A multiply split femoral nerve and psoas quartus muscle

Wong, T. L.; Kikuta, Shogo; Iwanaga, Joe; Tubbs, R. Shane

doi:10.5115/acb.2019.52.2.208

Cited by 12 publications

(9 citation statements)

References 13 publications

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“…Variations of the femoral nerve pierced by muscular slips from the iliacus or the psoas major in the iliac fossa have also been commented on [ 4 ]. Wong et al [ 5 ] identified multi-split femoral nerve by a variant psoas quartus muscle. However, no cases of femoral nerve split and reunification in the femoral triangle have been reported before, to the best of our knowledge.…”

Section: Discussionmentioning

confidence: 99%

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The ascending branch of the lateral circumflex femoral artery penetrating the posterior division of the femoral nerve

2021

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Understanding anatomic variations in neurovascular structure inside the femoral triangle is crucial for regional anesthesiologists performing femoral nerve block. During routine dissection of a cadaver, an ascending branch of the lateral circumflex femoral artery with an anomalous course passing through the femoral nerve, specifically the posterior division, was identified inside the femoral triangle on the left thigh. The novel variation identified in this study occurred in an early stage of prenatal development. Recognition of this anatomic variation will be helpful for reducing unexpected complications during the femoral nerve block and the tensor fascia latae flap. Penetration of the posterior division of the femoral nerve by the arterial branch might cause pain or paresthesia of the medial aspect of the leg in the distribution of the saphenous nerve.

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Section: Discussionmentioning

confidence: 99%

“…The hind-limb buds are formed in the fifth week of gestation and, during this period, muscles bring associated nerves from the torso into the limb buds [ 5 ]. This is also true in the case of the femoral nerve.…”

Section: Discussionmentioning

confidence: 99%

The ascending branch of the lateral circumflex femoral artery penetrating the posterior division of the femoral nerve

2021

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“…Jelev et al (2005) reportaron un caso de división (split) bilateral del NF encon- trada en la pelvis de una mujer, junto con la variación en su trayecto. Por otro lado, se han descrito variantes anatómicas del músculo iliopsoas (Jelev et al;Tubbs et al, 2006;Wong et al). Clarkson & Rainy (1889) descubrieron una subdivisión inusual del músculo psoas mayor en cuatro fascículos musculares a cada lado durante la disección de un cadáver adulto de sexo masculino y de mediana edad (Clarkson & Rainy).…”

Section: Discussionunclassified

“…El músculo psoas mayor se origina en cara anterolateral del cuerpo de las vértebras T12 a L5, en los discos intervertebrales relacionados y en los procesos transversos de las vértebras lumbares, entre otros lugares, pasa por posterior al ligamento inguinal junto con el músculo ilíaco y se inserta en el trocánter menor del fémur. El NF es una de las ramas más grandes del plexo lumbar y surge de las divisiones dorsales de los ramos ventrales de los nervios espinales L2-L4 (Ashwini et al, 2017;Alveal-Mellado et al, 2019) y ocasionalmente, la rama ventral de L1 y/o L5 contribuye a la formación del NF (Wong et al, 2019). EL NF desciende en relación con el margen lateral del músculo psoas y luego se dispone en el hiato entre este y el músculo ilíaco; contenido en la laguna muscular, aborda el compartimiento anterior del muslo para inervar los músculos del compartimiento y la piel de la zona anterior del muslo, llegando a la parte distal de la pierna e incluso el pie, a través del nervio safeno (Ashwini et al).…”

Section: Introductionunclassified

Split Unilateral del Nervio Femoral a Nivel del Músculo Psoas Mayor: Reporte de Caso

2021

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RESUMEN:El nervio femoral (NF) es el mayor o ramo del plexo lumbar. Normalmente se origina de las divisiones posteriores del segundo al cuarto ramo anterior del plexo lumbar (L2-L4). El músculo psoas mayor tiene su origen a nivel de las vértebras T12 a L5, se fusiona con el músculo ilíaco para luego insertarse en el trocánter menor del fémur. Normalmente, a nivel de la pelvis menor el NF se encuentra entre los músculos ilíaco y psoas mayor. En este trabajo presentamos un caso donde el músculo psoas mayor se relaciona con divisiones o split del NF, esta es una rara variación en la división y curso del NF con relación al músculo psoas mayor. Se observó que el NF se dividía en dos ramos por sobre el plano del ligamento inguinal después de su origen en el plexo lumbar. El NF del lado izquierdo se formó por las ramas ventrales de L2 a L4, a nivel de L5 el nervio es perforado por fascículos del músculo psoas mayor. La división inferior del NF pasaba profundamente a las fibras del músculo iliopsoas y la división superior pasaba superficialmente al músculo psoas mayor y profundo a la fascia ilíaca. Después de un trayecto de 60,21 mm ambas divisiones se unieron, después de atrapar fibras músculo iliopsoas justo inmediatamente proximal al ligamento inguinal para formar el tronco del NF. Si bien las causas embriológicas de las variaciones de los nervios periféricos se remontan a la quinta y sexta semana de vida intrauterina, la expresión clínica de disfunciones neuromusculares aparecerá varios decenios después. De modo que los médicos de las áreas de la traumatología y neurología deben estar al tanto de tales variantes anatómicas para entender mejor el dolor y los síndromes asociados a la compresión nerviosa y durante las maniobras quirúrgicas en esta región.

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“…Finally, the proximal division of the femoral cutaneous nerve could generate compression under the inguinal ligament. Seven studies [52][53][54][55][56][57]60,63] analyzed the compression of the FN, which was compressed in the following regions: entrapment by the accessory belly of the iliacus muscle occurs where the NF divides into two branches, one that goes over the accessory iliacus muscle and another that passes between the iliacus muscle and the accessory belly, the latter being where the nerve will have possible compression; another variation that can generate compression of the NF is where the iliacus muscle covers the NF, or where the nerve pierces the iliacus muscle; and finally, there is a critical fibromuscular ring between the inguinal ligament and the lateral part of the iliopsoas muscle, but some accessory bellies of the greater psoas muscle can compress the FN. For the compression of the ON, four studies were included [65][66][67][68], one in which compression was produced by a surgical complication due to vaginal tape for the treatment of urinary incontinence, which intra-surgically produced an iatrogenic compression of the ON, leaving the patient with symptoms in the nerve innervation territory.…”

Section: Thigh Region Variantsmentioning

confidence: 99%

The Association between Anatomical Variants of Musculoskeletal Structures and Nerve Compressions of the Lower Limb: A Systematic Review and Meta-Analysis

Valenzuela-Fuenzalida,

Inostroza-Wegner,

Osorio-Muñoz

et al. 2024

Diagnostics

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Objective: The aim of this study was to describe the main anatomical variants and morphofunctional alterations in the lower limb that compress surrounding nervous structures in the gluteal region, thigh region, and leg and foot region. Methods: We searched the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to October 2023. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality, and the Joanna Briggs Institute assessment tool for case reports was also used. Forest plots were generated to assess the prevalence of variants of the gluteal region, thigh, and leg. Results: According to the forest plot of the gluteal region, the prevalence was 0.18 (0.14–0.23), with a heterogeneity of 93.52%. For the thigh region, the forest plot presented a prevalence of 0.10 (0.03–0.17) and a heterogeneity of 91.18%. The forest plot of the leg region was based on seven studies, which presented a prevalence of 0.01 (0.01–0.01) and a heterogeneity of 96.18%. Conclusions: This review and meta-analysis showed that, in studies that analyzed nerve compressions, the prevalence was low in the thigh and leg regions, while in the gluteal region, it was slightly higher. This is mainly due to the PM region and its different variants. We believe that it is important to analyze all the variant regions defined in this study and that surgeons treating the lower limb should be attentive to these possible scenarios so that they can anticipate possible surgical situations and thus avoid surgical complications.

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A multiply split femoral nerve and psoas quartus muscle

Cited by 12 publications

References 13 publications

The ascending branch of the lateral circumflex femoral artery penetrating the posterior division of the femoral nerve

The ascending branch of the lateral circumflex femoral artery penetrating the posterior division of the femoral nerve

Split Unilateral del Nervio Femoral a Nivel del Músculo Psoas Mayor: Reporte de Caso

The Association between Anatomical Variants of Musculoskeletal Structures and Nerve Compressions of the Lower Limb: A Systematic Review and Meta-Analysis

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