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Obturator nerve anatomy

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The obturator nerve is crucial for the medial thigh, primarily responsible for innervating the adductor muscles and providing sensation to the inner thigh and parts of the hip and knee joints. Its anatomical path makes it susceptible to compression, leading to symptoms like groin pain and adductor weakness.

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[Music]

so you want to know about the obturator

nerve do you okay

okay

first of all we'll talk about what it

does then we'll talk about where it

comes from then we'll talk about where

it goes you know the route that it takes

and then we'll talk about what happens

if it doesn't work properly which

usually means it's being squashed by something

something

okay that's a plan [Music]

[Music]

what does it do what does the obturator

nerve do

uh well when people ask lowell

lowell

when people ask i say it is the nerve of

the medial thigh

okay what's in the medial thigh well it

carries sensory innervation from some of

the skin of the medial thigh and then in

here we find the adductor muscles

so it innervates a dr brevis

the short one a dr longis the long one

and dr magnus the big one and then also gracilis

gracilis

and as we'll see as we go also obturator

externus kind of an outlier hard to

remember that one and it might innovate

uh pectineus as it goes past as well

although that can be innervated by the

femoral nerve look how we're going off

on a complicated tangent already the

obturator nerve is the nerve of the

medial thigh so when you're learning

musculoskeletal stuff and limbs

the limbs are organized into

compartments so the anterior compartment

has the femoral nerve and it does

anterior thigh things the medial thigh

has the obturator nerve and it does

medial thigh things as in adduction

bringing the legs back to the midline

and then the posterior thigh has the

sciatic nerve and it does posterior

thigh things [Applause]

[Applause]

it's not too bad when you start looking

you group it up it gets worse when you

really go into the

into the weeds

where does it come from uh

uh um

where does the obturator nerve come from

here we're looking at the posterior

pelvis is down here so we can see the

kidneys major blood vessels and what

have you and the obturator nerve comes

from the lumbar plexus

the lumbar plexus

is a

a network of nerves that are coming

out of the lumbar vertebrae we can just

about see the l5 vertebral body there so

it's posterior to that so

so here are the lumbar vertebrae

l1 l2 l3 l4 l5 we might refer to them as

and coming out of the intervertebral

foramina in between

the vertebrae are the

lumbar spinal nerves l1 l2 l3 l4 l5 and

so on and

and

this is the lumbar plexus

it takes many of the spinal nerve roots

and forms other nerves from it

and the obturator nerve comes from l2 l3

spinal nerve roots and anterior branches

off so actually the green that we can

see here these are anterior branches

whereas the yellower posterior alright

so i reckon the green is going to be the

obturator nerve and

it's that one there because i know where

it's going to so

that's where the obturator nerve comes

from it comes from the lumbar plexus but

we can't see it because it's covered by

muscles now which muscles well back to

the posterior abdominal wall so the

lumbar vertebrae are behind here so the

lumbar plexus is posterior to this this

muscle here

is psoas major

big chunky muscle that is going to be a

hip flexor muscle

so the obturator nerve

is running inferiorly

through psoas major posterior to psoas

major somehow

it appears

immediately to psoas major around here somewhere

somewhere

this is the common iliac artery this is

the external iliac artery so we will

first see it

medial to psoas major

medial to the external iliac artery is

it there

no no it's not there okay my one little

trick for finding the obturator nerve

i don't do click bait

is right if i'm in the pelvis what i

look for

is the brim of the bowl of the pelvis

you see what i mean right this this brim

here before we get into the true pelvis

if i find a nerve running around the

brim of the bowl of the pelvis it's

the obturator nerve

and it will have with it the obturator

artery and the obturator vein because i

know where they're going they are going

through the obturator foramen

naked pelvis no muscles no ligaments or

anything this is the obturator foramen

it's a whacking great big hole but

actually in life

that hole is covered by a membrane called

called

the obturator membrane

leaving a small hole up here

a small canal called

the obturator canal through the

ultrahere canal past the obturator nerve

the obturator artery and the obturator

vein sometimes anatomy is just easy

so if the obturator nerve passes through

there look where it is

it's in the medial thigh

but there it is

obturator foramen made by the bone

covered by the obturator membrane

leaving a small gap the obturator canal

for the obturator nerve artery and vein

to pass through

a narrow canal of bone and connective

tissue and that's the sort of thing we

worry about when we have important

things passing through canals because

they get squashed right on top of that

i guess the main purpose of this

membrane existing is so

muscles can attach to it and the muscle

that covers this externally

externally

is the obturator externus muscle there's

also one on the inside which is called

the obturator internist muscle but we're

interested in the obturator externus the

obturator externus muscle is one of the

six lateral rotators

of the femur at the hip

so it's running from here out towards

the femur do you want me to list the

other five no of course

no you don't but i'm talking about that

today so the obturator externus muscle

runs to the to the femur now also

because it's covering this again it's

just leaving a little gap for these

things to pass through but the obturator

nerve then the first muscle it

innervates is obturator externus then it

continues into the medial thigh

so then it innervates the muscles of the

medial thigh the arbitrator nerve

when it passes into

the medial thigh

splits into two branches

the anterior branch and the posterior

branch now it's actually the posterior

branch that's going to innervate

obturator externas and travel

posteriorly and

i guess more deeply the anterior branch

will pass between

dr brevis and a doctor longus and

innovate those two

it will innervate the gracilis muscle

and it will pass to the medial

medial

thigh skin

the posterior branch

will pass between adductor longus and

adductor magnus the big adductor muscle

it will innervate adductor magnus

and it will continue down to the knee

a doctor magnus is also innovated by

branches from the tibial part of the

sciatic nerve by the way

but talking about the knee that gives me

reminds me of another function so the

obturator nerve is passing the hip joint

and is passing the knee joint so it will

also send sensory branches to the

structures of the knee like the joint

capsule and that sort of thing so the

obturator nerve is sensory to

the knee joint and the hip joint but

that's a shared duty that it has the

femoral nerve and branches of the

sciatic nerve also are sensory from the

knee joint and and so on right okay but

nerves these big nerves do that

so what goes wrong with the obturator

nerve well you can see through much of

its root is well protected like other

nerves that come out from between lumbar vertebrae

vertebrae

it's susceptible to impingement by say a

slipped intervertebral disc or things

like that in the low back but more

interesting is the path that we've

described through the obturator canal

possibly through obturator externus and

then deep to the fascia lata which means

that you know in for example elite

athletes that have lower limb focused

sports hip focus sports they might

develop tight muscles hypertrophy muscles

muscles

tough fascia things that might compress

the obturator nerve as it's passing

through those narrow spaces

so if you compress the obturator nerve then

then

what are you likely to see or feel this

is a cause of groin pain there are many

causes of groin pain but the pain if the

nerve is getting compressed as is

passing through the obturators canal

would be

deep groin pain and what else might you

see well if it's innervating the

abductor muscles then weakness of those

adductor muscles compare one side to the

other would be a sign that the obturator

nerve is not working properly and of

course also parasthesia of the medial

skin of the thigh would also innervate

that the arbitrator nerve is not

functioning properly

so there you go obturator nerve

we've talked about what it does

where it comes from its root

and its branches what it innervates and

what might go wrong if it gets squashed

on that route

all right obturator nerf

see you next week

another fascinating

nerve story [Music]

[Music] you

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YouTube Transcript:Obturator nerve anatomy