Nerve Entrapment Syndromes
Painful conditions affecting the innervation of the groin (ilioinguinal, iliohypogastric genitofemoral, lateral femoral cutaneous, and obturator nerves) are frequent and often follow surgical interventions on the inguinal region. Although referred to in g
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Giancarlo Barolat
17.1 Anatomy The main nerves innervating the inguinal/groin region include the ilioinguinal, iliohypogastric, genitofemoral, and obturator nerves. Globally they can be referred to as the “inguinal nerves.”
17.1.1 Ilioinguinal and Iliohypogastric Nerve The ilioinguinal and iliohypogastric nerves sometime arise as a common trunk and, in their course, usually separate between the transversus and internal oblique muscles. Iliohypogastric nerve. The iliohypogastric nerve arises primarily from the ventral primary rami of L1 and occasionally with a twig from T12. This nerve has a pathway similar to that of the intercostal nerves in the thoracic region. The iliohypogastric nerve traverses the psoas major muscle, piercing the lateral border of the muscle anterior to the quadratus lumborum muscle and posterior to the kidney to traverse the lateral abdominal wall. Superomedial to the anterior superior iliac spine, the iliohypogastric and ilioinguinal nerves pierce the transversus abdominis
G. Barolat, M.D. Barolat Neuroscience, Presbyterian/St. Lukes Medical Center, Denver, CO, USA e-mail: [email protected]
to lie between it and the internal oblique muscles. After traveling a short distance inferomedially, their ventral rami pierce the internal oblique to lie between the internal and external oblique muscles before giving off branches, which pierce the external oblique to provide cutaneous sensation. The iliohypogastric nerve supplies the skin over the inguinal region as well as a small region just superior to the pubis. Ilioinguinal nerve. The ilioinguinal nerves emanate from the first lumbar spinal root. In one study of 200 human bodies, the ilioinguinal nerve arose from the lumbar plexus in 72.5% and by a common trunk with the iliohypogastric nerve in 25%; it was absent in 2.5% (Fig. 17.1). The ilioinguinal nerve was formed from one root in 92.5% and from two roots in about 5% of cases. In 86%, the ilioinguinal carried fibers from one spinal nerve (primarily from L1) and, in 11%, from two spinal nerves (T12, L1; L1, L2; or L2, L3) [1]. Within the inguinal canal, the nerve usually lies ventral to the spermatic cord (60% of cases), but it may lie beneath (dorsal) the cord and/or within it. The ilioinguinal nerve runs anteroinferiorly to the superficial inguinal ring, where it emerges to supply the skin on the superomedial aspect of the thigh. The ilioinguinal nerve, usually smaller than the iliohypogastric nerve, arises with it from the first lumbar nerve. It emerges from the lateral border of the psoas major just below the iliohypogastric and, passing obliquely across the quadratus lumborum and iliacus, perforates the transversus abdominis, near the
© Springer International Publishing AG 2017 R. Zini et al. (eds.), Groin Pain Syndrome, DOI 10.1007/978-3-319-41624-3_17
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G. Barolat
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Ilioinguinal nerve (L1)
Iliohypogastric nerve (T12-L1)
L1
Genitofemoral nerve (L1-2)
completely replace the genital branch of the genitofemoral nerve or the lateral femoral cutaneous nerve. Of note, th
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