Volume 1

A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper.

Date:
1893-1894
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper. Source: Wellcome Collection.

    866/962 (page 846)
    Lumbar and Sacral Plexuses. The lumbar plexus, made up of loops of communication between the anterior branches of the four upper lumbar nerves, supplies the flexors and adductors of the hip-joint, the extensors of the feet, and the cremaster. The sensory fibres are distributed to tiie skin of the lower part of tiie abdomen, the antero-lateral region of the thigh, and the inner side of the leg and foot. The cords of the plexus itself are sometimes involved by tumors of the lymph-glands, in psoas abscess, and in caries of the vertebrae. Affections of the individual nerves of the lumbar plexus are not so common. The anterior crural nerve may be involved in wounds, in psoas,abscess, and in disease of the vertebrae, stretched in dislocation of the hip-joint, or invaded by pelvic tumors. When paralyzed there is loss of power in tiie extensors of the knee, and if the nerve is involved high up there may be loss of power in the psoas muscle. In prolonged involvement the muscles waste and walking may be difficult or impossible. There is anfesthesia of the greater jiorticm of the skin of the thigh, except a narrow strip at the back part, and in the distribution of the internal saphenous nerve along the inner side of tiie leg to the big toe. Neuralgia of the crural nerve is not very com- mon, apart from the pressure symptoms due to tumors and growths about the spine. The pain is in the antero-internal portion of the thigh and knee and extends along the inner surface of the leg and foot. Tiiere is often a painful spot where the nerve emerges below Poupart's ligament. The obturator nerve is occasionally injured during parturition. When par- alyzed there is loss of power in the adductoi's of the thigh, and the patient cannot cross one leg over the other. Owing to involvement of the obturator externus, rotation inward of the thigh is not well performed. Tliere are troublesome neux'algias of certain branches of the lumbar plexus. Tliere may be pain in the course of the ilio-inguinal and ilio-iiypogastric nerves, in the neighborhood of the crest of the ilium, and in the external abdominal ring. The ilio-inguinal nerve, Avhich accompanies the spermatic cord through the inguinal canal and escapes at the external abdominal ring, is distributed to the skin of the upper and inner part of the thigh and to the scrotum. There are instances in which the distribution of this nerve is the seat of verv severe pain, and the alfection known as the irritable tcdis of Cooper is believed to be an affection of this nerve. Associated with this pain there may be sensations of fainting and the sickening feeling such as is felt on coni])ression of the testis. Sacral Plexus.—This is still more likely to be damaged by pelvic tumors and various affections of the pelvic bones. The branches may be injured during parturition. Neuritis is not uncommon, and is frequently an extension from tiie sciatic. Of the branches, the sciatic nerve when paralyzed causes loss of power in the flexors of the leg and in the muscles below tlie knee. An affection or injury below the middle thigh involves only the muscles of the leg proper.