Lower Limb
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
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.
Complications in Gynecologic Surgery
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
The pudendal nerve (S2–S4) exits the pelvis via the infra-piriform or greater sciatic foramen, runs behind the lateral third of the sacrospinous ligament, and reenters the pelvis through the lesser sciatic foramen. Damage to the pudendal nerve can occur during vaginal surgery, especially during sacrospinous ligament fixation for vaginal vault prolapse.3 A suture placed through the sacrospinous ligament can quite easily incorporate the pudendal nerve as well. It has also been reported following a transobturator inside-out tension-free tape procedure.6 The incorporation of the pudendal nerve in a suture or placement of a transobturator tape more caudally than recommended can result in pudendal neuralgia, which presents as gluteal/perineal pain or paresthesia. The suture or tape may need to be removed in order to obtain relief of symptoms.
General Surgery
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh in 300 Essentials SBAs in Surgery, 2017
A sciatic hernia passes through: The lesser sciatic foramenThe greater sciatic foramenThe obturator canalThe arcuate line into the lateral border of the posterior rectus sheathThe inferior lumbar triangle
Clinical effect of computed guided pudendal nerve block for patients with premature ejaculation: a pilot study
Published in Scandinavian Journal of Urology, 2020
Fouad Aoun, Georges Mjaess, Joseph Assaf, Anthony Kallas Chemaly, Tonine Younan, Simone Albisinni, Fabienne Absil, Thierry Roumeguère, Renaud Bollens
Anatomically, the pudendal nerve is a branch of the sacral plexus [19–21]. It emerges from the S2, S3 and S4 roots, then departs the pelvis from the greater sciatic foramen along with the sciatic roots, between the sacrospinal and the sacrotuberous ligament, and re-enters the pelvis via the lesser sciatic foramen [19–21]. At this level, it releases a superior hemorroidal branch and then cruises through a duplication of the obturator muscle’s fascia called ‘Alcock’s canal’. The pudendal nerve gives rise at the exit of Alcock’s canal to three main branches which are the inferior rectal branch, the perineal branch and the dorsal sensory nerve of the penis or clitoris [19–21]. The pudendal nerve entrapment consists of a compression of this nerve especially between sacrospinous and sacrotuberous ligaments (which constitutes the most common level of entrapment) or in Alcock’s canal [19–21].
Related Knowledge Centers
- Internal Pudendal Artery
- Ischial Spine
- Obturator Internus Muscle
- Pudendal Nerve
- Sacrotuberous Ligament
- Pelvis
- Sacrum
- Ischial Tuberosity
- Sacrospinous Ligament
- Lesser Sciatic Notch