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Questions Answered: 180

Final Score 76%

137
43

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Anatomy

Lower Limb

Question 156 of 180

A 54 year old man presents to the ED complaining of a numbness over the posterior thigh. The skin in this area is primarily supplied by which of the following nerves:

Answer:

The posterior cutaneous nerve of the thigh, nerve from the sacral plexus, supplies skin over the posterior thigh and upper leg.

Cutaneous Innervation of Lower Limb

Table: Cutaneous Innervation of the Lower Limb

Nerve Origin Skin Supplied
Lateral cutaneous nerve of thigh Lumbar plexus (L2, L3) Lateral thigh
Anterior cutaneous nerve Femoral nerve Anterior thigh and anteromedial knee
Cutaneous branch Obturator nerve Medial thigh
Posterior cutaneous nerve of thigh Sacral plexus (S1 – S3) Posterior thigh and upper leg
Saphenous nerve Femoral nerve Anteromedial knee, medial leg and foot
Lateral sural cutaneous nerve Common fibular nerve Upper lateral leg
Superficial fibular nerve Common fibular nerve Lower anterolateral leg and dorsum of foot
Deep fibular nerve Common fibular nerve Webspace between 1st and 2nd toe
Sural nerve Tibial nerve Lower posterolateral leg, heel and foot
Medial calcaneal nerve Tibial nerve Medial side and sole of heel
Medial and lateral plantar nerves Tibial nerve Sole of foot anterior to heel

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)

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

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

Cutaneous Innervation of Thigh

  • The skin over the hip and gluteal region is supplied by the posterior and anterior rami of lumbosacral nerves (L1 – S3).
  • The lateral cutaneous nerve of the thigh, nerve from the lumbar plexus, supplies skin over the lateral thigh.
  • The anterior cutaneous nerve, branch of the femoral nerve, supplies skin over the anterior thigh and anteromedial knee.
  • The obturator nerve supplies skin over the upper medial thigh.
  • The posterior cutaneous nerve of the thigh, nerve from the sacral plexus, supplies skin over the posterior thigh and upper leg.

Cutaneous Innervation of Leg

  • The saphenous nerve, branch of the femoral nerve, supplies the skin over the anteromedial knee, medial leg and the medial side of the foot as far anteriorly as the head of the 1st metatarsal.
  • The lateral sural nerve, branch of the common fibular nerve, supplies the skin over the upper lateral leg.
  • The superficial fibular nerve supplies the area of skin over the lower anterolateral leg and the dorsum of the foot (except for the webspace between the 1st and 2nd toe and the lateral side of the little toe).
  • The deep fibular nerve supplies the skin over the webspace between the 1st and 2nd toe.
  • The sural nerve, branch of the tibial nerve, supplies the skin over the lower posterolateral leg, heel and foot.
  • The medial calcaneal nerve, branch of the tibial nerve, supplies the skin over the medial side and sole of the heel.
  • The medial and lateral plantar nerves, branches of the tibial nerve, supply the skin over the sole of the foot anterior of the heel.

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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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