator nerve block is useful in the evaluation and management of hip pain and spasm of the. Anatomy, histology and embryology 1 aoana02t2 book title essential clinical anatomy.
The nasal visual field on the affected side, and the temporal retinal shield on the unaffected side are affected. Mar 10, 2017 learn clinical anatomy from the best recommended book. The obturator nerve may have additional roots from the first or fifth lumbar nerves. Anatomy of obturator externus the obturator externus is one of the six short external rotators of the hip origin. Obturator paralysis in cattle merck veterinary manual. Lower extremity chapter january 2016 with 16,595 reads.
Richenberg, in clinical ultrasound third edition, 2011. The obturator nerve is clinically relevant in certain pathologic conditions and. Cutaneous branch innervates the skin of the medial thigh. The anatomy and clinical implications of the obturator nerve and its branches by. 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. Surface anatomy of the pelvis and perineum page 219. 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 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. Left gluteal region showing common peroneal nerve cpn piercing the piriformis muscle p and tibial. School of regional anesthesia textbook of regional anesthesia and acute pain management. The uniquely aesthetic and memorable netterstyle illustrationsaccompanied by descriptive text and tableshelp you to visually grasp and focus on the most relevant clinical implications of anatomical concepts.
The obturator artery is a branch of the internal iliac artery that passes anteroinferiorly forwards and downwards on the lateral wall of the pelvis, to the upper part of the obturator foramen, and, escaping from the pelvic cavity through the obturator canal, it divides into both an anterior and a posterior branch. Download snell clinical anatomy pdf anatomy, gross. Please wash your hands and practise social distancing. Obturator nerve anatomy and clinical application medical animation. The obturator nerve arises from the lumbar plexus on the posterior abdominal. The obturator nerve course motor sensory teachmeanatomy. The anterior division exits from the obturator canal to. Paralysisweakness of adductor muscles of thigh whic results in loss of adduction of thigh sensory loss.
Original research article anatomical variations of. It also leaves the greater sciatic foramen to innervate hip muscles. It arises from the anterior divisions of l24 in the lumbar plexus gross anatomy course pelvis. Ebraheims educational animated video describes the anatomy of the obturator nerve. 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. Chapter 26 covers the obturator nerve and its lesions, and includes needle electromyography of the adductor longus, adductor brevis, adductor magnus, and the gracilis. The close association of the obturator nerve with the origin of the ischiatic nerve can complicate interpretation of clinical signs. The anatomy and clinical implications of the obturator nerve and its. It is bounded by a thin, uneven margin, to which a strong membrane is attached, and presents, superiorly, a deep groove, the obturator. 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 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. 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.
Obturator nerve anatomy and clinical application medical. You are guilty of plagiarism if you copy something from another authors work. The obturator nerve is a large nerve arising from the lumbar plexus and the nerve of the medial compartment of the thigh. A morphometric study of the obturator nerve around the.
It exits the pelvis through the obturator canal in the upper part of the obturator foramen. 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. With an open book reduction, the reduction clamp is usually inserted through the. 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. Discussion although intrapelvic obturator nerve entrapment has been reported following surgical trauma, no cases of sportrelated entrapment have.
Clinical and anatomical tables, bulleted points, and shortanswer questions facilitate. A concise, focused and manageable medical reference textbook for your busy lives. The nerve goes down in psoas major and issues from its medial border at the ala of the sacrum. The obturator nerve forms in the lumbar plexus from the anterior primary rami of l2l4 roots and descends to the pelvis in the psoas muscle.
273 316 1496 1403 1215 1257 861 1201 1414 1437 1110 1586 1635 667 842 93 1066 515 1267 921 1519 41 1185 328 1334 94 1 37 539 1315 203 412 742 1073 1147 1037 617