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Lec 18 Peripheral Nerve Injuries Flashcards

1
Q

Explain dermatome patterns - front of leg

A

starting at inner thigh L1, then L2 moving laterally then L3, L4 makes it down to shin and medial malleolus, L5 comes from back side and wraps around at knee and cover dorsum of foot, S1 is pinky tow and lateral malleolus

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1
Q

KNOW PERIPHERAL INNERVATION OF THE LOWER LEG AND FOOT

KNOW PARENT STRUCTURES

A
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2
Q

Describe dermatomes back of leg

A

L5 upper lateral thigh/glute wraps around to front before the knee

moving in is S1, from top to bottom, S2,

bottom of foot is S2 and L5 (wrapped over toes from dorsum)

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2
Q

Name the peripheral nerves in the inguinal region and their general location

A

Genitofemoral nerve
Ilioinguinal nerve

From lateral to medial its femoral branch, ilioinguinal, genital branch

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2
Q

Peripheral sensory location of Obturator Nerve

A

upper medial thigh

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2
Q

remember sural =
saphenous =

A

sural = lateral
saph = medial

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3
Q

Peripheral sensory location of lateral cutaneous nerve

what’s its parent structure?

A

lateral thigh

from lumbar plexus L2 L3

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3
Q

describe the peripheral nerve map of the leg

A

femoral front of thigh

obturator upper medial thigh

lateral cutaneous femoral nerve on lateral thigh (not a branch of femoral!)

posterior cutaneous nerve on back of thigh past knee

femoral nerve saphenous branch on medial lower leg

common fibular lateral cutaneous on upper half of lateral leg

common fibular superficial on lower half of lateral lower leg and dorsum of foot

tibial nerve sural branch on lateral ankle and 5th toe

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4
Q

Femoral nerve peripheral sensory location

A

anterior thigh (anterior cutaneous nerve)

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4
Q

describe the peripheral nerves of the foot and their location (list their parent structure)

A

saphenous nerve (femoral) medial ankle

common fibular nerve superficial branch (common fibular nerve, then sciatic) on lateral ankle and dorsum of foot

lateral cutaneous nerve of foot (sural nerve)

dorsal digital nerve (from deep fibular nerve) between toe 1 and 2

medial plantar nerve (tibial nerve) on medial plantar side, toes 1-4.5, wraps around to toes on dorsal side (like the palm)

lateral plantat nerve (tibial nerve) on lateral plantar surace, toes 4.5-5

medial calcaneal branch (tibial nerve) on heel

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5
Q

Saphenous nerve Peripheral sensory location

What is its parent structure?

A

Medial lower leg

Femoral nerve branch

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6
Q

Common fibular nerve (lateral cutaneous) Peripheral sensory location

What is its parent structure?

A

superior half of lateral lower leg and lateral calf

Common fibular nerve

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7
Q

Peripheral sensory location of common fibular nerve (superficial branch)

A

inferior half of lateral lower leg and dorsum of foot

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8
Q

Peripheral sensory location of common fibular nerve (deep branch)

A

in between 1st and 2nd toe

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9
Q

Tibial nerve (sural) and (medial calcaneal branches) Peripheral sensory location

A

sural - lateral edge of foot and back of lateral ankle

medial calcaneal - back of heel

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10
Q

Peripheral nerves on the plantar surface of the foot

A

medial plantar nerve and lateral plantar nerve

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11
Q

Posterior cutaneous nerve of thigh Peripheral sensory location

A

posterior end of glute down just passed knee

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12
Q

so the entire plantar surface is supplied with peripheral nerves from what parent nerve?

A

tibial nerve

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13
Q

Who is the main hip medial rotator?

A

TFL!

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14
Q

What are causes of sciatica?

A

Herniated NP
Spondylosis
Spondylolysis/Spondylolisthesis
Spinal stenosis
Osteophytes
Piriformis
Hamstring strain

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15
Q

the piriformis divides the greater sciatic foramen into …

A

superior and inferior portions

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16
Q

What nerves are names based on their location relative to piriformis?

A

superior gluteal nerve

inferior gluteal nerve

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17
Q

tibial nerve course

A

The tibial nerve runs down the posterior thigh and posterior calf innervating muscles there before splitting into the medial and lateral plantar nerves at the ankle, which then provide sensory and motor innervation to the foot

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18
Q

common fibular nerve course

A

The common fibular nerve travels laterally around the fibular head (near the knee), then divides into its two terminal branches.

The deep fibular nerve innervates the anterior compartment of the leg (muscles that dorsiflex the foot, such as tibialis anterior).

The superficial fibular nerve innervates the lateral compartment of the leg (fibularis longus and brevis muscles).

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19
How is Piriformis Syndrome caused? What will it affect?
portion of the sciatic nerve can pierce the piriformis or the piriformis can become chronically tight/spasms especially in women and cyclist Will affect ROM (hip internal rot)
20
What would increase sciatic pain in piriformis syndrome? In what direction do you stretch it to relieve symptoms?
muscle contraction would compress the nerve causing symptoms stretch in opposite direction of its main action - so do hip internal rotation (with extended hip) and adduction with flexed hip (?)
21
The sciatic nerve runs down the entire...
posterior leg, entire foot, entire anterior lower leg think about these areas if the sciatic nerve was injured
22
Where does the lateral femoral cutaneous nerve get entrapped? Why does this happen?
under the inguinal ligament tight clothing - the Britney spears! obesity/weight gain pregnancy local trauma diabetes
23
What is the result of entrapment of the lateral femoral cutaneous nerve?
paresthesia and/or decreased sensation
24
What is Meralgia paresthetica related to?
when the lateral femoral cutaneous nerve becomes irritated, burning tingling sensation on lateral thigh
25
Spinal levels of lateral cutaneous femoral nerve
L2 L3
26
Femoral nerve entrapment sites Spinal levels?
beneath iliopsoas inguinal ligament femoral triangle adductor canal L2 L3 L4
27
Where is the obturator nerve commonly injured? What motions/sensory areas would this affect?
injury as it passes through the obturator canal - covered by the obturator membrane in the obturator foramen anterior hip dislocation or prostate surgery results in difficult adducting and decreased sensation of upper medial thigh L2 L3 L4
28
Superior Gluteal Nerve entrapment (location), what does it cause (symptoms)?
caused by piriformis muscle compression achy-type claudication buttock pain, tender to palpation and WADDLING gait (trendelenburg)
29
Why does entrapment of the superior gluteal nerve cause waddling gait/trendelenburg?
because SG nerve innervated glute medius which stabilizes the pelvis with SL stance so when the right leg comes up, you lean to the right bc you left glute can stabilize you well
30
What nerve is most often injured in the lower limb? Why?
Common fibular - runs very superficial around head of fibula
31
How can the common fibular nerve be injured?
direct trauma (its very superficial) severed during fracture of the fibular neck severely stretched when the knee joint is injured or dislocated
32
What would result from injuries to the common fibular nerve? Think about the muscles it innervates
common fibular nerve - flaccid paralysis of all muscles in the anterior and lateral compartments of the leg loss of dorsiflexion, no eccentric control and makes a clop sound when walking, steppage gait loss of sensation to anteriolateral lower leg and b/w first two toes *if it was just the superficial branch injured, would you have drop foot? NO
33
What gait consequences will the patient perform to compensate from drop foot?
they will have to lift their leg higher or foot will drag, they will lean onto stronger side
34
How can the deep fibular nerve be entrapped? Where would you feel pain?
excessive use of the muscles supplied by the deep fibular nerve (during skiing, running etc) may result in muscle injury and edema to anterior compartment *nerve is deep to inferior extensor retinaculum and EHB in dorsum of foot also occur in soccer players - can get "ski boot syndrome" with tight shoes pain in dorsum of foot and between 1st and 2nd toes
35
If you are wearing tight shoes, and compress your deep fibular nerve, an injury may occur. Would this affect your tibialis anterior?
No, because it would already be innervated before the top of the foot location of entrapment matters!
36
How is the superficial fibular nerve commonly entrapped?
chronic ankle sprains may produce recurrent stretching of the superficial fibular nerve which may cause pain on lateral side of leg and dorsum of foot and ankle inversion would stretch lateral features
37
What are symptoms of pudendal nerve entrapment?
chronic, severely disabling neuropathic pain, pudendal neuralgia, pain with sitting
38
What two ligaments does the pudendal nerve exit between? What space does it go through after?
sacrospinous and sacrotuberous transverses through pudendal canal formed by the obturator fascia and ST ligament
39
What is a popliteal cyst?
fluid filled growth behind the knee, continuation of the bursa complication of chronic knee joint effusion common in children but can grow large in adults
40
How is the tibial nerve injured at the knee? What motion or sensory would you lose?
Ca be severed during a posterior dislocation of the knee (tibia on femur) Lose plantarflexion and flexion of toes, sensation on lateral ankle, heel and bottom of foot
41
Besides the knee, where is another problem site for the tibial nerve? Symptoms?
Tarsal tunnel - runs posterior to medial mall, deep to flexor reticulum Causes edmea and tightness, synovial shealths tightness, heal pain, foot burning and weakness
42
Sural nerve entrapment sites
fibrous arcade at lower lateral leg baker cyst (popliteal) gastroc strains fracture of 5th metatarsal
43
Sural nerve entrapment symptoms
achy posterolateral calf pain neuropathic pain in sural nerve distribution
44
How is sural nerve entrapment tested for?
positive tinels - tapping the location of entrapment to look for pain hypoaesthesia - reduced sensation provocation (increasing tension on the nerve) by ankle DF and inversion to see if symptoms arise diagnostic injection consider imaging, EDT
45
What are the three branches of the tibial nerve
calcaneal branch medial plantar nerve lateral plantar nerve
46
What foot position is related to tarsal tunnel syndrome?
overpronation also causes pes planus - flat feet
47
Describe what is meant by "double crush" of the tibial nerve
you can have irritation at spinal levels and get low back pain (sciatic parent structure) and irritation of tibial nerve at tarsal tunnel causing toe weakness
48
What is Baxters Neuropathy What area of the body would be affected?
Medial nerve entrapment - compressive irritation as it passes deep to the flexor retinaculum or curves deep to abductor hallucis medial side of sole and foot and in navicular tuberosity region
49
What foot position causes medial plantar entrapment/baxters neuropathy?
eversion common in runners - joggers foot (footwear important)
50
Describe pronation and what joints participate
normal rotation of front of foot laterally relative to back of the foot ankle DF, Hindfoot eversion, forefoot abduction (all three planes of motion) talocrural joint subtalar joint (hindfoot) transtarsal joints tarsometatarsal
51
Describe supination and what joints participate
normal rotating of the front of foot medially relative to the back ankle PF hindfoot inversion forefoot adduction talocrural joint subtalat joint transtarsal joints tarsometatarsal
52
What happens to the medal foot arch in supination vs pronation?
pronation - medial arch lowers supination - medial arch rises if you do the movements you can feel your arch get bigger and smaller
53
A high ankle sprain is what kind of sprain? What structures are involved?
Synesdmotic ankle sprain Tibiofibular syndesmosis Interosseos membrane Anterior tibiofibular ligament
54
What foot movements are common mechanisms for a high ankle sprain?
External rotation and DF
55
Where does a chophart injury occur?
dislocation of midtarsal joints of foot, transverse tarsal joint often fractures of clacaneus, cuboid and navicular bone with it
56
What is Charcot Marie tooth?
Neurological disorder - hereditaty sensory and motor neuropathy Lack of muscle, high arches (pes CAVUS) or low arch (pes PLANUS), claw toes
57
What is mallet toe, what causes it?
flexion of the distal phalanx of a long toe ill fitting shoes, arthritis, trauma, neuromuscular and or metabolic disease
58
What is hammer toe? What can form with it?
Proximal phalanx hyperextended at MTP middle phalanx flexed at PIP DIP hyperextended callus can form on PIP
59
What muscles could be weak that result in hammer toe?
Lumbricals - they cause MTP flexion and PIP extension (opposite of hammer toe) and extrinsic muscles that affect toes
60
claw toes
hyperextended MTP and flexion of DIP of lateral 4 toes
61
What is morton's toe? What might it affect?
2nd toe extends more distal than the other digits from metatarsal origin can affect your gait and shoe style (10-30% of people)
62
Describe what mortons neuroma is and what nerve is affected What 2 toes are most affected?
Morton's neuroma is a benign growth (often a thickening or fibrosis) of nerve tissue, typically occurring in the intermetatarsal spaces of the foot. It most commonly affects the common digital nerve (from media, or plantar nerves from tibial n) between the third and fourth toes (interdigital) caused by nerve irritation, which often results from repetitive stress or compression on the nerve, leading to the formation of the neuroma (a benign tumor-like thickening of the nerve) cause - improper shoe type!
63
Joggers foot
Aching burning numbness and tingling on medial side of sole of foot and navicular tuberosity region Constant eversion Medial nerve entrapment / baxters

Anatomy (23 decks)

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