Anatomy of the lateral femoral cutaneous nerve related to inguinal ligament, adjacent bony landmarks, and femoral artery
Porames DoklamyaiSithiporn AgthongVilai ChentanezThanasil HuanmanopChavarin AmarasePurich SurunchupakornPattarapol Yotnuengnit
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Abstract Lateral femoral cutaneous nerve (LFCN) generally emerges from the pelvis behind the inguinal ligament (IL) to the thigh. Because of its proximity to the anterior superior iliac spine (ASIS) and hip joint, the LFCN is prone to injuries during various procedures. Anatomy of this nerve is highly variable among studies. Moreover, measurement data regarding its branches including the differences between genders and sides are still lacking. This study was, therefore, done to clarify these issues. Eighty‐five thighs from 43 cadavers of both genders were dissected at the inguinal region. Distances from each branch of the LFCN to palpable landmarks: the ASIS, pubic tubercle (PT) and femoral artery (FA) were measured along the IL. Up to four branches of the LFCN were found; however, the single trunk was the most common form (>65%). The common site of this pattern on the IL was within 2 cm medial to the ASIS but could be present at over 6 cm. The distances in case of bifurcation were mostly comparable to those of the single trunk. In contrast, the values varied considerably in the cases with three or more branches (three cases). Regarding side and gender, asymmetry in the branching pattern was found in one fourth of specimens. However, only some minor differences between genders or sides in the measurement data were seen. These findings suggest that asymmetry and multiple branches of the LFCN should be concerned. The measurement data are also useful for localizing the LFCN with higher accuracy. Clin. Anat. 21:769–774, 2008. © 2008 Wiley‐Liss, Inc.Keywords:
Inguinal ligament
Femoral nerve
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OBJECTIVE Meralgia paresthetica causes dysesthesias and burning in the anterolateral thigh. Surgical treatment includes nerve transection or decompression. Finding the nerve in surgery is very challenging. The author conducted a cadaveric study to better understand the variations in the anatomy of the lateral femoral cutaneous nerve (LFCN). METHODS Twenty embalmed cadavers were used for this study. The author studied the LFCN's relationship to different fascial planes, and the distance from the anterior superior iliac spine (ASIS). RESULTS A complete fascial canal was found to surround the nerve completely in all specimens. The canal starts at the inguinal ligament proximally and follows the nerve beyond its terminal branches. The nerve could be anywhere from 6.5 cm medial to the ASIS to 6 cm lateral to the ASIS. In the latter case, the nerve may lodge in a groove in the iliac crest. Other anatomical variations found were the LFCN arising from the femoral nerve, and a duplicated nerve. A thick nerve was found in 1 case in which it was riding over the ASIS. CONCLUSIONS The variability in the course of the LFCN can create difficulty in surgical exposure. The newly defined LFCN canal renders exposure even more challenging. This calls for high-resolution pre- or intraoperative imaging for better localization of the nerve.
Inguinal ligament
Femoral nerve
Iliac crest
Inguinal canal
Cadaveric spasm
Reinnervation
Femoral canal
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The site for needle insertion in femoral nerve block varies significantly among various descriptions of the technique. To determine the site with the highest likelihood of needle-femoral nerve contact, femoral nerve block was simulated in a human cadaver model (17 femoral triangles from 9 adult cadavers). Four 20-gauge 50-mm-long styletted catheters were inserted at four frequently suggested insertion sites for femoral nerve block. At the levels of inguinal ligament and the inguinal crease, the catheters were inserted adjacent to the lateral border of the femoral artery and 2 cm lateral to the femoral artery. During anatomical dissection, we studied the number of catheter-nerve contacts for each of the four insertion sites, and relationships between the femoral nerve and other anatomical structures of relevance to femoral nerve block. Insertion of the needle at the level of the inguinal crease, next to the lateral border of the femoral artery resulted in the highest frequency of needle-femoral nerve contacts (71%). Of note, the femoral nerve was significantly wider (14.0 vs 9.8 mm) and closer to the fascia lata (6.8 vs 26.4 mm) at the inguinal crease than at the inguinal ligament level. We conclude that needle insertion at the inguinal crease level immediately adjacent to the femoral artery produced the highest rate of needle-femoral nerve contacts. The main factors influencing this result include the greater width of the femoral nerve and the more predictable femoral artery-femoral nerve relationship at the inguinal crease level, compared with the inguinal ligament level. Implications Insertion of a needle at the inguinal crease level and immediately adjacent to the lateral border of the femoral artery results in a high rate of needle-femoral nerve contact.
Inguinal ligament
Femoral nerve
Obturator nerve
Femoral vein
Femoral nerve block
Femoral canal
Inguinal canal
Saphenous nerve
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Lateral femoral cutaneous nerve innervates the skin of lateral thigh. Entrapment of the nerve as it exits under the inguinal ligament is an important cause of neuropathic pain in the lateral thigh (meralgia paresthetica) and must be distinguished from other causes of chronic lateral thigh/hip pain. This chapter discusses anatomy, nerve block techniques, indications, contraindications and complications of nerve block.
Inguinal ligament
Femoral nerve
Hip pain
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The site for needle insertion in femoral nerve block varies significantly among various descriptions of the technique. To determine the site with the highest likelihood of needle-femoral nerve contact, femoral nerve block was simulated in a human cadaver model (17 femoral triangles from 9 adult cadavers). Four 20-gauge 50-mm-long styletted catheters were inserted at four frequently suggested insertion sites for femoral nerve block. At the levels of inguinal ligament and the inguinal crease, the catheters were inserted adjacent to the lateral border of the femoral artery and 2 cm lateral to the femoral artery. During anatomical dissection, we studied the number of catheter-nerve contacts for each of the four insertion sites, and relationships between the femoral nerve and other anatomical structures of relevance to femoral nerve block. Insertion of the needle at the level of the inguinal crease, next to the lateral border of the femoral artery resulted in the highest frequency of needle-femoral nerve contacts (71%). Of note, the femoral nerve was significantly wider (14.0 vs 9.8 mm) and closer to the fascia lata (6.8 vs 26.4 mm) at the inguinal crease than at the inguinal ligament level. We conclude that needle insertion at the inguinal crease level immediately adjacent to the femoral artery produced the highest rate of needle-femoral nerve contacts. The main factors influencing this result include the greater width of the femoral nerve and the more predictable femoral artery-femoral nerve relationship at the inguinal crease level, compared with the inguinal ligament level. Implications Insertion of a needle at the inguinal crease level and immediately adjacent to the lateral border of the femoral artery results in a high rate of needle-femoral nerve contact.
Inguinal ligament
Femoral nerve
Obturator nerve
Femoral vein
Femoral nerve block
Saphenous nerve
Femoral canal
Inguinal canal
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Small branches of the femoral artery in the femoral triangle are not palpable and could increase the risk of intravascular injection during femoral nerve (FN) block. I evaluated the position of the lateral circumflex femoral artery (LCFA), a lateral branch of the femoral artery, in relationship to accepted landmarks for FN blockade, including the inguinal ligament, inguinal crease, and FA. Forty cadaver lower extremities were dissected. In 50% of specimens, the LCFA, as it crossed the FN, was within 1 cm of the inguinal crease, the recommended level for needle insertion for FN blockade. The mean depth of this artery at the inguinal crease was 1.7 cm, whereas the mean depth of the FN was 1.1 cm at this level. In most specimens, the LCFA coursed between the branches of the FN, although it sometimes lay deep to all of the branches. Knowledge of this anatomy may allow for safer FN blockade.
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Circumflex
Deep Femoral Artery
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A recent spurt in incidence of meralgia paresthetica to 0.1-81% due to minimally invasive anterior approach to hip joint has resulted in reinterest in anatomy of lateral femoral cutaneous nerve (LFCN). Familiarity with variations in the course of LFCN will reduce the morbidity associated with orthopedic procedures around the anterior superior iliac spine (ASIS) and inguinal ligament (IL).Twenty five adult human formalin embalmed cadavers were dissected. Course and relations of nerve to ASIS, IL and sartorius muscle was noted, distance of nerve from ASIS at IL was measured and statistically analyzed.Mean distance of LFCN from ASIS at IL was 1.73±1.15 cm. Differences between two sides and sexes was statistically not significant (p=0.51 and p=0.96 respectively). Inferomedial to ASIS, 94% of LFCNs crossed IL with 92% of them present within 4 cm medial to ASIS. Majority of LFCNs (90%) exited pelvis and entered thigh posterior to IL. Out of these nerves 48% were single trunks on entry into thigh, then bifurcated into anterior and posterior branches. Remaining LFCNs bifurcated proximal to IL or at level of IL. Trifurcations were seen in 6% while a rare case of pentafication was observed. In 66% main trunk/branches were present in intermuscular cleft between sartorius muscle and tensor fascia lata.Care should be exercised by surgeons while dissecting around IL as more than half of nerves are liable to be injured during operative procedures. This would help in better anticipation of problem, acceptance and reducing litigation.Kalça eklemine minimal invaziv anterior yaklaşıma bağlı olarak meraljia parestetika insidansının %0,1-81’e yükselmesi, lateral femoral kutanöz sinir (LFCN) anatomisine yeniden ilgi duyulmasına neden olmuştur. LFCN seyrindeki varyasyonların daha iyi anlaşılmasıyla, anterior superior iliak spine (ASIS) ve inguinal ligaman (IL) çevresinde uygulanan ortopedik prosedürlerle ilişkili morbidite azalacaktır.Formalinle mumyalanmış yirmi beş yetişkin insan kadavrası parçalara ayrıldı. Sinirin ASIS, IL ve sartorius kası ile seyri ve ilişkileri not edildi, IL’de sinirin ASIS’e olan mesafesi ölçüldü ve istatistiksel olarak analiz edildi.IL’de LFCN’nin ASIS’e ortalama mesafesi 1,73±1,15 cm idi. İki taraf ve cinsiyetler arasındaki farklar istatistiksel olarak anlamlı değildi (sırasıyla p değeri =0,51 ve p değeri =0,96) ASIS’nin inferomedialinde, LFCN’lerin %94’ü IL’yi geçiyordu ve bunların %92’si ASIS’in 4 cm medialinde idi. LFCN’lerin çoğunluğu (%90) pelvisten çıkıyordu ve IL’nin arkasından uyluğa giriyordu. Bu sinirlerin %48’i uyluğa girişte tek gövde halindeydi ve daha sonra ön ve arka dallara ayrılıyordu. Geriye kalan LFCN’ler IL’ye yakın veya IL düzeyinde çatallanmıştı. %6 oranında trifürkasyon görülürken nadir görülen bir pentafikasyon olgusu da gözlendi. Sartorius kası ile tensör fasya lata arasındaki intermusküler yarıkta %66 ana gövde/dallar mevcuttu.Ameliyat prosedürleri sırasında sinirlerin yarısından fazlasının yaralanması muhtemel olduğundan, IL çevresinde diseksiyon yaparken cerrahlar tarafından dikkatli olunmalıdır. Bu şekilde, sorunun daha iyi öngörülmesi, kabul edilmesi ve hukuksal davaların azaltılması sağlanabilir.
Fascia lata
Inguinal ligament
Femoral nerve
Cadaveric spasm
Obturator nerve
Iliopsoas
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Compression of the lateral femoral cutaneous nerve (LFCN), known as meralgia paresthetica (MP), is common. We investigated the topographic anatomy of the LFCN focusing on the inguinal ligament and adjacent structures.Distances from various bony and soft-tissue landmarks to the LFCN were investigated in 33 formalin-embalmed cadavers.The mean distance from the anterior superior iliac spine (ASIS) to the LFCN was 8.8 mm. In approximately 90% of cases, the LFCN lay <2 cm from the medial tip of the ASIS, whereas, in 76% of cases, it was <1 cm away. The mean angle between the inguinal ligament and LFCN was 83.3°.We determined the variability of the location of the LFCN at the boundary between the pelvic and femoral portions. The reported results will be helpful for diagnosis and treatment of MP. Muscle Nerve 55: 646-650, 2017.
Inguinal ligament
Femoral nerve
Obturator nerve
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Inguinal ligament
Lumbar plexus
Femoral nerve
Lumbosacral plexus
Sartorius muscle
Obturator nerve
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Anatomical variations of the nerves derived from the lumbar plexus are common and clinically valid. Therefore, this report aims to present the coexisting anatomical variations of the lateral femoral cutaneous and genitofemoral nerves. During routine dissection of an isolated male left lower limb (fixed in 10 % formalin solution), atypical arrangements of the lateral femoral cutaneous and genitofemoral nerves were found. The lateral femoral cutaneous nerve division level into anterior and posterior branches was high, above the inguinal ligament. Both branches passed beneath the inguinal ligament at the midpoint of the distance between the anterior superior iliac spine and the femoral artery. The anterior branch of the lateral femoral cutaneous nerve was better developed and had a greater diameter than the posterior branch. The femoral branch of the genitofemoral nerve was absent and partially replaced by the most medial branch derived from the anterior division of the lateral femoral cutaneous nerve. The lateral femoral cutaneous and genitofemoral nerves can show anatomic variability, which should be remembered during clinical assessments of nerve lesions and while performing surgical interventions.
Inguinal ligament
Femoral nerve
Lumbar plexus
Cutaneous nerve
Saphenous nerve
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Femoral nerve
Inguinal canal
Entrapment
Itching
Entrapment Neuropathy
Hip pain
Cutaneous nerve
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