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You are watching: Femoral branch of genitofemoral nerve

StatPearls . Endowment Island (FL): StatPearls Publishing; 2021 Jan-.


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Introduction

The genitofemoral nerve occurs from the lumbar plexus. It offers sensation come the skin of the anterior scrotal area in males, mons pubis in females, and also the upper segment the the anterior thigh in both males and also females. While unique from the femoral nerve, the genitofemoral nerve originates indigenous the top lumbar segment L1-L2. It climate descends inferiorly, piercing the psoas significant muscle before emerging on its anterior surface. The nerve climate traverses the retroperitoneum, descending end the anterior surface of the psoas muscle. The nerve continues inferiorly, ultimately separating into two divisions- the femoral and also the genital branches. When the genitofemoral nerve will the groin area, the enters the deep inguinal ring coursing through the inguinal canal.<1><2>

In males, the nerve continues inferiorly and supplies the skin of the scrotum.

In females, the genitofemoral nerve operation alongside the round ligament of the uterus and terminates simply superior to the mons pubis and labia majora. Further, after crossing the inguinal ligament, the genitofemoral nerve travels adjacent to the exterior iliac artery, giving sensation to the anterior top thigh.<3>


Structure and Function

The genitofemoral nerve provides sensation via the femoral branch and also motor innervation via the genital branch. The cremasteric reflex is a duty of genitofemoral nerve innervation, as it provides sensation come the premium medial element of the thigh. In at least 50% that individuals, there is some variation in the course of the genitofemoral nerve as it travels within the retroperitoneum and ultimately entering into the inguinal canal. Sports is likewise found at the level the its bifurcation right into genital and also femoral branches.  


Blood Supply and also Lymphatics

The genitofemoral nerve is developed in the midsection of the psoas muscle by the union of branches indigenous the anterior rami the L1 and also L2 nerve roots.  The nerve then courses inferiorly in ~ the psoas muscle and finally increase on the anterior surface of the muscle distally. The nerve then descends inferiorly in the retroperitoneum along the psoas major muscle and courses deeper and on the left to the gonadal vessels, ureter, and also the ileocolic vein and artery.

Just before the nerve get the inguinal ligament, both the right and also left genitofemoral nerves perforate the psoas fascia and then divide into the femoral and also genital branches.


Nerves

The genital branch that the genitofemoral nerve start the inguinal canal via the deep inguinal ring. In males, the genital branch gives the scrotal skin and also cremaster. In females, the genital branch is attach by the round ligament of the uterus and supplies emotion to the labia majora and mons pubis.

The femoral branch of the genitofemoral nerve travel beneath the inguinal ligament in the lateral muscular compartment, whereby the femoral nerve process through into the leg. The femoral branch enters the cribriform fascia that the greater saphenous vein opening and supplies the skin the the anterior, upper, and also medial aspects of the thigh.


Physiologic Variants

Cadaveric studies have reported far-ranging variation in the course of the genitofemoral nerve in over fifty percent of specimens. 

While most specimens exhibition a predictable bifurcation pattern of the nerve in the mid-substance of the psoas muscle, a current study provided that the genitofemoral nerve prematurely bifurcates in the upper part of the psoas muscle about 20% of the time.  Also, the femoral and genital branches do not kind a typical trunk within the psoas muscle and remain as distinct nerves as they food in the retroperitoneum.


Surgical Considerations

Inguinal hernia repair

During surgery to fix an inguinal hernia, one has to visualize the genitofemoral nerve, i beg your pardon is found within the deep inguinal ring. If damaged, the patient will complain of pain in the scrotal area and also anterior thigh. The injury can result in genitofemoral neuralgia, leading to morbidity as no great treatment currently exists.  For exam purposes, one needs to differentiate between the genitofemoral and ilioinguinal nerves, both the which deserve to be injured during surgery.<4><5><6>

Lumbar spinal interbody fusion

During lumbar spine operation procedures, the surgeon must be aware of the anatomic relationships in between the lumbar plexus and the intervertebral key at all levels.  This concept is particularly relevant when performing lateral interbody blend by minimally invasive retroperitoneal trans-psoas approaches.  Ventral nerve root of the lumbar plexus are particularly vulnerable throughout psoas muscle retraction.  operated doctor must be conscious of the "safe functioning zone" pertaining come the details level that interest respective to the level that pathology being treated.  This "safe zone" is typically located between the anterior border that the lumbar nerve and also the posterior border of the sorry trunk.  The genitofemoral nerve shows up to be solely responsible because that narrowing this for sure zone, through its most significant anatomic affect being well-known at the L2-L3 level.


Clinical Significance

The genitofemoral nerve can be injured during surgery in numerous ways:


It can be lacerated during injury come the groin. This can take place with penetrating trauma, a knife wound, or surgical expedition of the groin. In part cases, throughout surgery top top the saphenous vein for varicose vein ligation, retractors can cause abrasive injury.
The genitofemoral nerve have the right to also be injured in the inguinal canal, usually during inguinal hernia repair. In most cases, the injury is unnoticed throughout surgery and also diagnosed in the postoperative period as soon as the patient complains that pain.
The genitofemoral nerve have the right to also be injured during a motor auto accident. The lower earlier injury may result in an extension of the ago while the patience is seated.
When there is spinal stenosis of the L1 or L2 segments, compression fracture, or metastatic lesions to the lumbar spine, the nerve roots, which give rise to the genitofemoral nerve, can be injured.
Psoas abscess i beg your pardon may take place after an open pelvic fracture or a retroperitoneal hematoma, is also known to cause irritation of the genitofemoral nerve.

Other Issues

Genitofemoral neuralgia is a fairly common pain syndrome observed in both males and also females. The patient generally presents through unilateral pain in the reduced abdomen. Hardly ever the pain may be bilateral. The pain is occasionally referred to together the groin area (because the the route of the genital nerve) and the upper medial thigh (because that the femoral branch). The pain different in intensity native moderate to severe and also is worsened by movements that reason extension the the lower back. In many patients, palpation the the lower abdomen in the inguinal region can reproduce the pain. In many cases, the cause is compression that the nerve in the inguinal canal, typically after open hernia surgery. The diagnosis is often daunting in patient who have actually not had actually surgery.<7><8>

The prognosis of patients who suffer entrapment or injury come the genitofemoral nerve is guarded. If the nerve is entrapped in the inguinal canal after ~ inguinal hernia surgery, one may try decompression, however often the scarring renders visualization that the nerve difficult.

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In patients v a lacerated nerve, many pain-relieving modalities have been used, but none functions effectively. Some patients respond come nerve blocks, however most patients call for long-term anticonvulsants and opiates because that pain relief.  


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Figure

The Sacral and also Coccygeal Nerves, Sacral plexus the the ideal side, Pelvic Area, Coccyx, Dorsal Nerve the Penis, Nerve come Bulb, Genito Femoral Nerve. Contributed by Gray"s Anatomy key


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