Lateral cutaneous nerve of thigh

The lateral cutaneous nerve of the thigh can be investigated using ultrasound. Local anaesthetic can be injected around the nerve for skin grafts and surgery around the outer thigh. Nerve compression (usually around the inguinal ligament) can cause meralgia paraesthetica.

Structure

The nerve is usually 1-2 mm thick.

Origin

The lateral cutaneous nerve of the thigh is a nerve of the lumbar plexus. It arises from the anterior rami of the second and third lumbar nerves (L2-L3).

Course and relations

It passes through psoas major muscle, and emerges from its lateral border. It crosses the iliacus muscle obliquely, toward the anterior superior iliac spine (ASIS). It is crossed by the deep circumflex iliac artery and the deep circumflex iliac vein. It enters the thigh by passing beneath (the lateral part of) the inguinal ligament in the muscular lacuna, or through (the lateral part of) the inguinal ligament itself. It then passes over the sartorius muscle, travelling from medial to lateral.

Branches

The lateral cutaneous nerve of the thigh usually divides into an anterior (or anterolateral) branch and a posterior branch.

Anterior branch

The anterior branch becomes superficial about 10 cm below the inguinal ligament. It divides into branches which are distributed to the skin of the anterior and lateral parts of the thigh, as far down as the knee. The terminal filaments of this nerve frequently communicate with the anterior cutaneous branches of the femoral nerve, and with the infrapatellar branch of the saphenous nerve, forming with them the peripatellar plexus.

Posterior branch

The posterior branch pierces the fascia lata. It subdivides into filaments, which pass backward across the lateral and posterior surfaces of the thigh. It supplies the skin around the greater trochanter.

Distribution

It provides sensory innervation to the lateral aspect of the thigh (as far as the knee), as well as the iliac fascia and perineum of the iliac fascia.

Variation

The lateral cutaneous nerve of the thigh may have multiple branches. Its position with relation to the ASIS can be very variable. It may partially pass through sartorius muscle rather than over its surface. It may be absent, and the sensory supply replaced by branches of the femoral nerve and the ilioinguinal nerve.