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Nerve to Obturator Internus

nervus musculi obturatorii interni

The nerve to obturator internus arises from the sacral plexus, typically from the ventral rami of L5, S1, and S2. It exits the pelvis through the greater sciatic foramen below the piriformis, crosses the ischial spine, re-enters the pelvis through the lesser sciatic foramen, and supplies the obturator internus from its pelvic surface. It also supplies the superior gemellus muscle on its way through the lesser sciatic foramen.

Region: Pelvis & Hip

Clinical Relevance

Clinical Notes

The nerve to obturator internus follows a complex path through both the greater and lesser sciatic foramina, making it vulnerable to compression at the ischial spine by sacrospinous ligament fixation sutures during pelvic floor surgery, leading to obturator internus palsy with weak hip external rotation. It is also at risk during posterior hip approaches. Understanding its course is important in pelvic reconstructive surgery and in interpreting posterior hip pain syndromes.

Pathology

Common Injuries & Conditions

Sacrospinous Fixation Neuropathy

Sutures placed too laterally during sacrospinous ligament fixation for pelvic organ prolapse can compress the nerve to obturator internus and gemellus at the ischial spine, causing buttock pain and hip external rotation weakness that typically resolves with suture adjustment.