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SACRAL PLEXUS

SACRAL PLEXUS

Sacral plexus (L4-S4) – forms anterior to piriformis muscle.

Lies immediately inferior to the lumbar plexus.

Formed by the ventral (anterior) rami of spinal nerves L4, L5, and S1 through S4.

STRUCTURE:

Formed from ventral rami of L4-S4; Contribution of L4-L5 is from Lumbosacral trunk.

The nerves forming the sacral plexus converge towards the lower part of the greater sciatic foramen and unite to form a flattened band.

The branches of the sacral plexus arise from anterior and posterior surfaces of this flattened band.

Branches innervating the pelvis and perineum remain in the pelvis.

Branches innervating the lower limb exit through greater sciatic foramen.

BRANCHES OF THE SACRAL PLEXUS

6 Branches Prior to Division of Sacral Roots

(Mnemonic: All of these start with the letter “P”)

1. S1,S2: Nerve to Piriformis

2. S2, S3: Perforating cutaneous nerve – to medial part of buttock

3. S1,S2,S3: Posterior femoral cutaenous nerve – To buttock and uppermost medial and posterior surfaces of thigh

4. S2,S3,S4: Pudendal nerve – leaves the pelvis through greater sciatic foramen but re-enters through lesser sciatic foramen and enters the pudendal or alcock’s canal (a fascial canal formed by splitting of obturator fascia on lateral wall of ischiorectal fossa).

Inferior rectal nerve: Perianal skin and External anal sphincter

Dorsal nerve of penis or clitoris: Accompanies dorsal artery of penis and clitoris and supplies skin of penis or clitoris and labia majora.

Perineal nerve: Superficial and Deep perineal muscles and External urethral sphincter

Parasympathetic pelvic splanchnic nerves (nervi erigentes) – Ascend to join inferior hypogastric plexus and together supply pelvic viscera.

5. S4: Perineal branch of Pudendal nerve

Sacral plexus, Nervi erigentes (S2,3,4) & pudenal nerve are involved in process of erection of penis.

	Anterior Division	Posterior Division
L4-S1	Nerve to Quadratus femoris and Inferior gemellus	Superior gluteal nerve Gluteus minimus Gluteus medius Tensor fascia lata
L5-S2	Nerve to Obturator internus and Superior gemellus	Inferior gluteal nerve Gluteus maximus
L4-S2 (All except S3 and S4)		Common peroneal (fibular) portion of Sciatic nerve Leaves popliteal fossa and turns around the lateral aspect of neck of fibula (dangerous position) and divides into superficial peroneal and deep peroneal (anterior tibial) nerve. Superficial peroneal nerve supplies lateral compartment of leg. – Peroneal muscules Deep peroneal nerve supplies anterior compartment of leg. – Anterior tibialis – Toe extensors
L4-S3 (All except S4)	Tibial portion of sciatic nerve Descends through popliteal fossa to the posterior compartment of leg. – Popliteus – Ankle plantar flexors – Tibialis posterior Passes behind medial malleolus (deep to flexor retinaculum) to reach sole of foot through medial and lateral plantar nerves. – Foot intrinsic muscles – Toe flexors

Nerve	Spinal Components	Innervation
Superior gluteal	L4, L5, S1	Abductor muscles of thigh (gluteus minimus, gluteus medius, tensor fasciae latae)
Inferior gluteal	L5-52	Extensor muscle of hip joint (gluteus maximus)
Nerve to piriformis	S1, 52	Abductor and rotator of thigh (piriformis)
Nerve to quadratus lemon’s	L4, L5, S1	Rotators of thigh (gemellus inferior, quadratus femoris)
Nerve to internal obturator	L5-S2	Rotators of thigh (gemellus superior, internal obturator)
Perforating cutaneous	S2, S3	Skin over lower medial surface of buttock
Posterior cutaneous femoral	S1 -S3	Skin over lower lateral surface of buttock, anal region, upper posterior surface of thigh, upper aspect of calf, scrotum in male and labia majora in female
Sciatic	L4-S3	Composed of two nerves (tibial and common fibular); splits into two portions at popliteal fossa; “hamstring muscles” (biceps femoris, semitendinosus, semimembranosus) and adductor magnus muscle
Sacral muscular	S4	Levator ani, External anal sphincter
Sacral visceral	S2-S4	Pelvic splanchnic nerve
Pudendal( sensory & motor)	S2-S4	Skin of penis and scrotum in male and skin of clitoris, labia majora, labia minora, and lower vagina in female; muscles of perineum, anal canal

Exam Important

Nerves passing through lesser sciatic foramen are obturator internus & pudenal nerve

Superior gluteal nerve supplies Gluteus medius, Gluteus minimus & Tensor fasia lata

Pudendal nerve supplying motor part to external sphincter is derived from S2-S4 roots

Gluteus medius is supplied by superior gluteal nerve

Pudenal nerve is both sensory and motor

Sacral plexus, Nervi erigentes (S2,3,4) & pudenal nerve are involved in process of erection of penis

Pudendal nerve leaves pelvis and enters gluteal region through greater sciatic foramen

Pudendal nerve leaves the gluteal region by passing through the lesser sciatic foramen and enters the pudendal canal

Anal canal Supplied by pudendal nerve

Ischial spine is related to pudenal nerve

Structures passing through lesser sciatic foramen:

Pudendal nerve( leaves gluteal region to enter pudenal canal) lies in relation to Ischial spine

Internal pudendal vessels

Nerve to obturator internus

Tendon of obturator internus

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SACRAL PLEXUS

SACRAL PLEXUS

STRUCTURE:

Exam Important

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SACRAL PLEXUS

STRUCTURE:

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