Hip

Question 1

What does the iliohypogastric nerve innervate (sensory, motor)?

Answer 1

Sensory: suprapubic region
Motor: transverse abdominis, internal oblique

Question 2

How does the iliohypogastric nerve get injured?

Answer 2

Abdominal surgery

Question 3

Symptoms of iliohypogastric nerve damage

Answer 3

Burning/tingling pain in surgical incision site radiating to inguinal & supra pubic region

Question 4

Sensory and motor innervation of genitofemoral nerve

Answer 4

Sensory: scrotum/labia majora, medial thigh
Motor: cremaster

Question 5

How does injury to the genitofemoral nerve occur?

Answer 5

Laparoscopic surgery

Question 6

Symptoms of injury to genitofemoral nerve

Answer 6

Decreased upper medial and anterior thigh sensation beneath inguinal ligament (lateral part of femoral triangle)
Absent cremasteric reflex

Question 7

Innervation of lateral femoral cutaneous

Answer 7

Sensory: anterior & lateral thigh

Question 8

Causes of injury to lateral femoral cutaneous nerve

Answer 8

Tight clothes, obesity, pregnancy, pelvic procedures

Question 9

Presentation of injury to lateral femoral cutaneous nerve

Answer 9

Decreased thigh sensation (anterior, lateral)
Meralgia paresthetica: compression of nerve results in tingling, numbness, burning pain in anterolateral thigh

Question 10

Sensory and motor innervation of obturator nerve

Answer 10

Sensory: medial thigh
Motor: obturator externus, adductors longus + magnus + brevis, gracilis, pectineus

Question 11

Damage to obturator nerve

Answer 11

Pelvic surgery

Question 12

Symptoms of obturator nerve damage

Answer 12

Decreased thigh sensation (medial) and adduction

Question 13

Sensory & motor innervation of femoral nerve

Answer 13

Sensory: anterior thigh, medial leg
Motor: quadriceps, iliacus, pectineus, sartorius

Question 14

Causes of injury to femoral nerve

Answer 14

Pelvic fracture

Question 15

Symptoms of femoral nerve injury

Answer 15

Decreased leg extension (decreased patellar reflex)

Question 16

Innervation of sciatic nerve

Answer 16

Motor: semitendinosus, semimembranosus, biceps femoris, adductor magnus

Question 17

Causes of injury to sciatic nerve

Answer 17

Herniated disc, posterior hip dislocation

Question 18

What does the sciatic nerve branch into

Answer 18

Common peroneal & tibial nerves

Question 19

Superficial and deep innervation of common (fibular) peroneal nerve

Answer 19

Superficial -
Sensory: dorsum of foot (except bw hallux & 2nd digit)
Motor: peroneus longus & brevis
Deep -
Sensory: webspace bw hallux & 2nd digit
Motor: tibialis anterior

Question 20

Causes of injury to common peroneal

Answer 20

Trauma/compression of lateral aspect of leg, fibula neck fracture

Question 21

Symptoms of common peroneal damage

Answer 21

Loss of sensation on dorsum of foot
Foot drop: inverted & plantarflexed at rest, loss of eversion & dorsiflexion; “steppage gait”

Question 22

Sensory & motor innervation of tibial nerve

Answer 22

Sensory: sole of foot
Motor: biceps femoris (long head), triceps surae (gastrocnemius, soleus), plantaris, popliteus, flexor muscles of the foot

Question 23

Causes of injury to tibial nerve

Answer 23

Knee trauma, Baker’s cyst (proximal lesion), tarsal tunnel syndrome (distal lesion)

Question 24

Symptoms of tibial nerve damage

Answer 24

Inability to curl toes & loss of sensation on sole
In proximal lesions (baker’s cyst), foot everted at rest w weakened inversion & plantarflexion

Question 25

Innervation of superior gluteal nerve

Answer 25

Motor: Gluteus medius & minimus, tensor fascia lata

Question 26

Causes of injury to superior gluteal nerve

Answer 26

Iatrogenic injury during IM injection to superomedial gluteal region (need to aim for anterolateral region)

Question 27

Signs of superior gluteal nerve damage

Answer 27

Trendelenberg gait: pelvis tilts because weight-bearing leg can't maintain alignment of pelvis through hip abduction Lesion is contralateral to the side of the hip that drops, ipsilateral to extremity on which the patient stands

Question 28

Innervation of inferior gluteal nerve

Answer 28

Motor: gluteus maximus

Question 29

Causes of injury to inferior gluteal nerve

Answer 29

Posterior hip dislocation

Question 30

Presentation of inferior gluteal nerve injury

Answer 30

Difficulty climbing stairs, rising from seated position Loss of hip extension

Question 31

Sensory and motor innervation of pudendal nerve

Answer 31

Sensory: perineum Motor: external urethral & anal sphincters

Question 32

Symptoms of pudendal nerve injury

Answer 32

Decreased sensation in perineum & genital area; can cause fecal &/or urinary incontinence Can be blocked w local anesthetic during childbirth using ischial spine as landmark

Question 33

Attachments of ACL

Answer 33

Lateral femoral condyle to anterior tibia

Question 34

Attachments of PCL

Answer 34

Medial femoral condyle to posterior tibia

Question 35

What is the anterior drawer sign

Answer 35

Bend knee at 90 degrees, increased anterior gliding of tibia anteriorly due to ACL injury Lachman test is more specific and done at 30 degrees

Question 36

What is the posterior drawer sign and what does it indicate?

Answer 36

Bend knee at 90 degrees, increased posterior gliding of tibia due to PCL injury

Question 37

Describe abnormal passive abduction in the knee

Answer 37

Aka valgus stress test Knee extended at 30 degree, lateral (valgus) force results in medial space widening of tibia = MCL injury

Question 38

Describe abnormal passive adduction in the knee

Answer 38

Aka varus stress test Knee at 30 degrees, medial (varus) force causes lateral space widening of tibia = LCL injury

Question 39

How is the McMurray Test conducted

Answer 39

During flexion/extension of the knee w rotation of tibia/foot (LIME) - pain, "popping" on internal rotation & varus force = lateral meniscus tear - pain, "popping" on external rotation & valgus force = medial meniscal tear