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Sonoanatomy of the ilioinguinal, iliohypogastric, genitofemoral, obturator, and pudendal nerves: a practical guide for US-guided injections

Elena E. Drakonaki
Elena E. Drakonaki
, 
Miraude E. A. P. M. Adriaensen
Miraude E. A. P. M. Adriaensen
, 
Hussain I. J. Al-Bulushi
Hussain I. J. Al-Bulushi
, 
Ioannis Koliarakis
Ioannis Koliarakis
, 
John Tsiaoussis
John Tsiaoussis
 and 
Kurt Vanderdood
Kurt Vanderdood
   | Feb 08, 2022
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Article Category: Review paper
Published Online: Feb 08, 2022
Page range: 44 - 50
Received: Aug 23, 2021
Accepted: Dec 13, 2021
DOI: https://doi.org/10.15557/JoU.2022.0008
Keywords
© 2022 Elena E. Drakonaki, Miraude E. A. P. M. Adriaensen, Hussain I. J. Al-Bulushi, Ioannis Koliarakis, John Tsiaoussis, Kurt Vanderdood published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

A. US image of the right ilioinguinal (II) and iliohypogastric (IH) nerves at the fascial plane between the internal oblique (IO) and transversus abdominis (TA) muscles at a level just distally to the ASIS. The dotted straight lines indicate the direction of the needle tract from medial to lateral during US-guided injection with an in-plane approach. B. Corresponding topographical anatomy photo of the right lower abdomen with the red line indicating the probe position. IO – internal oblique muscle; TA – transversus abdominis muscle; IC – iliac crest; ASIS – anterior superior iliac spine. C. Axial Pd-w MR image of the right ilioinguinal (II) and iliohypogastric (IH) nerves (arrow) at the fascial plane between the internal oblique (IO) and transversus abdominis (TA) muscles at a level just distally and medially to the ASIS. D. Corresponding US image acquired with probe positioning as shown in B. IO – internal oblique muscle; TA– transversus abdominis muscle; ASIS – anterior superior iliac spine
A. US image of the right ilioinguinal (II) and iliohypogastric (IH) nerves at the fascial plane between the internal oblique (IO) and transversus abdominis (TA) muscles at a level just distally to the ASIS. The dotted straight lines indicate the direction of the needle tract from medial to lateral during US-guided injection with an in-plane approach. B. Corresponding topographical anatomy photo of the right lower abdomen with the red line indicating the probe position. IO – internal oblique muscle; TA – transversus abdominis muscle; IC – iliac crest; ASIS – anterior superior iliac spine. C. Axial Pd-w MR image of the right ilioinguinal (II) and iliohypogastric (IH) nerves (arrow) at the fascial plane between the internal oblique (IO) and transversus abdominis (TA) muscles at a level just distally and medially to the ASIS. D. Corresponding US image acquired with probe positioning as shown in B. IO – internal oblique muscle; TA– transversus abdominis muscle; ASIS – anterior superior iliac spine

Fig. 2

A. US image of the right genital branch of the genitofemoral nerve (GBGF, dotted oval line) at a level of the inferior epigastric artery (IEA) origin. The dotted straight lines indicate the direction of the needle tract from lateral to medial during US-guided injection with an in-plane approach. B. Corresponding topographical anatomy photo of the right lower abdomen with the red line indicating the probe position. The anatomical landmarks are the ASIS (curved line) and course of the inguinal ligament (straight dotted line from ASIS to pubic tubercle). EIV – external iliac vein; EIA – external iliac artery; ASIS – anterior superior iliac spine. C. Axial Pd-w MR image of the right genital branch of the genitofemoral nerve (GBGF, thin arrow) lying superficial to the EIA at the level of the IEA origin (thick arrow). D. Corresponding US image acquired with probe positioning as shown in B. The GBGF is shown as dotted oval line. IEA – inferior epigastric artery, EIV – external iliac vein; EIA – external iliac artery
A. US image of the right genital branch of the genitofemoral nerve (GBGF, dotted oval line) at a level of the inferior epigastric artery (IEA) origin. The dotted straight lines indicate the direction of the needle tract from lateral to medial during US-guided injection with an in-plane approach. B. Corresponding topographical anatomy photo of the right lower abdomen with the red line indicating the probe position. The anatomical landmarks are the ASIS (curved line) and course of the inguinal ligament (straight dotted line from ASIS to pubic tubercle). EIV – external iliac vein; EIA – external iliac artery; ASIS – anterior superior iliac spine. C. Axial Pd-w MR image of the right genital branch of the genitofemoral nerve (GBGF, thin arrow) lying superficial to the EIA at the level of the IEA origin (thick arrow). D. Corresponding US image acquired with probe positioning as shown in B. The GBGF is shown as dotted oval line. IEA – inferior epigastric artery, EIV – external iliac vein; EIA – external iliac artery

Fig. 3

A. US image of the right obturator nerve branches (arrows) and the adductor muscles. The dotted straight line indicates the direction of the needle tract from lateral to medial during US-guided injection with an in-plane approach. B. Corresponding topographical anatomy photo of the groin area with the red line indicating the probe position. AL – adductor longus; AB – adductor brevis; AM – adductor magnus; ant – anterior branch of the obturator nerve; post – posterior branch of the obturator nerve. C. Axial Pd-w MR image of the right anterior branch of the obturator nerve (arrow). D. Corresponding US image acquired with probe positioning as shown in B. AL – adductor longus; AB – adductor brevis; ant – anterior branch of the obturator nerve
A. US image of the right obturator nerve branches (arrows) and the adductor muscles. The dotted straight line indicates the direction of the needle tract from lateral to medial during US-guided injection with an in-plane approach. B. Corresponding topographical anatomy photo of the groin area with the red line indicating the probe position. AL – adductor longus; AB – adductor brevis; AM – adductor magnus; ant – anterior branch of the obturator nerve; post – posterior branch of the obturator nerve. C. Axial Pd-w MR image of the right anterior branch of the obturator nerve (arrow). D. Corresponding US image acquired with probe positioning as shown in B. AL – adductor longus; AB – adductor brevis; ant – anterior branch of the obturator nerve

Fig. 4

A. US image of the pudendal nerve (dotted oval line) and associated anatomical structures at the level of the ischial spine. The dotted straight line indicates the direction of the needle tract from medial to lateral during US-guided injection with an in-plane approach B. corresponding topographical anatomy photo of the gluteal area with the red line indicating the probe position. IS – ischial spine; STL – sacrotuberous ligament; SSL – sacrospinous ligament; IPA – internal pudendal artery; GM – gluteus maximus muscle. C. Axial Pd-w MR image of the right gluteal area at the level of the ischial spine showing the pudendal nerve (dotted oval line) and the associated anatomical structures. The MR image is rotated, so that the gluteal area lies on the top of the image, to allow anatomical matching to the US image. D. Corresponding US image of the pudendal nerve (dotted oval line) and associated anatomical structures at the level of the ischial spine, acquired with probe positioning as shown in B. IS – ischial spine; STL – sacrotuberous ligament; SSL – sacrospinous ligament; IPA – internal pudendal artery; GM – gluteus maximus muscle
A. US image of the pudendal nerve (dotted oval line) and associated anatomical structures at the level of the ischial spine. The dotted straight line indicates the direction of the needle tract from medial to lateral during US-guided injection with an in-plane approach B. corresponding topographical anatomy photo of the gluteal area with the red line indicating the probe position. IS – ischial spine; STL – sacrotuberous ligament; SSL – sacrospinous ligament; IPA – internal pudendal artery; GM – gluteus maximus muscle. C. Axial Pd-w MR image of the right gluteal area at the level of the ischial spine showing the pudendal nerve (dotted oval line) and the associated anatomical structures. The MR image is rotated, so that the gluteal area lies on the top of the image, to allow anatomical matching to the US image. D. Corresponding US image of the pudendal nerve (dotted oval line) and associated anatomical structures at the level of the ischial spine, acquired with probe positioning as shown in B. IS – ischial spine; STL – sacrotuberous ligament; SSL – sacrospinous ligament; IPA – internal pudendal artery; GM – gluteus maximus muscle

Fig. 5

A. US image of the pudendal nerve (dotted oval line) and associated anatomical structures at the level of the lesser sciatic notch at the entrance of Alcock’s canal. The dotted straight line indicates the direction of the needle tract from lateral to medial during US-guided injection with an in-plane approach B. Corresponding topographical anatomy photo of the gluteal area with the red line indicating the probe position. LSN – lesser sciatic notch; STL– sacrotuberous ligament; OI – obturator internus muscle C. Axial Pd-w MR image of the right gluteal area at the level of Alcock’s canal showing the pudendal nerve (dotted oval line) and the associated anatomical structures. The MR image is rotated with the gluteal area on the top of the image to allow anatomical matching to the US image. C. Axial Pd-w MR image of the right gluteal area at the level of Alcock’s canal showing the pudendal nerve (dotted oval line) and the associated anatomical structures. The MR image is rotated with the gluteal area on the top of the image for anatomical association to US. D. Corresponding US image of the pudendal nerve (dotted oval line) and associated anatomical structures at the level of Alcock’s canal, acquired with probe positioning as shown in B. LSN – lesser sciatic notch, STL – sacrotuberous ligament; OI – obturator internus muscle
A. US image of the pudendal nerve (dotted oval line) and associated anatomical structures at the level of the lesser sciatic notch at the entrance of Alcock’s canal. The dotted straight line indicates the direction of the needle tract from lateral to medial during US-guided injection with an in-plane approach B. Corresponding topographical anatomy photo of the gluteal area with the red line indicating the probe position. LSN – lesser sciatic notch; STL– sacrotuberous ligament; OI – obturator internus muscle C. Axial Pd-w MR image of the right gluteal area at the level of Alcock’s canal showing the pudendal nerve (dotted oval line) and the associated anatomical structures. The MR image is rotated with the gluteal area on the top of the image to allow anatomical matching to the US image. C. Axial Pd-w MR image of the right gluteal area at the level of Alcock’s canal showing the pudendal nerve (dotted oval line) and the associated anatomical structures. The MR image is rotated with the gluteal area on the top of the image for anatomical association to US. D. Corresponding US image of the pudendal nerve (dotted oval line) and associated anatomical structures at the level of Alcock’s canal, acquired with probe positioning as shown in B. LSN – lesser sciatic notch, STL – sacrotuberous ligament; OI – obturator internus muscle
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