허리디스크 치료와 하지 신경포착증후군 치료를 위한 신경해부학

[문형철]

통증이 발생하면 근육이 긴장하고 

근육이 긴장하면서 수없이 많은 신경은 포착한다. 

신경스트레칭을 정확히 하기 위해서는 신경의 유주를 잘 알아야

둔부쪽에서 많은 신경포착

상둔부신경 포착증후군..

This classic entrapment occurs when a branch of the superior cluneal nerve becomes restricted in the tunnel of thoracolumbar fascia through which it crosses over the iliac crest. 

panic bird..

참고) subcostal nerve

The anterior division of the twelfth thoracic nerve (subcostal nerve) is larger than the others; it runs along the lower border of the twelfth rib, often gives a communicating branch to the first lumbar nerve, and passes under the lateral lumbocostal arch.

It then runs in front of the Quadratus lumborum, perforates the Transversus, and passes forward between it and the Obliquus internus to be distributed in the same manner as the lower intercostal nerves.

It communicates with the iliohypogastric nerve of the lumbar plexus, and gives a branch to the Pyramidalis. It also gives off a lateral cutaneous branch that supplies sensory innervation to the skin over the hip.

참고) iliohypogastric nerve

The iliohypogastric nerve is the superior branch of the anterior ramus of spinal nerve L1 (one of thelumbar nerves) after this nerve receives fibers from T12 (subcostal nerve). The inferior branch is theilioinguinal nerve.

It emerges from the upper part of the lateral border of the psoas major, and crosses obliquely in front of thequadratus lumborum to the iliac crest, running posterior to the kidneys.

It then perforates the posterior part of the transversus abdominis, near the crest of the ilium, and divides between that muscle and the obliquus internus abdominis into a lateral and an anterior cutaneous branch.

The ilioinguinal nerve is a branch of the first lumbar nerve (L1). It separates from the first lumbar nerve along with the larger iliohypogastric nerve.

It emerges from the lateral border of the psoas major just inferior to the iliohypogastric, and passes obliquely across the quadratus lumborum and iliacus. The ilioinguinal nerve then perforates the transversus abdominisnear the anterior part of the iliac crest, and communicates with the iliohypogastric nerve between the transversus and the internal oblique muscle.

It then pierces the internal oblique muscle, distributing filaments to it, and then accompanies the spermatic cord through the superficial inguinal ring. Its fibers are then distributed to the skin of the upper and medial part of the thigh, and to the following locations in the male and female:

• In the male ("anterior scrotal nerve"): to the skin over the root of the penis and upper part of the scrotum.
• In the female ("anterior labial nerve"): to the skin covering the mons pubis and labium majus.

Note that the ilioinguinal nerve does not pass through the deep inguinal ring, and therefore it only travels through part of the inguinal canal.

genitofemoral nerve

The genitofemoral nerve refers to a human nerve that is found in the abdomen. Its branches, the genital branch and femoral branch supply sensation to the upper anterior thigh, as well as the skin of the anteriorscrotum in males and mons pubis in females

lateral femoral cutaneous nerve

The lateral femoral cutaneous nerve, a pure sensory nerve, is susceptible to compression as it courses from the lumbosacral plexus, through the abdominal cavity, under the inguinal ligament, and into the subcutaneous tissue of the thigh. Meralgia paresthetica is the term used to describe the clinical syndrome of pain, dysesthesia, or both in the anterolateral thigh associated with compression of the nerve [1].

The obturator nerve in human anatomy arises from the ventral divisions of the second, third, and fourthlumbar nerves; the branch from the third is the largest, while that from the second is often very small.

It descends through the fibers of the Psoas major, and emerges from its medial border near the brim of the pelvis; it then passes behind the common iliac arteries, and on the lateral side of the internal iliac artery andureter, and runs along the lateral wall of the lesser pelvis, above and in front of the obturator vessels, to the upper part of the obturator foramen.

Here it enters the thigh, through the obturator canal, and divides into an anterior and a posterior branch, which are separated at first by some of the fibers of the Obturator externus, and lower down by the Adductor brevis.

The femoral nerve, the largest branch of the lumbar plexus, arises from the dorsal divisions of the ventral rami of the second, third, and fourth lumbar nerves (L2-L4). It descends through the fibers of the psoas major muscle, emerging from the muscle at the lower part of its lateral border, and passes down between it and the iliacus muscle, behind the iliac fascia; it then runs beneath the inguinal ligament, into the thigh, and splits into an anterior and a posterior division. Under the inguinal ligament, it is separated from the femoral artery by a portion of the psoas major.

The superior gluteal nerve is a nerve that originates in the pelvis and supplies the gluteus medius, thegluteus minimus, and the tensor fasciae latae muscles.

The superior gluteal nerve originates in the sacral plexus. It arises from the dorsal divisions of the fourth and fifth lumbar and first sacral nerves.^[2] It leaves the pelvis through the greater sciatic foramen above thepiriformis, accompanied by the superior gluteal artery and the superior gluteal vein.^[3] It then accompanies the upper branch of the deep division of the superior gluteal artery and ends in the gluteus minimus andtensor fasciae latae muscle.

In normal gait, the small gluteal muscles on the stance side can stabilize the pelvis in the coronal plane. Weakness or paralysis of these muscles caused by a damaged superior gluteal nerve can result in a weak abduction in the affected hip joint. This gait disturbance is known as Trendelenburg gait. In a positiveTrendelenburg's sign the pelvis sags toward the normal unsupported side (the swing leg). The opposite, when the pelvis is elevated on the swing side, is known as Duchenne limp. Bilateral loss of the small gluteal muscles results in a waddling gait. ^[3]

The inferior gluteal nerve is the main motor neuron that innervates the gluteus maximus muscle. It is responsible for the movement of the gluteus maximus in activities requiring the hip to extend the thigh, such as climbing stairs. Injury to this nerve is rare but often occurs as a complication of posterior approach to the hip during hip replacement. When damaged, one would develop gluteus maximus lurch, which is a gaitabnormality which causes the individual to 'lurch' backwards to compensate lack in hip extension.

The muscle is supplied by the inferior gluteal nerve which arises from the dorsal branches of the ventral ramiof the fifth the first (S1) and second (S2) sacral nerves.^[2]

The inferior gluteal nerve originates from sacral plexus from the dorsal L5, S1, and S2 rami.^[3]

The lumbosacral trunk, which is made up of L5 and a small branch of L4, effectively connects the lumbar and sacral plexuses.^[4] The lower branches of the L4 and the L5 nerves enter the sacral plexus.

The sacral plexus is formed by the lumbosacral trunk, the first to third sacral ventral rami, and part of the fourth, the remainder of the last joining the coccygeal plexus. The sacral plexus is formed in the pelvis in front of the piriformis muscle.^[4]

The sacral plexus is formed anterior to the piriformis muscle and gives rise to the sciatic nerve, the superiorand inferior gluteal nerves, and the pudendal and posterior femoral cutaneous nerves.^[4]

However, most of the sacral plexus nerves are scarcely recognizable, because they leave the pelvis through the greater sciatic foramen. From the pelvis, the anterior primary branches of the nerves entering the plexus (the first sacral nerve being a particularly large one) and a mass of nerves on the piriformis can be recognized.^[5]

[heoss]

감사합니다.