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Lower Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The skin of the gluteal region is innervated by the cluneal nerves: The inferior cluneal nerves are branches of the posterior femoral cutaneous nerve, while the superior cluneal nerves and middle cluneal nerves are branches of the dorsal rami (Plate 5.1b). Apart from these cutaneous nerves, there are two major nerves in the gluteal region that provide motor innervation to muscles: The superior gluteal nerve runs superior to the piriformis muscle and the inferior gluteal nerve runs inferior to this muscle (Plate 5.7). Also inferior to the piriformis runs—together with the sciatic nerve and the posterior femoral cutaneous nerve—the pudendal nerve. The pudendal nerve is peculiar because it emerges from the greater sciatic foramen, wraps around the sacrospinous ligament, and then turns medially again to pass through the lesser sciatic foramen to enter the perineum together with the internal pudendal artery. As an aside, the name “pudendal” derives from the Latin word “puta,” which refers to the “shameful” supply/drainage of the anal and genital tissues by these vessels and nerves. These classical human anatomists either had a major hang-up about their sexuality or a great sense of humor.
Vulvar and extragenital clinical sensory perception*
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Miranda A. Farage, Kenneth W. Miller, Denniz A. Zolnoun, William J. Ledger
Various sensory nerves innervate the vulva and perineum (Figure 6.1): the posterior femoral nerve innervates the latter aspect of the perineum posteriorly and the lateral margin of the vulva superiorly along the leg crease; the genitofemoral and ilioinguinal nerves (originating from L1–L2) innervate the mons pubis and upper labia majora, approximately to the level of the urethra; and the perineal branch of the pudendal nerve (from sacral roots S2–S4) is viewed by most clinicians as the primary source of vulvar innervation (lobes of the labia majora through the vestibule). A network of nerves over the dorsal aspect of the glans clitoris arises from the deeper pudendal nerve. Coverage of the vulva can also include the inferior cluneal nerve, which originates from S1–S3. The correlation between these anatomical details and the characteristics of vulvar sensation and pain is not well characterized, and mapping these relationships is an area of active research in our laboratories (2).
Diagnosis and treatment of pudendal and inferior cluneal nerve entrapment syndrome: a narrative review
Published in Acta Chirurgica Belgica, 2022
Katleen Jottard, Pierre Bonnet, Viviane Thill, Stephane Ploteau, Stefan de Wachter
The inferior cluneal nerve branches, which are purely sensitive, stem from the posterior femoral cutaneous nerve (PFCN), which is composed of fibers coming from the ventral branches of S1, S2 and S3 spinal nerves. The PFCN accompanies the sciatic nerve (SN), usually coursing medially or posteriorly to this nerve, while lying against the lateral aspect of the ischial tuberosity. The PFCN gives rise, medially, to the inferior cluneal nerves. They course below the inferior border of the gluteus maximus muscle and enter the skin of the buttocks. The number and course of the inferior cluneal nerves not only varies from one individual to another but also from one side to the other. via its numerous collateral branches, the posterior femoral cutaneous nerve innervates a very extensive area including the posterior surface of the thigh, the infragluteal fold, the skin over the ischial tuberosity, but also the lateral anal region, scrotum, or labium majus via its perineal branches. These perineal branches generally arise from the medial border of the posterior femoral cutaneous nerve, at the level of the inferior extremity of the ischial tuberosity and then courses subcutaneously over the origins of the hamstring muscles, transversely crossing over the tendons lateromedially [5,6].