Saphenous nerve

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Saphenous nerve
Nerves of the right lower extremity. Front view. (Saphenous labeled at center right.)
Details
Fromfemoral nerve (L3, L4)
Identifiers
Latinnervus saphenus
TA98A14.2.07.023
TA26525
FMA45262
Anatomical terms of neuroanatomy

The saphenous nerve (long or internal saphenous nerve) is the largest

cutaneous branch of the femoral nerve. It is derived from the lumbar plexus (L3-L4). It is a strictly sensory nerve, and has no motor function. It commences in the proximal (upper) thigh and travels along the adductor canal. Upon exiting the adductor canal, the saphenous nerve terminates by splitting into two terminal branches: the sartorial nerve, and the infrapatellar nerve (which together innervate the medial, anteromedial, posteromedial aspects of the distal thigh). The saphenous nerve is responsible for providing sensory innervation to the skin of the anteromedial leg.[1]

Structure

It is purely a sensory nerve.[2]

Origin

The saphenous nerve is the largest and terminal branch of the femoral nerve.[3] It is derived from the lumbar plexus (L3-L4).[1]

Course

Shortly after the femoral nerve passes under the

aponeurotic covering of the canal. It descends vertically along the medial side of the knee behind the sartorius muscle, pierces the fascia lata, between the tendons of the sartorius muscle and gracilis muscle. It becomes subcutaneous around 10 cm above the medial epicondyle of the femur.[3]

The nerve then passes along the tibial side of the leg, accompanied by the great saphenous vein.[4] It descends behind the medial border of the tibia, and, at the lower third of the leg, divides into two branches:

  • one continues its course along the margin of the tibia, and ends at the ankle.
  • the other passes in front of the ankle, and is distributed to the skin on the medial side of the
    superficial peroneal nerve
    .

Branches

The saphenous nerve, about the middle of the thigh, gives off a branch which joins the subsartorial plexus.

At the medial side of the knee it gives off a large

infrapatellar branch, which pierces the sartorius muscle and fascia lata.[2] It is distributed to the skin in front of the patella.[4][2]

Below the knee, the branches of the saphenous nerve (medial crural cutaneous branches) are distributed to the skin of the front and medial side of the leg, communicating with the cutaneous branches of the femoral, or with filaments from the obturator nerve.

Clinical significance

Procedures such as

bypass surgery and during trocar placement during knee arthroscopy. There appears to be occasional meaningful individual variation in the pathway of this nerve, such that the illustration of it done for Gray's Anatomy, for example, likely represents an unusual rather than usual course.[5]

The saphenous nerve can experience

entrapment syndrome from exercises involving the quadriceps or from prolonged walking or standing. It is characterized by a burning sensation in most patients. Pain often occurs at night, long after the physical exercise which induced it has stopped, and may be aggravated by climbing stairs. Usually, in this case, motor function of the lower leg will not be impaired. This is a key distinction between saphenous nerve neuropathy and lower back radiculopathy. Saphenous nerve neuropathy only demonstrates sensory alterations, while lumbar radiculopathy will affect the motor, sensory, and deep tendon reflexes of the lower leg.[6]

Additional images

  • Cross-section through the middle of the thigh.
    Cross-section through the middle of the thigh.
  • Cross-section through middle of leg.
    Cross-section through middle of leg.
  • The femoral artery.
    The femoral artery.
  • Cutaneous nerves of the right lower extremity. Front and posterior views.
    Cutaneous nerves of the right lower extremity. Front and posterior views.
  • Cutaneous nerves of the right lower extremity. Front and posterior views.
    Cutaneous nerves of the right lower extremity. Front and posterior views.
  • Diagram of the segmental distribution of the cutaneous nerves of the sole of the foot.
    Diagram of the segmental distribution of the cutaneous nerves of the sole of the foot.
  • Deep nerves of the front of the leg.
    Deep nerves of the front of the leg.
  • Nerves of the dorsum of the foot.
    Nerves of the dorsum of the foot.

References

Public domain This article incorporates text in the public domain from page 956 of the 20th edition of Gray's Anatomy (1918)

  1. ^
    PMID 31082089
    , retrieved 11 January 2023
  2. ^
    ISBN 978-0-443-06651-1
    , retrieved 21 February 2021
  3. ^
    ISBN 978-0-12-226870-0
    , retrieved 21 February 2021
  4. ^
    ISBN 978-0-12-226870-0
    , retrieved 21 February 2021
  5. PMID 22096447
    .
  6. ^ Brad McKechnie (22 May 1995). "Saphenous Nerve Entrapment Neuropathy". Dynamic Chiropractic. 13 (11).

External links

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