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Anatomy

Lower Limb

Question 119 of 180

You form part of the trauma team caring for a roofer who fell approximately 7 metres from a roof, landing across a beam. Imaging of the spine has revealed traumatic injuries to multiple lumbar vertebrae and the femoral nerve. Which of the following muscles is NOT innervated by the femoral nerve:

Answer:

The femoral nerve innervates the iliacus, the pectineus, the sartorius and the quadriceps femoris muscles. The gracilis is innervated by the obturator nerve.

The femoral nerve arises from the lumbar plexus, receiving fibres from the anterior rami of L2 - L4.

Table: Anatomical Overview of the Femoral Nerve

Nerve Femoral
Nerve roots L2 – L4
Motor supply Iliacus, pectineus, sartorius, quadriceps femoris
Sensory supply Skin over the anterior thigh, anteromedial knee, medial leg and medial foot
Injury Motor Loss: Weak flexion at hip and loss of extension at knee

Sensory Loss: Loss of sensation over anterior thigh, anteromedial knee, medial leg and medial foot

Anatomical course

The femoral nerve descends from the lumbar plexus in the posterior abdomen through the substance of the psoas major muscle, emerging from the lower lateral border of the psoas major. Continuing its descent, the femoral nerve lies between the lateral border of the psoas major and the anterior surface of the iliacus muscle. It is deep to the iliacus fascia and lateral to the femoral artery as it passes posterior to the mid-inguinal point to enter the femoral triangle in the anterior compartment of the thigh, before dividing into an anterior and posterior division.

By Henry Vandyke Carter [Public domain], via Wikimedia Commons

Femoral Nerve. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

Branches

Table: Branches of the Femoral Nerve

Branch Supply
Muscular branches in abdomen Iliacus and pectineus
Anterior cutaneous branches Skin over anterior thigh
Anterior muscular branches Sartorius
Posterior muscular branches Quadriceps femoris muscles
Posterior articular branches Hip and knee joint
Saphenous nerve Skin over anteromedial knee, medial side of leg and foot

In the abdomen it gives rise to branches that innervate the iliacus and pectineus muscles.

The anterior division gives off anterior cutaneous branches (supplying skin over the anterior and medial thigh) and muscular branches (innervating the sartorius).

The posterior division gives off muscular branches (innervating the quadriceps femoris muscles) and articular branches (supplying the hip and knee joint), before continuing as the saphenous nerve (supplying skin over the anteromedial knee and the medial side of the leg and foot).

Function

Table: Motor Supply of the Femoral Nerve

Muscle Function
Sartorius Flexion, abduction and lateral rotation at hip and flexion at knee
Iliacus Flexion and lateral rotation at hip
Pectineus Adduction and flexion at hip
Rectus femoris Flexion at hip and extension at knee
Vastus lateralis Extension at knee
Vastus medialis Extension at knee
Vastus intermedius Extension at knee

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Cutaneous Innervation of Lower Limb. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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