Posterior Division Of The Sacral Plexus

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The posterior division of the sacral plexus consists of ventral rami from L4-S3, which form a network and give rise to the following six nerves:

Perforating cutaneous nerve (S2-S3). Pierces the sacro-tuberous ligament and travels to the inferior edge of the glu-teus maximus muscle, providing sensory innervation to the skin over the inferior aspect of the gluteus maximus (inferior gluteal fold).

Nerve to piriformis muscle (S1-S2). Travels directly from the plexus to the piriformis muscle, providing motor innervation without leaving the pelvic cavity.

Posterior femoral cutaneous nerve (S1-S3). Exits the pelvis via the greater sciatic foramen, inferior to the piriformis muscle. The posterior femoral cutaneous nerve receives half of its innervation levels (S1-S2) from the posterior division of the sacral plexus and the other half (S2-S3) from the anterior division.

Superior gluteal nerve (L4-S1). Exits the pelvis via the greater sciatic foramen and travels superior to the piriformis muscle and between the gluteus medius and minimus muscles, providing innervation to both muscles. The superior gluteal nerve continues anteriorly, providing motor innervation to the tensor fascia latae muscle.

Inferior gluteal nerve (L5-S2). Exits the pelvis via the greater sciatic foramen and travels inferior to the piriformis, providing motor innervation to the gluteus maximus muscle. Common fibular (peroneal) nerve (L4-S3). Is the smallest division of the sciatic nerve (half the size of the tibial nerve). The common fibular nerve exits the pelvis via the greater sciatic foramen to enter the gluteal region inferior to the piri-formis muscle. The nerve descends along the posterior aspect of the thigh, providing motor innervation to the short head of the biceps femoris muscle. The common fibular nerve descends to the popliteal fossa and curves laterally around the neck of the fibula to bifurcate into the superficial and deep fibular nerves, providing motor innervation to the lateral and anterior compartments of the leg, respectively. Furthermore, the superficial fibular nerve provides sensory innervation to the anterolateral region of the leg and the dorsum of the foot. The deep fibular nerve provides sensory innervation to a small area between digits 1 and 2. In addition, a branch from the common fibular nerve (lateral sural nerve) provides cutaneous innervation to the superior lateral leg.

VThe gluteal region is a common site for intermuscular injections. Specifically, the superior lateral portion of the gluteal region is the preferred site to avoid injuring structures such as the sciatic nerve. ▼

Lumbosacral trunk

Lumbosacral Plexus Foot

Subcostal n.

Iliohypogastric n. Ilioinguinal n.

— Genitofemoral n.

Lateral femoral cutaneous n.

Femoral n.

Obturator n.

-Superior gluteal n.

Common fibular n.

Tibial n.

Sciatic n.

Posterior femoral cutaneous n.

Pudendal n.

Coccygeal n.

55 Co1

55 Co1

Subcostal n.

Iliohypogastric n. Ilioinguinal n.

— Genitofemoral n.

Lateral femoral cutaneous n.

Femoral n.

Obturator n.

-Superior gluteal n.

Common fibular n.

Tibial n.

Sciatic n.

Posterior femoral cutaneous n.

Pudendal n.

Coccygeal n.

Lumbar plexus

Gluteus maximus m. (cut)

Pudendal n.-

Nerve to obturator — internus and superior gemellus mm.

Perforating cutaneous n. (piercing the sacrotuberous ligament)

Inferior rectal n.-

Posterior femoral cutaneous n.

Gluteus maximus m. (cut)

Nerve to obturator — internus and superior gemellus mm.

Tensor Fascia Lata Nerve

Tensor fascia lata m.

Gluteus minimus m.

Sciatic n.

Common fibular n. Tibial n.

Gluteus maximus m. (cut)

Figure 35-2: A. Schematic of the lumbosacral plexus. B. Neurovascular structures of the gluteal region.

Tensor fascia lata m.

Gluteus minimus m.

Inferior gluteal n.

Gluteus medius m. (cut)

Piriformis m.

Sciatic n.

Common fibular n. Tibial n.

Gluteus maximus m. (cut)

Figure 35-2: A. Schematic of the lumbosacral plexus. B. Neurovascular structures of the gluteal region.

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