0:00

The saphenous nerve is a small branch of the femoral, uh,

0:05

nerve, the deep branch that, uh,

0:08

provides only sensory innovation, uh, to the medial knee,

0:13

uh, lower leg and ankle.

0:15

And it runs deep and parallel to the sartorius muscle

0:20

and is more anteriorly proximally.

0:23

And then at the mid thigh, it will become

0:26

a more medial in hunter's canal, the adductor canal,

0:30

and it will then descend, uh, along the, uh, medial aspect

0:34

of the thigh, always deep to the sartorius muscle.

0:38

It'll emerge from the Dr.

0:40

Canal and descend, uh, deep

0:43

to the sartorious muscle at the postural medial knee.

0:46

So here, if you find a sartorious, uh, muscle here,

0:50

you can see the femoral nerve, uh, deep

0:53

to the sartorious, uh, muscle.

0:55

So, uh, it, it's a good, uh, idea to look in that area.

0:59

Make sure there's no scar tissue or no no lesion.

1:02

If we have, um, um,

1:05

sensory dis sensory disturbance in, in the territory

1:09

of the ous nerve, it will then continue, uh,

1:12

in fairly down the, uh, leg to the medial ankle.

1:17

So, ous neuropathy is an important cause

1:20

of persistent media knee pain following, uh, injury

1:24

or surgery, and can be also a complication following

1:28

ous vein, uh, stripping.

1:30

So patients will clinically, uh, present with pain

1:33

and numbness along the media, knee and middle, knee and leg.

1:38

The opterator nerve, uh, also form from, from the altitude

1:42

to L four nerve roots will supply the adductor brevis

1:46

and opterator ex sternness, uh, muscles more proximally.

1:50

And then at the thigh will, uh, provide innovation

1:54

to the adductor longus, the adductor manus,

1:56

and the gracilis, uh, muscles.

1:59

And it'll also provide some sensation to the medial thigh.

2:04

In the, uh, pelvis, you can see the er inner nerve

2:07

as it emerges medially to the so west muscle

2:11

and the descends almost vertically in the pelvis.

2:14

It's usually surrounded by, uh, fat, which allows, uh,

2:18

detection of that nerve,

2:20

and it will then course medially to the aceta.

2:25

So on al images, you can see the operator nerve, uh,

2:29

medially to the operator internist muscle at the level

2:32

of the ace tablum,

2:34

and then it'll dis descend

2:35

to enter the ator canal in its sup.

2:38

Lateral aspect here, deep

2:41

to the ator internist, um, muscle.

2:45

So in the canal, it's vulnerable to compression by a tumor

2:49

by scar tissue, uh, cyst.

2:52

Or during surgery in the canal, the, uh,

2:56

observator nerve will divide into an

2:58

Anterior branch anterior to the adductor brevis muscle,

3:02

and a posterior branch posterior

3:04

to the adductor brevis muscle.

3:06

Uh, these little branches can be difficult

3:09

to see if the patient is very muscular

3:11

and much easier

3:13

to identify when there is some fat surrounding the muscles.

3:18

Um, sports related activator neuropathy can occur when

3:22

there's tethering of the anterior branch by adhesions caused

3:26

by auc tendon tendinopathy.

3:29

For example, the, uh, this is an example of a patient

3:34

who had a pelvic sidewall tumor,

3:37

and you can see the marked enhancement along the, uh,

3:41

pelvic sidewall here and on the path of the opterator nerve.

3:46

And here he also had some denervation changes in the

3:49

opterator exter muscle

3:51

and the, in the adductor musculature,

3:54

more distally at the thigh in the adductor longus and Manus.

3:58

Uh, there was also some associated, uh, lymphedema.

4:03

This is another case of ator neuropathy in a patient

4:06

who had a groin tumor, uh, that was fatty,

4:10

but the fat had a slightly different, uh,

4:13

density than the subcutaneous fat.

4:16

It was thought to be a lipo sarcoma

4:19

because of the marked, uh, uptake on the pet ct.

4:23

And on MRI, the lesion was slightly different

4:26

to the subcutaneous fat on T one and enhanced markedly

4:30

and on pathology was a tumor of the brown fat, uh, hypo.

4:35

He had surgery. And, uh,

4:38

on the follow-up MRI three months later, uh,

4:41

the patient had developed some, uh,

4:44

denervation changes in the adductor musculature

4:46

and in the CCIS that you can see here.

4:50

So probably the nerve was injured at the time of surgery.