Saphenous nerve (n. saphenus): anatomy, topography, and branches

Where does the saphenous nerve run?

The topography of n. saphenus is associated with the course of the femoral vessels and the adductor canal.

In the thigh: The nerve accompanies the femoral vessels (a. et v. femoralis). Together with them, it enters the adductor canal (Hunter's canal, canalis adductorius).
In the adductor canal: The nerve lies within the canal, whose walls are formed laterally by m. vastus medialis, medially by lamina vastoadductoria, and posteriorly by m. adductor longus in the upper part and m. adductor magnus more inferiorly.
Exit from the canal: The saphenous nerve does not exit through the tendinous hiatus of the adductor magnus (hiatus tendineus / adductorius). It leaves the canal through the anterior opening in the intermuscular septum (septum intermusculare vastoadductoria). According to variant anatomy, the exit may occur through a single common opening or multiple separate openings.
After exit: The nerve emerges into the subcutaneous tissue beneath the sartorius muscle (m. sartorius) and passes beneath the fascia toward the medial surface of the knee. N. saphenus and v. saphena magna are indicated in the medial retromalleolar region.

What structures accompany the nerve?

Along its course, n. saphenus is associated with the following structures:

Femoral vessels (a. et v. femoralis) — the nerve accompanies them in the thigh and within the adductor canal.
Descending genicular artery (a. descendens genus) and the saphenous branch of the descending genicular artery (r. saphenus a. genus descendens) — the nerve emerges with them through the anterior opening of the adductor canal.

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Innervation zones

The saphenous nerve innervates the skin in the following areas:

Leg: A narrow strip of skin on the posteromedial surface. On the medial side of the leg, its branches reach the border with the anterior region.
Foot: The branches of the nerve innervate the skin of the medial margin of the foot, reaching the middle of its inner border. The lateral margin of the foot is innervated by n. suralis, and the main part of the dorsum by branches of n. fibularis superficialis.

Clinical significance

Injury or compression of the saphenous nerve presents with the following clinical picture:

Compression in the adductor canal: Compression of n. saphenus in the narrow part of the canal may cause paresthesias along the medial surface of the leg. Compression of the femoral vessels causes ischemic pain in the leg and foot.
Isolated lesion: Results in hypoesthesia along the medial margin of the leg and foot. An important diagnostic sign is the absence of motor deficit.
Diagnostics: To assess the severity of peripheral nerve damage, including n. saphenus, electromyography (EMG) and nerve conduction velocity (NCV) testing are the gold standards.

Class and exam questions

Does n. saphenus exit through the tendinous hiatus (hiatus adductorius)?

No. The femoral artery passes through the tendinous hiatus and continues as the popliteal artery. The femoral vein is listed among the contents of the canal, but the saphenous nerve does not exit through the tendinous hiatus. It leaves the adductor canal through the anterior opening in the intermuscular septum.

With which structures does the saphenous nerve emerge from the adductor canal?

The nerve emerges through the anterior opening of the canal together with the descending genicular artery (a. descendens genus) and the saphenous branch of the descending genicular artery (r. saphenus a. genus descendens).

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What else to study on this topic

Adductor canal (canalis adductorius)
Femoral nerve (n. femoralis)
Great saphenous vein (v. saphena magna)
Cutaneous innervation of the lower limb

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Saphenous nerve