The Liver (LR)
Narda G. Robinson in Interactive Medical Acupuncture Anatomy, 2016
Clinical Relevance: Sites of compression for the anterior division of the obturator nerve occur between pectineus and obturator externus muscles as well as between the adductor longus and brevis. The obturator nerve travels medial to the femoral nerve within the pelvis. Near to where the obturator nerve exits the pelvis through the obturator foramen, it divides into anterior and posterior branches. The anterior branch courses cranial to the obturator externus muscle while the posterior branch courses through it. The anterior division supplies motor innervation to the adductor longus, adductor brevis, pectineus, and gracilis muscles. It also sends sensory supply to the hip joint and medial thigh. The posterior branch supplies the adductor brevis, the adductor magnus, and the obturator externus. It provides sensation to the knee joint as well. Causes of obturator neuropathy include pelvic and acetabular fractures, post-traumatic hematoma, pelvic tumors, obturator hernia, myositis ossificans, penetrating or surgical trauma, and nerve compression by fibrous brands secondary to chronic adductor tendinopathy with osteitis pubis, more common in athletes.
Practice Paper 4: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
The saphenous nerve can be damaged during surgery on the long saphenous vein, particularly when the vein is stripped below the knee, resulting in loss of sensation to the medial aspect of the calf. The sural nerve is a cutaneous sensory branch of the tibial nerve, and can be damaged during surgery on the short saphenous vein. Lesions of the sural nerve result in a loss of sensation to the lateral side of the foot and little toe. The obturator nerve can be damaged in obstetric procedures and pelvic disease. Features of obturator nerve palsy include loss of hip adduction and loss of sensation to the upper inner thigh. Superior gluteal nerve lesions result in loss of hip abduction and a pelvic dip on walking (Trendelenburg gait). Inferior gluteal nerve lesions lead to loss of hip extension and to buttock wasting.
Complications in Gynecologic Surgery
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Obturator nerve injuries are seen most frequently following extensive retroperitoneal dissections, particularly those done for endometriosis or pelvic malignancy. Symptoms include sensory loss in the upper medial thigh and motor weakness in the hip abductors.2 The likelihood of nerve injury can be reduced by retracting the external iliac vessels to maximize exposure of the obturator space. If transection of the obturator nerve is noted intraoperatively, it should be repaired with micro-surgical techniques.2 Obturator nerve injuries respond well to postoperative physical therapy, and complete recovery is common.
Contralateral obturator nerve transfer for femoral nerve restoration: a case report
Published in British Journal of Neurosurgery, 2021
Yu Cao, Yuehong Li, Youlai Zhang, Shulin Li, Junjian Jiang, Yudong Gu, Lei Xu
Various procedures have been reported for the reconstruction of femoral nerve function, including sural nerve graft and obturator nerve transfer at different levels, and most cases have resulted in satisfactory outcomes. The best outcome of obturator transfer was reported in a case of obturator anterior branch transfer combined with tensor fasciae later branch in the thigh, which received a 4+ Medical Research Council Grade and total normal running and climbing stair function after 3 years of follow-up.1 However, an unrepaired branch of quadriceps also gained recovery during electrophysiological follow-up and we suspect that spontaneous recovery may have contributed to the outcome. This procedure has already been widely accepted and has generated good outcomes in follow-up studies. Based on previous literature as well as our experience, we were confident that the obturator nerve could offer sufficient fibers for some restoration of femoral function.2–4
Long-standing groin pain in an elite athlete: usefulness of ultrasound in differential diagnosis and patient education – a case report
Published in European Journal of Physiotherapy, 2018
Kingsley S. R. Dhinakar, Anjanette Cantoria Lacaste
The radiation of pain on the inner thigh along the distribution of obturator nerve may also suggest injury of neurogenic in origin. This can be supported by the reduced muscle activity of left hip adductors on surface EMG findings and physical assessments. The nature of sport participated by the patient and the repetitive stresses placed on the above structures may have contributed to tendinitis. The anterior branch of the obturator nerve can be potentially entrapped by fascia as it traverses the adductor brevis muscle. This may have started as pain of an inflammatory nature and gradually developed to consistent exercise-related pain. Hip adductor-related groin pain may have developed that can potentially lead to fibrosis and adhesion resulting to nerve entrapment.
Successful restoration of knee extension after transferring of the anterior branch of the obturator nerve: a case study
Published in International Journal of Neuroscience, 2022
Mohammadreza Emamhadi, Iraj Aghaei, Sama Noroozi Guilandehi, Roxana Emamhadi, Mohammad Shabani
In supine position, the femoral nerve was exposed with a longitudinal incision lateral to the palpable femoral artery pulse. The rectus femoris and vastus medialis motor branch of the femoral nerve were identified as recipient nerves and then sectioned. The anterior branch of the obturator nerve was identified with a second longitudinal incision that was made in the proximal medial of the thigh (Supplementary material Video 1). Intraoperative nerve stimulation of this donor nerve demonstrated good contraction and then the nerve was cut and transposed subcutaneously to the femoral nerve. End-to-end neurorrhaphy was performed between the donor and recipient branches using 8-0 monofilament sutures under magnification (Figure 1).
Related Knowledge Centers
- Common Iliac Artery
- Internal Iliac Artery
- Lumbar Nerves
- Lumbar Plexus
- Obturator Foramen
- Pelvic Brim
- Psoas Major Muscle
- Pelvic Cavity
- Body
- Spinal Nerve Root