Fascia, vessels and nerves of the lower limb
Definitions & Key takeaways
Veins of the lower limb also fall into two main categories, the superficial and deep veins. The superficial veins pass are those found within the subcutaneous tissue, whereas the deep veins are located in the deep fascia and move along major arteries.
Arteries of the lower limb originate from a branch of the common iliac artery called the external iliac artery. Right behind the inguinal ligament, the external iliac artery becomes the femoral artery, which also becomes the popliteal artery at the level of the adductor canal. The popliteal artery gives rise to the anterior tibial, posterior tibial, and fibular arteries, which supply the leg and foot.
Regarding the innervation of the lower limb, the lumbosacral plexus made of the lumbar (T12 �L4) and the sacral (L4 �S4) plexuses, provides the innervation, the motor innervation of the lower limb mainly originate from obturator nerve, the femoral nerve, and the sciatic nerve and its branches.
Introduction0:00–0:19
The lower limb contains an intricate metrosystem of blood vessels, muscles, and nerves. These structures are wrapped up and organized into different compartments by superficial and deep fascia layers, and together they form the multifunctional limbs we know as legs.
Let's begin with fascia, which is, well, what is it anyway? You can think of fascia as a pair of thin stockings made of connective tissue that support and bind together different parts of the body, including the lower limbs.
Fascia0:19–7:30
Now, each lower limb actually has two pairs of stockings on top of each other, the superficial fascia, which sits right underneath our skin, and the deep fascia, which sits on top of the muscles, organizing them into compartments.
OK, so the superficial fascia, also known as the subcutaneous tissue, is located directly deep to the skin and consists of loose connective tissue with variable amounts of fat.
It contains arteries, veins, nerves, lymph vessels, and lymph nodes. Superiorly, the fascia is continuous with the subcutaneous tissue of the anterolateral abdominal wall and buttock.
Inferiorly at the knee, the superficial fascia loses its fat and blends with the deep fascia, but fat is again present distal to the knee in the subcutaneous tissue of the leg.
Moving on, deep fascia is especially strong and elastic, allowing it to limit the outward expansion of contracting muscles and act as a barrier to help compress the veins, which in turn propel blood towards the heart.
The deep fascia can be divided into the deep fascia of the thigh, which is called fascia lata, and the deep fascia of the leg or the curl fascia.
First, the fasciata is very strong and flexible. Superiorly, the fasciata attaches to the inguinal ligament and pubic bone anteriorly, to the iliac crest laterally and posteriorly, and to the sacrum, coccyx, sacro tuberous ligaments, and ischial tuberosity posteriorly.
It also attaches to the membranous layer of subcutaneous tissue of the inferior abdominal wall, also called scarpa fascia, just inferior to the inguinal ligament.
Regarding its inferior limits anteriorly and on both sides of the knee, fasciaata attaches to the subcutaneous bony prominences of the knee joint and is continuous with the deep fascia of the leg inferior to the knee.
That was a mouthful, wasn't it? The fascia lata encloses the large thigh muscles and is thickened laterally by an excess of longitudinal fibers to form the iliotibial tract.
The iliotibial tract, which extends from the iliac tubercle superiorly to the anterior lateral tubercle of the tibia inferiorly, also known as Gerdi tubercle.
It's the shared aponeurosis of the tensor fasciata and gluteus maximus muscle. And in case you were wondering, an aponeurosis is a type of deep fascia consisting of a sheet of pearly white fibrous connective tissue that helps attach sheet-like muscles needing a wide area of attachment.
The deep surface of the fasciata forms three intramuscular septa, a fancy word for walls. These are the medial.
Lateral And posterior intramuscular septa which attach to the lineaspora of the femur. Out of the three, the lateral intermuscular septum is the strongest and extends from the iliotibial tract to the lateral lip of the linea aspera and lateral supracondylar line of the femur.
Now the septa and the fasciata form the walls of three thigh muscle compartments. Anterior Medal.
And posterior, each of these compartments contain and separate the muscles of the thigh based on function and also house their own neurovascular structures associated with those muscles.
The medial compartment lies between medial and posterior septa and contains muscles that add up the thigh. And finally, the posterior compartment lies between posterior and lateral septa and contains muscles that extend the hip and flex the knee.
There is also an oval gap in the fasciata, the saphenous opening, which is located inferior to the medial part of the inguinal ligament in the anterior medial thigh.
The center of the opening is about 4 centimeters below and lateral to the pubic tubercle and is about 3.75 centimeters in length and 2.5 centimeters in breadth.
The saphenous opening is not actually an opening since it's usually covered by a curtain of fat and fibrous tissue called the cribriform fascia.
Cribriform comes from Latin and it means sieve or strainer, so the cribriform fascia is pierced by numerous structures such as the great saphenous vein before it drains into the femoral vein.
The superficial epigastric and superficial external pudendal vessels and a few lymph vessels containing superficial and deep inguinal lymph nodes in addition to the deep fascia of the thigh.
We have the deep fascia of the leg called the coral fascia, which is continuous superiorly with the fasciata. This deep fascia attaches to the anterior and medial border of the tibia where it is continuous with the bone's outer layer, the periosteum.
Posteriorly behind the knee, it forms the popliteal fascia which covers the popliteal fossa. Proximally, the fascia is thick and forms part of the proximal attachments of the underlying muscles, and distally, the deep fascia of the leg forms thickened horizontal bands of tissue both superior and anterior to the ankle joint called the extensor retinaculum.
The coral fascia also has an anterior intramuscular septum and a posterior intramuscular septum. These two septa extend inward from the deep coral fascia surface and attach to the anterior and posterior borders of the fibula respectively.
The septa, together with the interosseous membrane, which is a membrane that unites the fibula and tibia, divide the leg into three compartments.
There's the lateral compartment separated by the anterior and posterior septa which contains the averters of the foot. The anterior compartment is separated by the anterior septum and interosseous membrane, and it contains the muscles that invert the foot and extend the ankle joint.
By the way, a fancy word you might want to remember for extension of the ankle joint is dorsiflexion. And finally, there is the posterior compartment which is separated by the posterior septum and interosseous membrane and contains the muscles that invert the foot and flex the ankle joint.
Another fancy term for flexion of the ankle joint is plantar flexion. The posterior compartment is further subdivided by a transverse intramuscular septum, creating a deep and superficial portion of the posterior compartment, and that's a wrap, get it, because fascia acts as a wrap for, never mind.
Quiz7:30–7:53
Let's instead take a break and try to recognize some of the most important features of the fascia of the lower limb. Now let's focus on the veins of the lower limb.
Veins7:53–9:01
These can be divided into superficial veins and deep veins. The superficial veins are located in the superficial fascia or subcutaneous tissue, and therefore they run independent of major arteries.
So unlike other major veins of the body that are named according to the arteries they travel with, these are named on their own.
The deep veins of the thigh are located underneath the deep fascia and accompany the major arteries of the lower limb. Both superficial and deep veins have valves.
However, these are more numerous and deep veins because they transport most of the blood of the lower limbs. You can think of valves as elastic flaps of endothelium with cup-like cusps that fill from above.
When they're full, the valve cusps block the lumen of the vein, preventing reflux of the blood distally, as blood tends to flow downward due to gravity.
The valves preventing backflow combined with the compression exerted by muscle contraction forms the musculo venous pump which overcomes the force of gravity to return the blood to the heart.
Superficial veins9:01–12:01
OK, so first, the two main superficial veins are the great and small saphenous veins, which lie in the superficial fascia.
The great or long saphenous vein is formed at the dorsum of the foot by the dorsal vein of the great toe and the dorsal venous arch of the foot.
Now the great saphenous vein is ambitious and aims high. From the dorsum of the foot, it passes on the anterior part of the medial malleolus of the tibia at the ankle.
At the superior border of the popliteal region, it becomes anterior again, where it transverses the thigh anterior superiorly to the saphenous opening where it finally empties into the femoral vein, a long and winding road indeed.
Now as it climbs up the leg and thigh, the great saphenous vein receives numerous tributaries or branches while also communicating in several locations with the small saphenous vein through communicating veins.
Higher up, tributaries from the medial and posterior parts of the thigh frequently unite to form the accessory saphenous vein.
When present, this vein becomes the main communication between the great and small saphenous veins. And finally near its termination, the great saphenous vein also receives the superficial circumflex iliac.
Superficial epigastric and external pudendal veins. Moving on, the small saphenous vein arises on the lateral side of the foot from the union of the dorsal vein of the little toe with the dorsal venous arch.
The small saphenous vein ascends posterior to lateral malleolus. It passes along the lateral border of the calcaneal tendon and then it ascends roughly in the middle of the leg before piercing the deep fascia.
From here on it ascends between the heads of the gastronemius muscle until it reaches the popliteal fossa or the space behind your knee.
To empty into the popliteal vein. OK, now bear in mind that the superficial and deep venous systems communicate with each other, and blood is continuously diverted from these superficial veins to the deep veins via the perforating veins.
Perforating veins are called that because they perforate the deep fascia of muscles to connect the superficial veins to the deep veins, and they contain valves which only allow blood to drain from superficial to deep.
These perforating veins are also important to the mechanism of the muscular venous pump because as they pass through the deep fascia they are compressed during muscular contraction.
This prevents blood from flowing from the deep to superficial veins. And directs venous blood to the heart.
Deep veins12:01–14:13
Now let's look at the deep veins of the lower limb which lie in the fascial compartments formed by the deep fascia. They accompany all the major arteries of the lower limb and their branches.
Additionally, deep veins usually come in pairs that flank the artery they accompany, meaning that each major artery of the lower limb is paired with two deep veins.
Now the veins and the artery they follow are wrapped up within a vascular sheath. As the muscular arteries undergo pulsatile contractions, they compress the deep veins against the vascular sheath, propelling blood towards the heart.
OK, so the main deep venous structures of the foot begin from the medial and lateral plantar veins, which arise from the deep plantar venous arch on the plantar aspect of the foot.
The medial and lateral plantar veins travel proximally to the posterior side of the medial malleolus, where they unite to form the posterior tibial vein.
They also often contribute to the formation of the fibular vein which ascends posterior to the fibula. Additionally, the anterior tibial vein travels through the anterior leg arising from the perforating veins, traveling proximately up to the knee.
These three veins, the anterior tibial, posterior tibial, and fibular veins unite to form the popliteal vein. The popliteal vein travels upward through the popliteal region until it reaches the adductor hiatus where it enters the thigh and becomes the femoral vein.
The femoral vein accompanies the femoral artery throughout its upward trajectory in the thigh until it reaches the inguinal ligament and leaves the thigh, at which point it is known as the external iliac vein.
Moving on, veins that accompany the perforating arteries branching from the profunda femoris artery drain blood from the thigh muscles and terminate in the profunda femoris vein or deep vein of the thigh.
Which is another major venous structure that empties into the terminal portion of the femoral vein at the inferiormost portion of the ischial tuberosity.
Overall, deep veins are more variable, and they anastomo much more frequently than the arteries they accompany. See, all that hard work was not in vain, because we've actually reached the end of this section.
Quiz14:13–14:38
Time for a break and for you to recognize some high yield landmarks. OK, so, moving on, the lower limb has both superficial and deep lymphatic vessels.
Lymphatic vessels14:38–16:52
The superficial lymphatic vessels are like a network of lines that converge and accompany the saphenous veins and their tributaries.
Now the lymphatic vessels that accompany the great saphenous vein originate on the dorsal surface of the foot and end in the superficial inguinal lymph nodes.
These lymph nodes are separated into two groups the horizontal group, which is about 2 centimeters below the inguinal ligament, and the vertical group, which is around the proximal end of the great saphenous vein.
Most lymph from these nodes passes directly to the external iliac lymph nodes, which are located along the external iliac vein.
But some lymph from the superficial nodes also passes to the deep inguinal lymph nodes. On the other hand, the lymphatic vessels accompanying the small saphenous vein arise from the lateral surface of the foot and enter the popliteal lymph nodes.
Located in the fat of the popliteal fossa surrounding the popliteal vein. The deep lymphatic vessels of the lower limb follow the corresponding main artery and enter the popliteal lymph nodes.
Most lymph from the popliteal lymph nodes ascends through deep lymphatic vessels to the deep inguinal lymph nodes. Lymph from the deep inguinal nodes passes to the external and common iliac lymph nodes and then enters the lumbar lymphatic trunks.
So now let's talk about the peripheral nerves, which can be divided into cutaneous, motor, and mixed nerves. Here we're going to focus on the cutaneous innervation of the lower limb.
Which is derived mostly from the lumbar plexus formed by the anterior rami of the L1 to L4 spinal nerves. And the sacral plexus formed by the anterior rami of the L4 to S4 spinal nerves.
Decutaneous nerves are located in the subcutaneous tissue, and they supply sensory innervation to the skin of the lower limb.
OK, so let's start with a cutaneous innervation of the thigh. First, the L1 anterior ramus divides at the lateral edge of the psoas major muscle into the iliohypogastric nerve and the ilio inguinal nerve.
Cutaneous innervation16:52–24:57
After branching from the common trunk, the iliohypogastric nerve continues behind the kidneys and in front of the quadratus lumborum muscle.
It then pierces the transversus abdominus muscle to move anteriorly between it and the internal oblique muscle. When it reaches the iliac crest, it gives off a lateral cutaneous branch to supply the posterior lateral gluteal skin.
The remaining part of the iliohypogastric nerve, which is now called the anterior cutaneous branch, turns obliquely downwards and medially at the anterior superior iliac spine, and it pierces the aponeurosis of the external oblique muscle superior to the superficial inguinal ring.
It distributes multiple branches to the skin of the pubic region, more specifically, the skin over the lower part of the rectus abdominus and mons pubis.
The ilio inguinal nerve passes obliquely across the quadratus lumborum before entering the transversus abdominus near the anterior end of the iliac crest.
Moving on, the nerve enters the inguinal canal where it travels with the spermatic cord in males or the round ligament of the uterus in females until it leaves the inguinal canal at the superficial inguinal ring.
In the lower limb, the ileo inguinal nerve supplies the skin over the medial femoral triangle. The lateral cutaneous nerve of the thigh, also known as the lateral femoral cutaneous nerve, is a nerve that arises from the anterior rami of the L2 and L3 spinal nerves.
The nerve emerges near the middle of the lateral border of the psoas major muscle from where it courses obliquely and then deep to the inguinal ligament where it emerges 2 to 3 centimeters medial to the anterior superior iliac spine.
It then passes over the sartorius muscle to supply the skin over the anterior and lateral aspects of the thigh. Then there's the genitofemoral nerve, which arises from the anterior rami of the L1 and L2 spinal nerves.
The nerve descends along the anterior surface of the psoas major towards the inguinal ligament. Now just above the inguinal ligament, both genitofemoral nerves divide into genital and femoral branches.
So now it should make sense why the nerve is called the genitofemoral nerve. In men, the genital branch enters the inguinal canal through the deep inguinal ring and accompanies the spermatic cord, ultimately supplying the anterior scrotum.
In females, the nerve accompanies the round ligament of the uterus and provides innervation to the skin of the mons pubis and labia majora.
The femoral branch descends lateral to the external iliac artery and passes beneath the inguinal ligament to supply the skin of the upper anterior medial thigh.
The femoral nerve is the nerve of the anterior compartment of the thigh. It arises from the anterior rami of L2 to L4, and it descends through the psoas major only to emerge on its lateral border where it passes between the psoas major and iliacus.
It gives off branches that innervate the iliacus and then enters the thigh by passing deep to the inguinal ligament, lateral to the femoral sheath.
This is where it splits into motor branches which innervate all the muscles of the anterior compartment of the thigh and into cutaneous branches which supply the majority of the skin of the anterior thigh.
A terminal cutaneous branch called the saphenous nerve continues distally to innervate the skin of the anterior and medial surface of the leg and foot.
Another important nerve of the thigh is the operator nerve, which innervates the medial compartment of the thigh. This nerve also arises from the anterior rami of L2 to L4.
It descends medial to psoas major, then passes through the operator canal, which is the hole in the operator membrane that covers the operator foramen.
Upon entering the thigh, the operator nerve divides into anterior and posterior divisions, with the anterior division going over top of and the posterior division piercing the obterior externus muscle.
Both divisions innervate muscles of the medial compartment of the thigh, and a cutaneous branch from the anterior division supplies skin along mid portion of the medial thigh.
Next, the posterior cutaneous nerve of the thigh, also known as the posterior femoral cutaneous nerve, arises from the anterior rami of the S1 through S3 spinal nerves.
It travels laterally into the greater sciatic foramen where it exits the pelvis below the piriformis muscle. Within the gluteal region, the nerve is situated deep to the gluteus maximus muscle, and it has a downward trajectory deep into the fasciata.
Branches of the nerve pierce the fascia to supply the skin of the posterior thigh and popliteal fossa. Moving on to the cutaneous innervation of the leg and foot, the saphenous nerve is a continuation of the deep division of the femoral nerve in the femoral triangle.
The nerve runs within the adductor canal, but it doesn't pass through the adductor hiatus. Then it curves behind the sartorius to reach the medial part of the knee.
It continues its downward trajectory by accompanying the great saphenous vein along the posterior border of the tibia and in the lower third of the leg.
The nerve provides sensation to the medial aspects of the leg and the medial border of the foot. The common fibular nerve contains fibers from the anterior rami of L4 to S2.
It's actually the lateral division of the sciatic nerve, with the bifurcation typically occurring in the lower third of the thigh.
From here it slopes laterally and downwards in the popliteal fossa, where it runs along the medial border of biceps femoris.
It exits the popliteal fossa over the plantais muscle and the lateral head of the gastronimus muscle. And then it winds its way around the neck of the fibula to enter the lateral compartment of the leg.
Here in the fibularis longus muscle, it divides into two terminal branches the superficial and deep fibular nerves. Now the sensory branches of the superficial fibular nerve innervate the skin of the anterior lateral leg and dorsum of the foot.
The deep fibular nerve innervates the skin of the web space between the 1st and 2nd toes. The serral nerve is formed by the union of the branch of the tibial nerve and a branch of the common fibular nerve.
Once formed at the distal third of the gastronneus, the nerve descends on the posterior lateral aspect of the leg and innervates the posterolateral leg and lateral margin of the foot.
And finally, the medial plantar nerve, which consists of fibers from L4 and L5, and the lateral plantar nerve, which consists of fibers from S1 and S2, represent the two terminal divisions of the tibial nerve.
The medial plantar nerve passes between the 1st and 2nd layers of plantar muscles and eventually between the medial and middle muscles of the first muscular layer of the foot to supply the skin of the medial sole and plantar aspects and sides of the medial.
3.5 toes, the lateral plantar nerve also passes between the 1st and 2nd layers of the plantar muscles and then between the middle and lateral muscles of the first muscular layer to supply the skin of the lateral sole and the plantar aspect and size of the lateral 1.5 toes.
Dermatomes24:57–26:41
And finally, it's important to note that an area of skin supplied by an individual spinal nerve is called a dermatome. This means that the cutaneous innervation of the skin can be described in terms of a discrete dermatome map.
For example, the skin overlying the proximal anterior thigh belongs to the L2 dermatome. This is because this cutaneous area is innervated by sensory fibers from the femoral nerve and lateral cutaneous nerve of the thigh that terminate at the L2 spinal level.
By looking at a dermatome map, we can see the distribution of dermatomes in the lower limb. The L1 dermatome is at the upper anterior thigh right underneath the inguinal ligament.
L2 is an oblique band of skin at the level of the mid anterior thigh midway between the midpoint of the inguinal ligament and the medial epicondyle of the femur.
L3 is a diagonal band of skin covering the medial epicondyle of the femur. L4 is a roughly vertical band that covers the medial malleolus and the medial side of the great toe.
L5 spans the lateral aspect of the thigh, leg, and most of the dorsum of the foot. The S1 dermatome covers the posterior lateral aspect of the thigh, leg, and foot.
S2 is also a vertical posterior band, and it covers the midpoint of the popliteal fossa. S3 covers part of the genitals and encircles the buttock region.
Covering the ischial tuberosity and finally S4 and S5 cover the perianal area. Similar to dermatomes, the lower limb also has myotomes, which are groups of muscles that receive motor innervation from a single spinal nerve.
Myotomes26:41–28:21
Now, lower limb muscles usually receive motor fibers from more than one spinal cord segment, which complicates things and results in most muscles being composed of more than one myotome.
To understand the concept of myotomes, it's easier to know which myotomes are associated with the different movements that occur in the lower limb.
For example, the myotome for knee extension is L3 and L4. This makes sense because knee extension is carried out by the quadriceps femoris muscle.
The L3 L4 myotome is derived from the fact that the femoral nerve receives contributions from the L2, L3, and L4 spinal segments.
By knowing which muscles cause movements of the lower limb, we can figure out that movement's myotome. Let's take a closer look.
Hip flexion is myotom L2, L3, while hip extension is L4, L5. Hip abduction is L1 through L4, and abduction is L5-S1.
Internal rotation of the hip is L1 through L3, and external rotation of the hip is L5-S1. Regarding the knee, knee extension is L3, L4, while knee flexion is L5-S1.
Ankle dorsiflexion is L4, L5, and plantar flexion is S1S2. Finally, inversion of the foot is L4, L5, and E version is L5-S1.
Quiz28:21–28:41
Well, that must have been nerve-wracking. Let's pause for a minute and see if you can correctly identify the dermatomes and myotomes of the lower limb.
Review28:41–33:43
All right, as a quick recap. The superficial fascia or subcutaneous tissue is a fat-filled layer of connective tissue underneath the skin that contains arteries, veins, nerves, and lymph vessels and nodes.
The deep fascia can be further divided into fasciata and the coral fascia. Fasciata encloses the large thigh muscles, and it gives birth to three intermuscular septa which form the walls of the anterior, medial, and posterior compartments of the thigh.
The saphenous opening is an oval gap in the fasciata located anteriorly in the upper medial part of the thigh, and it provides passage for many structures including the great saphenous vein.
Similarly, the coral fascia forms two intermuscular septa which, along with the interosseous membrane, divide the leg into three fascial compartments anterior, lateral, and posterior.
The veins of the lower limb can be divided into superficial and deep veins. Superficial veins include the great saphenous vein, which is formed by the dorsal vein of the great toe and the dorsal venous arch of the foot.
And then there's also the small saphenous vein, which ascends the posterior leg. The deep veins of the lower limb lie in the fascial compartments formed by the deep fascia, and they all accompany the major arteries of the lower limb in pairs.
Regarding lymphatic nodes, the most important ones are in the inguinal nodes. Which are found in the upper aspects of the femoral triangle and the popliteal nodes which are often embedded in fat reserves of the popliteal fossa.
Now the lymphatic vessels that accompany the great saphenous vein originate on the dorsal surface of the foot and end in the superficial inguinal lymph nodes.
The lymphatic vessels accompanying the small saphenous vein arise from the lateral surface of the foot and enter the popliteal lymph nodes.
Moving on to the cutaneous innervation of the lower limb, the iliohypogastric nerve arises with the ilio inguinal nerve as a single trunk from the L1 anterior ramus, and it supplies the posterior lateral gluteal skin and the skin of the upper pubic region.
The ileo inguinal nerve supplies the skin over the medial femoral triangle. The lateral cutaneous nerve of the thigh receives contributions from L2 and L3, and it supplies the anterior and posterior aspects of the lateral thigh.
Then there's a genitofemoral nerve, which receives contributions from L1 and L2. Its genital branch supplies the anterior scrotum in males and the skin of the mons pubis and labia majora in females, while its femoral branch supplies the skin of the groin just below the mid part of the inguinal ligament.
The femoral nerve arises within the psoas major muscle from L2 to L4, and it supplies the skin of the anterior thigh. The obtraor nerve arises from L2 to L4 as well, and its cutaneous branch supplies skin along the mid portion of the medial thigh.
Next, the posterior cutaneous nerve of the thigh arises from the S1 through S3 nerves, and it supplies the skin of the lower portion of the buttock, posterior thigh, and popliteal fossa.
The saphenous nerve is a continuation of the deep division of the femoral nerve in the femoral triangle, and it provides sensation to the medial leg and the medial aspect of the foot.
The common fibular nerve contains fibers from L4 to S2. It splits into the superficial fibular nerve, which innervates the skin of the anterior lateral leg and dorsum of the foot, and the deep fibular nerve, which innervates the skin of the web surface between the 1st and 2nd toes.
The serile nerve is formed by the union of a branch of the tibial nerve and a branch of the common fibular nerve, ultimately innervating the skin on the lower lateral aspect of the calf and foot.
And finally, the medial plantar nerve contains fibers from L4 and L5, and supplies skin to the medial sole and the plantar aspects of the medial 3.5 toes.
The lateral plantar nerve, which contains fibers from S1 and S2, supplies skin of the lateral sole and the plantar aspects of the lateral 1.5 toes.
The dermatomes of the lower limb consist mostly of vertical bands of skin, each innervated by sensory fibers that terminate in a single spinal cord segment between L1 and S4.
Finally, regarding myotomes, muscles are innervated by multiple spinal cord segments, so they are a part of multiple myotomes.
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- "The morphological and microscopical characteristics of posterior layer of human thoracolumbar fascia; A potential source of low back pain" Morphologie (2021)
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