An detailed Lumbar & Sacral Plexus with Muscles and nerves supply to lower limb. lower limb Muscles action and clinical anatomy "Sciatica".

1. LUMBAR & SACRAL PLEXUS
Sciatic Nerve

2. Peripheral nerves inlower quadrant
• The lumbosacral plexus terminates in three
primary peripheral nerves
• These are responsible for innervating the
tissues of the lower extremity
• Lumbar plexus – Femoral & obturator
nerves
• Sacral plexus – Sciatic nerve

5. Nerve Muscle affected
with nerve injury
Common sites of
nerve
Compression /
tension or
causes of nerve
injury
Deformity /
symptoms
Primary
functional loss
Femoral
(L2 – L4)
Illiacus
Sartorius
Pectineus
Quadriceps
Pelvic or upper
femur fracture
During reduction
of DDH
Pressure during
forceps delivery
Atrophy in
anterior
thigh
Weakness or
inability to flex
thigh and
extend knee
Gait and weight
bearing
disturbances:
unable to
control knee
flexion during
loading
response

6. Nerve Muscle affected
with nerve injury
Common sites of
nerve
Compression /
tension or
causes of nerve
injury
Deformity /
symptoms
Primary
functional loss
Obturator
(L2 – L4)
Obturator
externus
Adductor muscle
groups
Pelvic or upper
femur fracture
During reduction
of DDH
Pressure during
forceps delivery
Pressure from
gravid uterus
and difficult
labour
Atrophy in
medial thigh
Difficulty in
crossing legs
Impaired
adduction &
external rotation
of thigh

8. Nerve Muscle affected
with nerve injury
Common sites of
nerve
Compression /
tension or
causes of nerve
injury
Deformity /
symptoms
Primary
functional loss
Sciatic
(L4 – S3)
Hamstring group
Adductor
magnus
Compression
from tight
piriformis
Hip dislocation
# of femur
Sciatica –
Pain
radiating in
posterior
thigh and
leg
Atrophy
posterior
thigh , leg &
foot
Atrophy in
calf
Weak knee
flexion and loss
of ankle and foot
control affecting
all phases of
gait

9. Nerve Muscle affected
with nerve injury
Common sites of
nerve
Compression /
tension or
causes of nerve
injury
Deformity /
symptoms
Primary
functional loss
Tibial
(L4 – S3)
Distal to
ankle
Medial
and
lateral
plantar
nerves
Plantar flexors
Popliteus
Tibialis posterior
Flexor digitorum
longus
Flexor hallucis
longus
Distal to ankle
Abductor hallucis
Flexor hallucis
brevis
Lumbricales
Interossei
Quadratus
plantae
-
Ankle and foot
Compromise in
tarsal tunnel
Irritation from
pes planus or
pes cavus
-
Foot
deformities
Pes cavus
Claw toes
Foot strain
Painful heel
Inability to
plantar flex
ankle or flex the
toes
Gait impairment
in terminal
stance
-

10. Nerve Muscle affected
with nerve injury
Common sites of
nerve
Compression /
tension or
causes of nerve
injury
Deformity /
symptoms
Primary
functional loss
Common
peroneal
(L4 – S2)
Deep
peroneal
nerve
Superfici
al
peroneal
nerve
Ankle
dorsiflexors
Toe extensors
Peroneus tertius
Peroneus
longus and
brevis
Compression
from crossing
legs
Injury from # at
head/neck of
fibula Foot drop
May
develop pes
valgus
May
develop
equinovarus
Gait impairment
during the
loading
response with
foot slap and
during swing
phase with
excessive
flexion (
steppage gait )
to clear the toes

12. SciaticNerve
Sciatica

13. Introduction
 The sciatic nerve is the thickest nerve in the human
body
 In its upper part, it forms a band about 2 cm
 It begins in the pelvis and terminates at the superior
angle of popliteal fossa by dividing in to the tibial
and common peroneal nerves

14. Origin and Rootvalue
 This is the largest branch of sacral plexus
 Root value – L4, L5, S1, S2, S3
 It is made up of 2 parts, the tibial part and common
peroneal part
 The tibial part is formed by the anterior primary rami
of L4, L5, S1, S2, S3
 The common peroneal part is formed by the dorsal
division of the anterior primary rami of L4, L5, S1,
S2

17. Course
 Pelvis – The nerve lies in front of the piriformis,
under cover of its fascia
 Gluteal region – The nerve enters the gluteal region
through the greater sciatic foramen below the
piriformis – It runs downwards and
passing between the ischial tuberosity and the
greater trochanter
 Thigh – Enters back of the thigh at the lower border
of the gluteus maximus
– It runs vertically downwards up to the superior
angle of the popliteal fossa, at the junction of the
upper two – third and lower one – third of the
thigh, where it terminates by dividing in to the
tibial and the common peroneal nerves

18. Relations
 Gluteal region:
– Medial:
• Inferior gluteal nerve and vessels
– Superficial or posterior:
• Gluteus maximus
– Deep or Anterior:
• Body of the ischium
• Tendon of obturator internus with the gemelli
• Quadratus femoris, obturator externus
• The capsule of the hip joint
• The upper, transverse fibres of the adductor magnus

19.  Thigh: Small companion artery branch of inferior
gluteal artery
– Superficial / Posterior:
• Crossed by long head of biceps femoris
– Deep / Anterior:
• Lies on the adductor Magnus
– Medial:
• Semimembranosus & Semitendinosus
– Lateral:
• Biceps femoris

20. Muscles& NerveSupply
 Semitendinous TS
 Semimembranosus TS
 Biceps femoris LTS SCP
 Adductor magnusCP

23. SCIATICA
 It is a common type of pain affecting
the sciatic nerve, a large nerve
extending from the lower back down
the back of each leg.

26. Causes
 Sciatica is caused by irritation of the root(s) of the
lower lumbar and lumbosacral spine.
 Lumbar spinal stenosis (narrowing of the spinal
canal in the lower back)
 Degenerative disc disease (breakdown of discs,
which act as cushions between the vertebrae)
 Spondylolisthesis (a condition in which one
vertebra slips forward over another one)
 Pregnancy
 Other things that may make your back pain worse
include being overweight, not exercising regularly,
wearing high heels, or sleeping on a mattress that is
too soft.

33. Symptoms
 Pain in the rear or leg that is worse when sitting
 Burning or tingling down the leg
 Weakness, numbness, or difficulty moving the leg or
foot
 A constant pain on one side of the rear
 A shooting pain that makes it difficult to stand up
 Sciatica usually affects only one side of the lower
body
 The pain extends from the lower back all the way
through the back of the thigh and down through the
leg

34.  In Severe cases lower extremity weakness,
numbness in the upper thighs, and/or loss of
bladder or bowel control.
 Loss of knee flexion due to weakness of hamstring
group of muscles

36. Riskfactors
 Age. Age-related changes in the spine, such as
herniated disks and bone spurs, are the most
common causes of sciatica.
 Obesity. By increasing the stress on your spine,
excess body weight may contribute to the spinal
changes that trigger sciatica.
 Occupation. A job that requires you to twist your
back, carry heavy loads or drive a motor vehicle for
long periods may play a role in sciatica, but there's
no conclusive evidence of this link.
 Prolonged sitting. People who sit for prolonged
periods or have a sedentary lifestyle are more likely
to develop sciatica than active people are.
 Diabetes. This condition, which affects the way your
body uses blood sugar, increases your risk of nerve

37. Complications
 Although most people recover fully from sciatica,
often without any specific treatment, sciatica can
potentially cause permanent nerve damage
 Loss of feeling in the affected leg
 Weakness in the affected leg
 Loss of bowel or bladder function

38. Tests
 During the physical exam, your PT may check your
muscle strength and reflexes.
 For example, you may be asked to walk on your
toes or heels, rise from a squatting position and,
while lying on your back, lift your legs one at a time
straight in the air. Pain that results from sciatica will
usually become worse during these activities.

40. Investigations
 X-ray. An X-ray of your spine may reveal an
overgrowth of bone (bone spur) that may be
pressing on a nerve.
 Magnetic resonance imaging (MRI). MRI
produces detailed images of bone and soft tissues
such as herniated disks

42. Management
Medical :
 The types of drugs that might be prescribed for
sciatica pain include:
 Anti-inflammatories
 Muscle relaxants
 Narcotics
 Tricyclic antidepressants
 Anti-seizure medications

43. Physical Therapy
 Once your acute pain improves, your physical
therapist can design a rehabilitation program to help
you prevent recurrent injuries.
 This typically includes exercises to help correct your
posture, strengthen the muscles supporting your
back and improve your flexibility.
 To reduce compression – Traction
 To reduce pain – Ultrasound therapy & TENS or IFT

47. AlternativeMedicine
 Acupuncture. In acupuncture, the practitioner
inserts hair-thin needles into your skin at specific
points on your body. Some studies have suggested
that acupuncture can help back pain, while others
have found no benefit.
 Chiropractic. Spinal adjustment (manipulation) is
one form of therapy chiropractors use to treat
restricted spinal mobility. The goal is to restore
spinal movement and, as a result, improve function
and decrease pain. Spinal manipulation appears to
be as effective and safe as standard treatments for
low back pain

50. Surgery
 This option is usually reserved for times when the
compressed nerve causes significant weakness,
bowel or bladder incontinence or when you have
pain that progressively worsens or doesn't improve
with other therapies.
 Surgeons can remove the bone spur or the portion
of the herniated disk that's pressing on the pinched
nerve.

51. Home Remedy
 Cold packs. Initially, you may get relief from a cold
pack placed on the painful area for up 20 minutes
several times a day. Use an ice pack or a package
of frozen peas wrapped in a clean towel.
 Hot packs. After two to three days, apply heat to
the areas that hurt. Use hot packs, a heat lamp or a
heating pad on the lowest setting. If you continue to
have pain, try alternating warm and cold packs.

52.  Stretching. Stretching exercises for your low back
can help you feel better and may help relieve nerve
root compression. Avoid jerking, bouncing or
twisting during the stretch and try to hold the stretch
at least 30 seconds.
 Over-the-counter medications. Pain relievers such
as ibuprofen (Advil, Motrin, others) and naproxen
(Aleve) are sometimes helpful for sciatica.

53. Prevention
 It's not always possible to prevent sciatica, and the
condition may recur. The following suggestions can
play a key role in protecting your back:
 Exercise regularly. This is the most important thing
you can do for your overall health as well as for your
back. Pay special attention to your core muscles —
the muscles in your abdomen and lower back that
are essential for proper posture and alignment.

55.  Maintain proper posture when you sit. Choose a
seat with good lower back support, arm rests and a
swivel base. Consider placing a pillow or rolled
towel in the small of your back to maintain its normal
curve. Keep your knees and hips level.
 Use good body mechanics. If you stand for long
periods, rest one foot on a stool or small box from
time to time. When you lift something heavy, let your
lower extremities do the work. Move straight up and
down. Keep your back straight and bend only at the
knees. Hold the load close to your body. Avoid lifting
and twisting simultaneously. Find a lifting partner if
the object is heavy or awkward.

58. TANKIEW 