Sacral plexus
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View Henry Knipe's current disclosuresAt the time the article was last revised Kajanan Nithiyananthan had no financial relationships to ineligible companies to disclose.
View Kajanan Nithiyananthan's current disclosures- Sacral nerve plexus
The sacral plexus is formed by anterior rami of L4 to S4 and its branches innervate the pelvis, perineum and lower limb.
Gross anatomy
The sacral plexus forms on the anterior belly of the piriformis muscle and is formed by the lumbosacral trunk (L4-5) of the lumbar plexus, which enters the pelvis coursing medially to psoas major and unites with the ventral rami of the S1 to S4 nerve roots, which emerge from the anterior foramina of the sacrum. It forms a triangular shape with an inferiorly pointing apex.
The are a total of twelve branches5. The anterior sacral rami give off six branches and then divide into the anterior and posterior divisions, which provide a further three branches each (see below).
Branches
Anterior rami
nerve to piriformis (S1-S2)
perforating cutaneous nerve (S2-S3)
pudendal nerve (S2-S4)
perineal branch (S4)
See: mnemonic.
Anterior division of anterior rami
nerve to quadratus femoris and inferior gemellus muscles (L4-S1)
nerve to internal obturator and superior gemellus muscles (L5-S2)
tibial portion (L4-S3) of the sciatic nerve (L4-S3)
See: mnemonic.
Posterior division of anterior rami
superior gluteal nerve (L4-S1)
inferior gluteal nerve (L5-S2)
common peroneal portion (L4-S2) of the sciatic nerve (L4-S3)
See: mnemonic.
Relations
-
medial
anterior sacral foramina
sympathetic trunk
-
posterior
piriformis
-
anterior
parietal pelvic fascia
lateral sacral arteries and veins
common iliac vessels on top of lumbrosacral trunk
internal iliac vessels
ureter (in front of internal iliac vessels) lies well anterior to upper part of plexus
Variant anatomy
common peroneal and tibial parts of the sciatic nerve fail to unite and course into the lower limb separately
additional caudal nerve root contribution to the sacral plexus 6
Quiz questions
References
- 1. Gierada DS, Erickson SJ, Haughton VM et-al. MR imaging of the sacral plexus: normal findings. AJR Am J Roentgenol. 1993;160 (5): 1059-65. doi:10.2214/ajr.160.5.8470576 - Pubmed citation
- 2. Gebarski KS, Gebarski SS, Glazer GM et-al. The lumbosacral plexus: anatomic-radiologic-pathologic correlation using CT. Radiographics. 1986;6 (3): 401-25. doi:10.1148/radiographics.6.3.2825251 - Pubmed citation
- 3. Lanzieri CF, Hilal SK. Computed tomography of the sacral plexus and sciatic nerve in the greater sciatic foramen. AJR Am J Roentgenol. 1984;143 (1): 165-8. doi:10.2214/ajr.143.1.165 - Pubmed citation
- 4. Naidich TP, Castillo M, Cha S et-al. Imaging of the Spine. Saunders. ISBN:1437715516. Read it at Google Books - Find it at Amazon
- 5. McMINN. Lasts Anatomy Regional and Applied. CHURCHILL LIVINGSTONE. (2003) ISBN:B0084AQDG8. Read it at Google Books - Find it at Amazon
- 6. Goldstein B. Anatomic issues related to cervical and lumbosacral radiculopathy. Phys Med Rehabil Clin N Am. 2003;13 (3): 423-37. Pubmed citation
- 7. https://www.youtube.com/watch?v=dAe7GL1YoSk
Incoming Links
- Nerve to internal obturator and superior gemellus
- Lateral sacral artery
- Nerve to piriformis
- Nerve to quadratus femoris and inferior gemellus
- Coccyx
- Parasympathetic pelvic splanchnic nerves
- Sacrum
- Inferior rectal nerve
- Malignant peripheral nerve sheath tumour
- Perforating cutaneous nerve
- Sacral plexus branches (mnemonic)
- Perineal nerve
- Lumbar plexus
- Pudendal nerve entrapment syndrome
- Sacral nerve plexus - anterior components (mnemonic)
- Posterior femoral cutaneous nerve
- Sacral nerve plexus - posterior components (mnemonic)
- Lumbar enlargement
- Pudendal nerve
- Cervical enlargement
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