Saphenous nerve

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Saphenous nerve
Gray827.png
Nerves of the right lower extremity. Front view. (Saphenous labeled at center right.)
Details
From Femoral nerve (L3, L4)
Identifiers
Latin nervus saphenus
TA98 A14.2.07.023
TA2 6525
FMA 45262
Anatomical terms of neuroanatomy

The saphenous nerve (long or internal saphenous nerve) is the largest cutaneous branch of the femoral nerve. It is derived from the lumbar plexus (L3-L4). It is a strictly sensory nerve, and has no motor function. It commences in the proximal (upper) thigh and travels along the adductor canal. Upon exiting the adductor canal, the saphenous nerve terminates by splitting into two terminal branches: the sartorial nerve, and the infrapatellar nerve (which together innervate the medial, anteromedial, posteromedial aspects of the distal thigh). The saphenous nerve is responsible for providing sensory innervation to the skin of the anteromedial leg. [1]

Contents

Structure

It is purely a sensory nerve. [2]

Origin

The saphenous nerve is the largest and terminal branch of the femoral nerve. [3] It is derived from the lumbar plexus (L3-L4). [1]

Course

Shortly after the femoral nerve passes under the inguinal ligament, it splits into anterior and posterior divisions by the passage of the lateral femoral circumflex artery (a branch of the profunda femoris artery). [3] The posterior division then gives off the saphenous nerve as it converges with the femoral artery where it passes beneath the sartorius muscle. [3] The saphenous nerve lies in front of the femoral artery, behind the aponeurotic covering of the adductor canal, as far as the opening in the lower part of the adductor magnus muscle. There it diverges from the artery, and emerges from behind the lower edge of the aponeurotic covering of the canal. It descends vertically along the medial side of the knee behind the sartorius muscle, pierces the fascia lata, between the tendons of the sartorius muscle and gracilis muscle. It becomes subcutaneous around 10 cm above the medial epicondyle of the femur. [3]

The nerve then passes along the tibial side of the leg, accompanied by the great saphenous vein. [4] It descends behind the medial border of the tibia, and, at the lower third of the leg, divides into two branches:

Branches

The saphenous nerve, about the middle of the thigh, gives off a branch which joins the subsartorial plexus.

At the medial side of the knee it gives off a large infrapatellar branch, which pierces the sartorius muscle and fascia lata. [2] It is distributed to the skin in front of the patella. [4] [2]

Below the knee, the branches of the saphenous nerve (medial crural cutaneous branches) are distributed to the skin of the front and medial side of the leg, communicating with the cutaneous branches of the femoral, or with filaments from the obturator nerve.

Clinical significance

Procedures such as saphenous vein cutdown or orthopedic surgery that includes incisions or dissection over the distal tibia or medial malleolus can result in damage to the saphenous nerve, resulting in loss of cutaneous sensation in the medial leg. This is due to the intimate path that the saphenous nerve and the great saphenous vein travel. The saphenous nerve is also often damaged during vein harvest for bypass surgery and during trocar placement during knee arthroscopy. There appears to be occasional meaningful individual variation in the pathway of this nerve, such that the illustration of it done for Gray's Anatomy, for example, likely represents an unusual rather than usual course. [5]

The saphenous nerve can experience entrapment syndrome from exercises involving the quadriceps or from prolonged walking or standing. It is characterized by a burning sensation in most patients. Pain often occurs at night, long after the physical exercise which induced it has stopped, and may be aggravated by climbing stairs. Usually, in this case, motor function of the lower leg will not be impaired. This is a key distinction between saphenous nerve neuropathy and lower back radiculopathy. Saphenous nerve neuropathy only demonstrates sensory alterations, while lumbar radiculopathy will affect the motor, sensory, and deep tendon reflexes of the lower leg. [6]

Additional images

Related Research Articles

<span class="mw-page-title-main">Human leg</span> Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula. The thigh is between the hip and knee, while the calf (rear) and shin (front) are between the knee and foot.

<span class="mw-page-title-main">Thigh</span> The part of the body between the pelvis and the knee; upper leg

In anatomy, the thigh is the area between the hip (pelvis) and the knee. Anatomically, it is part of the lower limb.

<span class="mw-page-title-main">Femoral triangle</span> Anatomical region of the thigh

The femoral triangle is an anatomical region of the upper third of the thigh. It is a subfascial space which appears as a triangular depression below the inguinal ligament when the thigh is flexed, abducted and laterally rotated.

<span class="mw-page-title-main">Genitofemoral nerve</span>

The genitofemoral nerve is a mixed branch of the lumbar plexus derived from anterior rami of L1-L2. It splits a genital branch and a femoral branch. It provides sensory innervation to the upper anterior thigh, as well as the skin of the anterior scrotum in males and mons pubis in females. It also provides motor innervation to the cremaster muscle.

<span class="mw-page-title-main">Pectineus muscle</span> Adductor of the thigh

The pectineus muscle is a flat, quadrangular muscle, situated at the anterior (front) part of the upper and medial (inner) aspect of the thigh. The pectineus muscle is the most anterior adductor of the hip. The muscle's primary action is hip flexion; it also produces adduction and internal rotation of the hip.

<span class="mw-page-title-main">Adductor longus muscle</span> Skeletal muscle located in the thigh

In the human body, the adductor longus is a skeletal muscle located in the thigh. One of the adductor muscles of the hip, its main function is to adduct the thigh and it is innervated by the obturator nerve. It forms the medial wall of the femoral triangle.

<span class="mw-page-title-main">Adductor magnus muscle</span> Muscle in the thigh

The adductor magnus is a large triangular muscle, situated on the medial side of the thigh.

<span class="mw-page-title-main">Gracilis muscle</span> Most superficial muscle on the medial side of the thigh

The gracilis muscle is the most superficial muscle on the medial side of the thigh. It is thin and flattened, broad above, narrow and tapering below.

<span class="mw-page-title-main">Iliopsoas</span> Joined psoas and the iliacus muscles

The iliopsoas muscle refers to the joined psoas major and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. They are usually given the common name iliopsoas. The iliopsoas muscle joins to the femur at the lesser trochanter. It acts as the strongest flexor of the hip.

<span class="mw-page-title-main">Femoral nerve</span> Long nerve down the thigh and inner leg

The femoral nerve is a nerve in the thigh that supplies skin on the upper thigh and inner leg, and the muscles that extend the knee. It is the largest branch of the lumbar plexus.

<span class="mw-page-title-main">Posterior cutaneous nerve of thigh</span> Sensory nerve that supplies the back of the thigh, leg, buttock, and perineum

The posterior cutaneous nerve of the thigh is a sensory nerve of the thigh. It is a branch of the sacral plexus. It supplies the skin of the posterior surface of the thigh, leg, buttock, and also the perineum.

<span class="mw-page-title-main">Lumbar plexus</span> Web of nerves in the lower spine

The lumbar plexus is a web of nerves in the lumbar region of the body which forms part of the larger lumbosacral plexus. It is formed by the divisions of the first four lumbar nerves (L1-L4) and from contributions of the subcostal nerve (T12), which is the last thoracic nerve. Additionally, the ventral rami of the fourth lumbar nerve pass communicating branches, the lumbosacral trunk, to the sacral plexus. The nerves of the lumbar plexus pass in front of the hip joint and mainly support the anterior part of the thigh.

<span class="mw-page-title-main">Obturator nerve</span>

The obturator nerve in human anatomy arises from the ventral divisions of the second, third, and fourth lumbar nerves in the lumbar plexus; the branch from the third is the largest, while that from the second is often very small.

<span class="mw-page-title-main">Lateral cutaneous nerve of thigh</span> Nerve of the thigh

The lateral cutaneous nerve of the thigh is a cutaneous nerve of the thigh. It originates from the dorsal divisions of the second and third lumbar nerves from the lumbar plexus. It passes under the inguinal ligament to reach the thigh. It supplies sensation to the skin on the lateral part of the thigh by an anterior branch and a posterior branch.

<span class="mw-page-title-main">Adductor canal</span> Aponeurotic tunnel in the middle third of the thigh

The adductor canal is an aponeurotic tunnel in the middle third of the thigh giving passage to parts of the femoral artery, vein, and nerve. It extends from the apex of the femoral triangle to the adductor hiatus.

<span class="mw-page-title-main">Anterior cutaneous branches of the femoral nerve</span>

The anterior cutaneous branches of the femoral nerve consist of the following nerves: intermediate cutaneous nerve and medial cutaneous nerve.

The cutaneous branch of the obturator nerve is an occasional continuation of the communicating branch to the femoral medial cutaneous branches and saphenous branches of the femoral to the thigh and leg. When present it emerges from beneath the distal/inferior border of the adductor longus muscle and descends along the posterior margin of the sartorius muscle to the medial side of the knee where it pierces the deep fascia and communicates with the saphenous nerve. When present, it provides sensory innervation to the skin of proximal/superior half of the medial side of the leg.

<span class="mw-page-title-main">Outline of human anatomy</span> Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

The subsartorial plexus is a plexus of nerves that is located under the sartorius muscle.

Femoral nerve dysfunction, also known as femoral neuropathy, is a rare type of peripheral nervous system disorder that arises from damage to nerves, specifically the femoral nerve. Given the location of the femoral nerve, indications of dysfunction are centered around the lack of mobility and sensation in lower parts of the legs. The causes of such neuropathy can stem from both direct and indirect injuries, pressures and diseases. Physical examinations are usually first carried out, depending on the high severity of the injury. In the cases of patients with hemorrhage, imaging techniques are used before any physical examination. Another diagnostic method, electrodiagnostic studies, are recognized as the gold standard that is used to confirm the injury of the femoral nerve. After diagnosis, different treatment methods are provided to the patients depending upon their symptoms in order to effectively target the underlying causes. Currently, femoral neuropathy is highly underdiagnosed and its precedent medical history is not well documented worldwide.

References

PD-icon.svgThis article incorporates text in the public domain from page 956 of the 20th edition of Gray's Anatomy (1918)

  1. 1 2 Mathew, Kevin; Varacallo, Matthew (2022), "Anatomy, Bony Pelvis and Lower Limb, Saphenous Nerve, Artery, and Vein", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   31082089 , retrieved 11 January 2023
  2. 1 2 3 Candido, Kenneth D.; Benzon, Honorio T. (1 January 2005), Benzon, Honorio T.; Raja, Srinivasa N.; Molloy, Robert E.; Liu, Spencer S. (eds.), "Chapter 76 - Lumbar Plexus, Femoral, Lateral Femoral Cutaneous, Obturator, Saphenous, and Fascia Iliaca Blocks", Essentials of Pain Medicine and Regional Anesthesia (Second Edition), Philadelphia: Churchill Livingstone, pp. 645–658, doi:10.1016/b978-0-443-06651-1.50080-0, ISBN   978-0-443-06651-1 , retrieved 21 February 2021
  3. 1 2 3 4 Bromberg, Mark B. (1 January 2003), "Saphenous Nerve", in Aminoff, Michael J.; Daroff, Robert B. (eds.), Encyclopedia of the Neurological Sciences, New York: Academic Press, pp. 198–200, doi:10.1016/b0-12-226870-9/00902-3, ISBN   978-0-12-226870-0 , retrieved 21 February 2021
  4. 1 2 Bromberg, Mark B. (1 January 2003), "Saphenous Nerve", in Aminoff, Michael J.; Daroff, Robert B. (eds.), Encyclopedia of the Neurological Sciences, New York: Academic Press, pp. 198–200, doi:10.1016/b0-12-226870-9/00902-3, ISBN   978-0-12-226870-0 , retrieved 21 February 2021
  5. D Mercer; N T Morrell; J Fitzpatrick; S Silva; Z Child; R Miller; T A DeCoster (2011). "The course of the distal saphenous nerve: A cadaveric investigation and clinical implications". Iowa Orthopedic Journal. 31: 231–235. PMC   3215141 . PMID   22096447.
  6. Brad McKechnie (22 May 1995). "Saphenous Nerve Entrapment Neuropathy". Dynamic Chiropractic. 13 (11).