Lower Limb Nerve Injuries Flashcards
(118 cards)
1
Q
Organisation of Lower Limb nerves
- Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between … and L2)
- Below - cauda … - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
A
- Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and L2)
- Below - cauda equina - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
2
Q
Organisation of Lower Limb nerves
- Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and …)
- Below - … equina - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L…/L4 - below spinal cord end)
A
- Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and L2)
- Below - cauda equina - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
3
Q
Organisation of Lower Limb nerves
- Lower limb nerves starts in … horn cell within spinal cord (spinal cord stops between L1 and L2)
- Below - cauda equina - … puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
A
- Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and L2)
- Below - cauda equina - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
4
Q
Organisation of Lower Limb nerves
- Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and L2)
- Below - cauda equina - lumbar puncture go below end of spinal cord (lie laterally, … crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
A
- Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and L2)
- Below - cauda equina - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
5
Q
Cauda equina vs conus lesions
A
6
Q
Landmarks for lumbar puncture
- Below end of … … - lie laterally, find iliac … - 1 or 2 spaces above = below spinal cord which will be around L3,L4 (spinal cord ends at …)
A
- Below end of spinal cord - lie laterally, find iliac crest - 1 or 2 spaces above = below spinal cord which will be around L3,L4 (spinal cord ends at L1/L2)
7
Q
Cauda equina vs conus medullaris
A
8
Q
Cauda equina vs conus medullaris
A
9
Q
Cauda equina vs conus medullaris
A
10
Q
Causes of Cauda equina
- Disc …
- … fracture
- T…
A
- Disc herniation
- Spinal fracture
- Tumours
11
Q
3 causes of cauda equina are…
A
- Disc herniation
- Spinal fracture
- Tumours
12
Q
Causes of Conus medullaris
- Disc …, T..
- … conditions (e.g. Chronic Inflammatory Demyelinating Polyradiculopathy ,Sarcoidosis)
- … (E.g. CMV, HSV, EBV, Lyme, TB)
A
- Disc herniation, tumour,
- Inflammatory conditions (e.g. Chronic Inflammatory Demyelinating Polyradiculopathy ,Sarcoidosis)
- Infection (E.g. CMV, HSV, EBV, Lyme, TB)
13
Q
Causes of Conus medullaris (4)
A
- Disc herniation
- Tumour
- Inflammatory conditions (Chronic Inflammatory Demyelinating Polyradiculopathy Sarcoidosis)
- Infection (e.g. CMV, HSV, EBV, Lyme, TB)
14
Q
This shows a …
A
L5/S1 disc herniation compressing cauda equina
15
Q
Nerve Root Entrapment – ‘sciatica
- Compression- Disc- posterior central, lateral Bone- osteophyte Ligaments
- Small canal- stenosis
- Sciatica – usually L…, S… n. root impingement
- L… n. root – exits between L…/ S…vertebral bodies S… n. root exits between S… / S… vertebral bodies
- Pain may be felt in dermatome (sharp/ superficial) or myotome (deep ache)
A
- Compression- Disc- posterior central, lateral Bone- osteophyte Ligaments
- Small canal- stenosis
- Sciatica – usually L5, S1 n. root impingement
- L5 n. root – exits between L5/ S1 vertebral bodies S1 n. root exits between S1 / S2 vertebral bodies
- Pain may be felt in dermatome (sharp/ superficial) or myotome (deep ache)
16
Q
Nerve Root Entrapment – ‘sciatica
- Compression- Disc- posterior central, lateral Bone- osteophyte Ligaments
- Small canal- stenosis
- Sciatica – usually L5, S1 n. root …
- L5 n. root – exits between L5/ S1 vertebral bodies S1 n. root exits between S1 / S2 vertebral bodies
- Pain may be felt in … (sharp/ superficial) or … (deep ache)
A
- Compression- Disc- posterior central, lateral Bone- osteophyte Ligaments
- Small canal- stenosis
- Sciatica – usually L5, S1 n. root impingement
- L5 n. root – exits between L5/ S1 vertebral bodies S1 n. root exits between S1 / S2 vertebral bodies
- Pain may be felt in dermatome (sharp/ superficial) or myotome (deep ache)
17
Q
Nerve Root Entrapment – ‘sciatica
- Compression- …- posterior central, lateral Bone- osteophyte Ligaments
- Small canal- stenosis
- Sciatica – usually L5, S1 n. … impingement
- L5 n. root – exits between L5/ S1 vertebral bodies S1 n. root exits between S1 / S2 vertebral bodies
- Pain may be felt in dermatome (s…/ s…) or myotome (… ache)
A
- Compression- Disc- posterior central, lateral Bone- osteophyte Ligaments
- Small canal- stenosis
- Sciatica – usually L5, S1 n. root impingement
- L5 n. root – exits between L5/ S1 vertebral bodies S1 n. root exits between S1 / S2 vertebral bodies
- Pain may be felt in dermatome (sharp/ superficial) or myotome (deep ache)
18
Q
Lower Limb Root Lesions - reflex and sensory loss
- Lower limb dermatomes more variable than upper limb
- L1 … area
- L2 front of … (front pocket)
- L3 front of …
- L4 front- inner/ medial leg
- L5 outer leg, dorsum of foot, inner sole
- S1 little toe, rest of sole, back of leg
- S2 thigh to top of buttock (back pocket)
- S3-S5 concentric rings round anus/ genitalia
- Knee jerk L4, Ankle jerk S1
A
- Lower limb dermatomes more variable than upper limb
- L1 inguinal area
- L2 front of thigh (front pocket)
- L3 front of knee
- L4 front- inner/ medial leg
- L5 outer leg, dorsum of foot, inner sole
- S1 little toe, rest of sole, back of leg
- S2 thigh to top of buttock (back pocket)
- S3-S5 concentric rings round anus/ genitalia
- Knee jerk L4, Ankle jerk S1
19
Q
Lower Limb Root Lesions - reflex and sensory loss
- Lower limb dermatomes more variable than upper limb
- L1 inguinal area
- L2 front of thigh (front pocket)
- L3 front of knee
- L4 front- inner/ … leg
- L5 … leg, … of foot, inner …
- S1 … toe, rest of …, back of leg
- S2 thigh to top of … (back pocket)
- S3-S5 concentric rings round anus/ genitalia
- Knee jerk L4, Ankle jerk S1
A
- Lower limb dermatomes more variable than upper limb
- L1 inguinal area
- L2 front of thigh (front pocket)
- L3 front of knee
- L4 front- inner/ medial leg
- L5 outer leg, dorsum of foot, inner sole
- S1 little toe, rest of sole, back of leg
- S2 thigh to top of buttock (back pocket)
- S3-S5 concentric rings round anus/ genitalia
- Knee jerk L4, Ankle jerk S1
20
Q
Lower Limb Root Lesions - reflex and sensory loss
- Lower limb dermatomes more variable than upper limb
- L1 … area
- L2 front of thigh (… pocket)
- L3 front of knee
- L4 front- inner/ medial leg
- L5 outer leg, dorsum of foot, inner sole
- S1 little toe, rest of sole, back of leg
- S2 … to top of buttock (… pocket)
- S3-S5 … rings round anus/ genitalia
- Knee jerk L4, Ankle jerk S1
A
- Lower limb dermatomes more variable than upper limb
- L1 inguinal area
- L2 front of thigh (front pocket)
- L3 front of knee
- L4 front- inner/ medial leg
- L5 outer leg, dorsum of foot, inner sole
- S1 little toe, rest of sole, back of leg
- S2 thigh to top of buttock (back pocket)
- S3-S5 concentric rings round anus/ genitalia
- Knee jerk L4, Ankle jerk S1
21
Q
Lower Limb Root Lesions - reflex and sensory loss
- Lower limb dermatomes more variable than upper limb
- L1 inguinal area
- L2 front of thigh (front pocket)
- L3 front of …
- L4 front- inner/ medial leg
- L5 outer leg, dorsum of foot, inner sole
- S1 little toe, rest of sole, back of leg
- S2 thigh to top of buttock (back pocket)
- S3-S5 concentric rings round …/ …
- … jerk L4, … jerk S1
A
- Lower limb dermatomes more variable than upper limb
- L1 inguinal area
- L2 front of thigh (front pocket)
- L3 front of knee
- L4 front- inner/ medial leg
- L5 outer leg, dorsum of foot, inner sole
- S1 little toe, rest of sole, back of leg
- S2 thigh to top of buttock (back pocket)
- S3-S5 concentric rings round anus/ genitalia
- Knee jerk L4, Ankle jerk S1
22
Q
Lower Limb Root Lesions - weakness
- L1/2 … flexion
- L3/4 … extension
- L4 … inversion
- L5 Knee flexion Ankle …
- Toe extension
- Foot inversion and eversion
- S1 Knee flexion
- Ankle plantar flexion
- Toe flexion Foot eversion
A
- L1/2 Hip flexion
- L3/4 Knee extension
- L4 Foot inversion
- L5 Knee flexion Ankle dorsiflexion
- Toe extension
- Foot inversion and eversion
- S1 Knee flexion
- Ankle plantar flexion
- Toe flexion Foot eversion
23
Q
Lower Limb Root Lesions - weakness
- L1/2 Hip flexion
- L3/4 Knee extension
- L4 Foot inversion
- L5 … flexion … dorsiflexion
- … extension
- Foot … and …
- S1 Knee flexion
- Ankle plantar flexion
- Toe flexion Foot eversion
A
- L1/2 Hip flexion
- L3/4 Knee extension
- L4 Foot inversion
-
L5 Knee flexion Ankle dorsiflexion
- Toe extension
- Foot inversion and eversion
- S1 Knee flexion
- Ankle plantar flexion
- Toe flexion Foot eversion
24
Q
Lower Limb Root Lesions - weakness
- L1/2 Hip flexion
- L3/4 Knee extension
- L4 Foot inversion
- L5 Knee flexion Ankle dorsiflexion
- Toe extension
- Foot inversion and eversion
- S1 … flexion
- Ankle … flexion
- Toe … Foot …
A
- L1/2 Hip flexion
- L3/4 Knee extension
- L4 Foot inversion
- L5 Knee flexion Ankle dorsiflexion
- Toe extension
- Foot inversion and eversion
-
S1 Knee flexion
- Ankle plantar flexion
- Toe flexion Foot eversion
25
_Lower Limb Root Lesions - weakness_
* .../... Hip flexion
* .../... Knee extension
* ... Foot inversion
* ... Knee flexion Ankle dorsiflexion
* Toe extension
* Foot inversion and eversion
* ... Knee flexion
* Ankle plantar flexion
* Toe flexion Foot eversion
* **L1/2** Hip flexion
* **L3/4** Knee extension
* **L4** Foot inversion
* **L5** Knee flexion Ankle dorsiflexion
* Toe extension
* Foot inversion and eversion
* **S1** Knee flexion
* Ankle plantar flexion
* Toe flexion Foot eversion
26
_Lower Limb Root Lesions - weakness_
* L1/2 Hip flexion
* L3/4 Knee ...
* L4 Foot ...
* L5 Knee ... Ankle dorsiflexion
* Toe ...
* Foot inversion and ...
* S1 Knee ...
* Ankle plantar flexion
* Toe flexion Foot eversion
* L1/2 Hip flexion
* L3/4 Knee **extension**
* L4 Foot **inversion**
* L5 Knee **flexion** Ankle dorsiflexion
* Toe **extension**
* Foot inversion and **eversion**
* S1 Knee **flexion**
* Ankle plantar flexion
* Toe flexion Foot eversion
27
_Lower Limb Root Lesions - weakness_
* L1/2 ... flexion
* L3/4 ... extension
* L4 Foot inversion
* L5 Knee flexion ... dorsiflexion
* Toe extension
* ... inversion and eversion
* S1 Knee flexion
* ... plantar flexion
* Toe flexion ... eversion
* L1/2 **Hip** flexion
* L3/4 **Knee** extension
* L4 Foot inversion
* L5 Knee flexion **Ankle** dorsiflexion
* Toe extension
* **Foot** inversion and eversion
* S1 Knee flexion
* **Ankle** plantar flexion
* Toe flexion **Foot** eversion
28
_Lumbar plexus_
29
_Sacral plexus_
30
_Lumbosacral Plexus Lesions_
* ... (large head, prolonged labour)- esp ... n., numbness inner thigh, pudendal n.
* Structural
* ... (on Warfarin)
* Abscess
* ... – infiltration
* Trauma
* Non structural
* Inflammatory
* Diabetes
* Vasculitis
* Radiotherapy
* **Childbirth** (large head, prolonged labour)- esp **obturator** n., numbness inner thigh, pudendal n.
* Structural
* **Haematoma** (on Warfarin)
* Abscess
* **Malignancy** – infiltration
* Trauma
* Non structural
* Inflammatory
* Diabetes
* Vasculitis
* Radiotherapy
31
_Lumbosacral Plexus Lesions_
* Childbirth (large .., prolonged ..)- esp obturator n., numbness inner thigh, pudendal n.
* Structural
* Haematoma (on Warfarin)
* A...
* Malignancy – infiltration
* Trauma
* Non structural
* I...
* D...
* Vasculitis
* Radiotherapy
* Childbirth (large **head**, **prolonged** labour)- esp obturator n., numbness inner thigh, pudendal n.
* Structural
* Haematoma (on Warfarin)
* **Abscess**
* Malignancy – infiltration
* Trauma
* Non structural
* **Inflammatory**
* **Diabetes**
* Vasculitis
* Radiotherapy
32
_Lumbosacral Plexus Lesions_
* Childbirth (large head, prolonged labour)- esp obturator n., ... inner thigh, pudendal n.
* Structural
* Haematoma (on W...)
* Abscess
* Malignancy – infiltration
* T...
* Non structural
* Inflammatory
* Diabetes
* V...
* R..
* Childbirth (large head, prolonged labour)- esp obturator n., **numbness** inner thigh, pudendal n.
* Structural
* Haematoma (on **Warfarin**)
* Abscess
* Malignancy – infiltration
* **Trauma**
* Non structural
* Inflammatory
* Diabetes
* **Vasculitis**
* **Radiotherapy**
33
_Femoral Nerve Organisation_
* Hip ..., Iliopsoas affected if proximal damage (above inguinal Ligament)
* Only knee ... if below inguinal ligament (preserve hip flexion)
* Distal lesion may produce a pure motor or pure ... syndrome
* Hip **flexors**, Iliopsoas affected if proximal damage (above inguinal Ligament)
* Only knee **extension** if below inguinal ligament (preserve hip flexion)
* Distal lesion may produce a pure motor or pure **sensory** syndrome
34
_Femoral Nerve Organisation_
* Hip flexors, ... affected if proximal damage (above ... Ligament)
* Only knee extension if below ... ligament (preserve hip ...)
* ... lesion may produce a pure motor or pure sensory syndrome
* Hip flexors, **Iliopsoas** affected if proximal damage (above **inguinal** Ligament)
* Only knee extension if below **inguinal** ligament (preserve hip **flexion**)
* **Distal** lesion may produce a pure motor or pure sensory syndrome
35
_Femoral / Lateral Cutaneous Nerves_
* Femoral N.
* Weakness
* Femoral nerve responsible for Hip ... (iliacus)
* Femoral nerve responsible for Knee ...
* Loss of Knee Jerk
* Can’t do ...
* Femoral N.
* Weakness
* Femoral nerve responsible for Hip **flexion** (iliacus)
* Femoral nerve responsible for Knee **Extension**
* Loss of Knee Jerk
* Can’t do **stair**
36
_Femoral / Lateral Cutaneous Nerves_
* Femoral N.
* ...
* Femoral nerve responsible for Hip flexion (iliacus)
* Femoral nerve responsible for Knee Extension
* Loss of Knee ...
* Can’t do stair
* Femoral N.
* **Weakness**
* Femoral nerve responsible for Hip flexion (iliacus)
* Femoral nerve responsible for Knee Extension
* Loss of Knee **Jerk**
* Can’t do stair
37
_Femoral N. damage_
* Femoral ...
* Childbirth
* S...
* Gynae procedures, esp ..., femoral a. bypass/ puncture)
* Femoral **fracture**
* Childbirth
* **Surgery**
* Gynae procedures, esp **hysterectomy**, femoral a. bypass/ puncture)
38
_Femoral N. damage_
* Femoral ...
* C...
* Surgery
* ... procedures, esp hysterectomy, femoral a. bypass/ puncture)
* Femoral **fracture**
* **Childbirth**
* Surgery
* **Gynae** procedures, esp hysterectomy, femoral a. bypass/ puncture)
39
_Sciatica_
* Pain in sciatic n. distrib
* Nerve root entrapment (usually L... / S...)
* Differential diagnosis: ... – pain may radiate not below knee, Sacroiliac joints
* Causes:
* Trauma
* H...
* Rarely sciatic nerve compression per se (P.. synd)
* Or misplaced IM injections
* Pain in sciatic n. distrib
* Nerve root entrapment (usually **L5 / S1**)
* Differential diagnosis: **Hip** – pain may radiate not below knee, Sacroiliac joints
* Causes:
* Trauma
* **Haematoma**
* Rarely sciatic nerve compression per se (**Piriformis** synd)
* Or misplaced IM injections
40
_Sciatica_
* Pain in sciatic n. distrib
* Nerve root ... (usually L5 / S1)
* Differential diagnosis: Hip – pain may radiate not below knee, Sacroiliac joints
* Causes:
* T...
* Haematoma
* Rarely sciatic nerve ... per se (Piriformis synd)
* Or misplaced ... injections
* Pain in sciatic n. distrib
* Nerve root **entrapment** (usually L5 / S1)
* Differential diagnosis: Hip – pain may radiate not below knee, Sacroiliac joints
* Causes:
* **Trauma**
* Haematoma
* Rarely sciatic nerve **compression** per se (Piriformis synd)
* Or misplaced **IM** injections
41
_Sciatica_
* Pain in sciatic n. distrib
* Nerve ... entrapment (usually L5 / S1)
* Differential diagnosis: Hip – pain may radiate not below knee, S... joints
* Causes:
* Trauma
* Haematoma
* Rarely sciatic nerve compression per se (... synd)
* Or misplaced IM injections
* Pain in sciatic n. distrib
* Nerve **root** entrapment (usually L5 / S1)
* Differential diagnosis: Hip – pain may radiate not below knee, **Sacroiliac** joints
* Causes:
* Trauma
* Haematoma
* Rarely sciatic nerve compression per se (**Piriformis** synd)
* Or misplaced IM injections
42
_Sciatica_
* Pain in sciatic n. distrib
* Nerve root entrapment (usually L5 / S1)
* Differential diagnosis: Hip – pain may radiate not below ..., Sacroiliac joints
* Causes:
* Trauma
* Haematoma
* ... sciatic nerve compression per se (Piriformis synd)
* Or misplaced IM ...
* Pain in sciatic n. distrib
* Nerve root entrapment (usually L5 / S1)
* Differential diagnosis: Hip – pain may radiate not below **knee**, Sacroiliac joints
* Causes:
* Trauma
* Haematoma
* **Rarely** sciatic nerve compression per se (Piriformis synd)
* Or misplaced IM **injections**
43
Pain from ... radiates from the buttock down the leg and can travel as far as to the feet and toes
Pain from **sciatica** radiates from the buttock down the leg and can travel as far as to the feet and toes
44
_? Piriformis Syndrome_
* Controversial as to whether muscle ... per se can cause tingling in ... and down ... (eg after exercise or straining, or prolonged sitting)
* Probably may rarely occur in those with anatomical predisposition.
* No consensus on criteria Diagnosis of ...
* Controversial as to whether muscle **compression** per se can cause tingling in **buttock** and down **leg** (eg after exercise or straining, or prolonged sitting)
* Probably may rarely occur in those with anatomical predisposition.
* No consensus on criteria Diagnosis of **exclusion**
45
_? Piriformis Syndrome_
* Controversial as to whether muscle compression per se can cause tingling in buttock and down leg (eg after ... or straining, or prolonged ...)
* Probably may rarely occur in those with ... predisposition.
* No consensus on criteria Diagnosis of exclusion
* Controversial as to whether muscle compression per se can cause tingling in buttock and down leg (eg after **exercise** or straining, or prolonged **sitting**)
* Probably may rarely occur in those with **anatomical** **predisposition**.
* No consensus on criteria Diagnosis of exclusion
46
_Sciatic N. Injury_
* Apart from: Hip ... Knee ... Hip ... (femoral nerve first 2 and obturator ...)
* Sciatic nerve or its branches, are motor to virtually all other muscle groups in the leg
* Isolated Hip ... – sciatic n. Pelvic/ sacral fracture – sacral plexus)
* Apart from: **Hip flexion Knee extension Hip adduction** (femoral nerve first 2 and obturator adduction)
* Sciatic nerve or its branches, are motor to virtually all other muscle groups in the leg
* Isolated Hip **fracture** – sciatic n. Pelvic/ sacral fracture – sacral plexus)
47
_Sciatic N. Injury_
* Apart from: Hip flexion Knee extension Hip adduction ((... nerve first 2 and ... adduction))
* Sciatic nerve or its branches, are motor to virtually all other muscle groups in the leg
* Isolated Hip fracture – sciatic n. Pelvic/ sacral fracture – sacral plexus)
* Apart from: Hip flexion Knee extension Hip adduction (**femoral** nerve first 2 and **obturator** adduction)
* Sciatic nerve or its branches, are motor to virtually all other muscle groups in the leg
* Isolated Hip fracture – sciatic n. Pelvic/ sacral fracture – sacral plexus)
48
_2 compartments of sciatic N._
* The sciatic nerve usually divides into the ... ... and ... nerves at the level of the lower thigh.
* These two nerves usually arise separately from the sacral plexus.
* Beware Partial sciatic n. damage can look like ... ... or ... n. damage
* The sciatic nerve usually divides into the **common peroneal and tibial** nerves at the level of the lower thigh.
* These two nerves usually arise separately from the sacral plexus.
* Beware Partial sciatic n. damage can look like **Common peroneal or Tibial** n. damage
49
_Sciatic Nerve Major Divisions_
* The sciatic nerve usually divides into the common ... and ... nerves at the level of the lower thigh.
* These two nerves usually arise separately from the ... plexus.
* The sciatic nerve usually divides into the **common** peroneal and **tibial** nerves at the level of the lower thigh.
* These two nerves usually arise separately from the **sacral** plexus.
50
_Tibial Nerve- Behind knee (injury)_
* Can’t stand on ....
* Weak foot ...
* Painful numb ...
* Causes:
* Trauma: Haemorrhage
* ... cyst
* Nerve ...
* Entrapment by the tendinous arch at the soleus muscle.
* In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
* Can’t stand on **tiptoes**
* Weak foot **inversion**
* Painful numb **sole**
* Causes:
* Trauma: Haemorrhage
* **Bakers** cyst
* **Nerve** tumour
* Entrapment by the tendinous arch at the soleus muscle.
* In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
51
_Tibial Nerve- Behind knee (injury)_
* Can’t stand on tiptoes
* Weak ... inversion
* Painful numb sole
* Causes:
* Trauma: ...
* Bakers ...
* Nerve tumour
* Entrapment by the tendinous arch at the ... muscle.
* In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
* Can’t stand on tiptoes
* Weak **foot** inversion
* Painful numb sole
* Causes:
* Trauma: **Haemorrhage**
* Bakers **cyst**
* Nerve tumour
* Entrapment by the tendinous arch at the **soleus** muscle.
* In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
52
_Tibial Nerve- Behind knee (injury)_
* Can’t stand on tiptoes
* Weak foot inversion
* Painful numb sole
* Causes:
* ...: Haemorrhage
* Bakers cyst
* ... tumour
* ... by the tendinous arch at the soleus muscle.
* In the ... fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
* Can’t stand on tiptoes
* Weak foot inversion
* Painful numb sole
* Causes:
* **Trauma**: Haemorrhage
* Bakers cyst
* **Nerve** tumour
* **Entrapment** by the tendinous arch at the soleus muscle.
* In the **popliteal** fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
53
_Tibial Nerve- Behind knee (injury)_
* Can’t stand on ...
* Weak foot ...
* ... numb sole
* Causes:
* Trauma: ...
* ... cyst
* Nerve tumour
* Entrapment by the tendinous arch at the soleus muscle.
* In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
* Can’t stand on **tiptoes**
* Weak foot **inversion**
* **Painful** numb sole
* Causes:
* Trauma: **Haemorrhage**
* **Bakers** cyst
* Nerve tumour
* Entrapment by the tendinous arch at the soleus muscle.
* In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
54
_Tibial N.- lower leg/ ankle_
* ... ... - tibial nerve passes through
* Sole pain worse .../ walking - Not heel pain
* Differential - Morton’s neuroma
* **Tarsal Tunnel** - tibial nerve passes through
* Sole pain worse **standing**/ walking - Not heel pain
* Differential - Morton’s neuroma
55
_Tibial N.- lower leg/ ankle_
* Tarsal Tunnel - tibial nerve passes through
* Sole pain worse standing/ ... - Not heel pain
* Differential - ... neuroma
* Tarsal Tunnel - tibial nerve passes through
* Sole pain worse standing/ **walking** - Not heel pain
* Differential - **Morton’s** neuroma
56
_Tibial N.- lower leg/ ankle_
* ... Tunnel - tibial nerve passes through
* ... pain worse standing/ walking - Not ... pain
* Differential - Morton’s neuroma
* **Tarsal** Tunnel - tibial nerve passes through
* **Sole** pain worse standing/ walking - Not **heel** pain
* Differential - Morton’s neuroma
57
_Tibial N.- lower leg/ ankle_
* Tarsal Tunnel - tibial nerve passes through
* Sole pain worse standing/ walking - Not heel pain
* Differential - ... neuroma
* Tarsal Tunnel - tibial nerve passes through
* Sole pain worse standing/ walking - Not heel pain
* Differential - **Morton’s** neuroma
58
_Sural nerve_
* It is made up of branches of the ... nerve and ... ... nerve (the medial cutaneous branch from the ... nerve, and the lateral cutaneous branch from the ... ... nerve.)
* **It is made up of branches of the tibial nerve and common fibular nerve (the medial cutaneous branch from the tibial nerve, and the lateral cutaneous branch from the common fibular nerve.)**
59
_Sural Nerve – superficial, sensory_
* Nerve ... useful - but damages the nerve, so use a superficial and sensory nerve (little bit of ... but will help with diagnosis)
* Nerve **biopsy** useful - but damages the nerve, so use a superficial and sensory nerve (little bit of **numbness** but will help with diagnosis)
60
_Common Peroneal Nerve_
* May also be damaged by tight ... casts, leg ..., Weight loss- ... palsy
* Sensory loss -... of foot and outer aspect lower leg
* Weakness of -dorsiflexion and eversion of foot
* May also be damaged by tight **plaster casts, leg crossing, Weight loss- slimmers palsy**
* Sensory loss -**dorsum** of foot and outer aspect lower leg
* Weakness of -dorsiflexion and eversion of foot
61
_Common Peroneal Nerve_
* May also be damaged by tight plaster casts, leg crossing, Weight loss- slimmers ...
* Sensory loss -dorsum of foot and ... aspect ... leg
* Weakness of -dorsiflexion and ... of foot
* May also be damaged by tight plaster casts, leg crossing, Weight loss- slimmers **palsy**
* Sensory loss -dorsum of foot and **outer** aspect lower leg
* Weakness of -dorsiflexion and **eversion** of foot
62
Weakness of -dorsiflexion and eversion of foot usually indicates problem with what nerve?
common peroneal nerve
63
Sensory loss -dorsum of foot and outer aspect lower leg indicates problem with what nerve?
common peroneal nerve
64
_Neurogenic Foot drop_
* Upper motor neuron (brain/ spinal cord)
* Conus
* L4/L5
* ... equina
* ... plexus
* ... n.
* Common peroneal n.
* Upper motor neuron (brain/ spinal cord)
* Conus
* L4/L5
* **Cauda equina**
* **Sacral plexus**
* **Sciatic n.**
* Common peroneal n.
65
_Neurogenic Foot drop_
* .... motor neuron (brain/ spinal cord)
* Co...
* L.../L...
* Cauda equina
* Sacral plexus
* Sciatic n.
* Common ... n.
* **Upper** motor neuron (brain/ spinal cord)
* **Conus**
* **L4/L5**
* Cauda equina
* Sacral plexus
* Sciatic n.
* Common **peroneal** n.
66
_Polyneuropathy_
* Polyneuropathy – generalised relatively homogeneous process affecting many ... nerves with the ... nerves affected most prominently.
* Polyneuropathy – generalised relatively homogeneous process affecting many **peripheral** nerves with the **distal** nerves affected most prominently.
67
_Polyneuropathy_
* Polyneuropathy – generalised relatively ... process affecting many peripheral nerves with the distal nerves affected most prominently.
* Polyneuropathy – generalised relatively **homogeneous** process affecting many peripheral nerves with the distal nerves affected most prominently.
68
... ... – refers to any disorder of the peripheral nervous system including radiculopathies and mononeuropathies
**Peripheral neuropathy** – refers to any disorder of the peripheral nervous system including radiculopathies and mononeuropathies
69
Distribution of Peripheral Neuropathy
70
_Length dependent polyneuropathy_
* Common causes (Toxic/metabolic)
* D...
* A...
* B12 def
* C...
* Idiopathic
* Clinical symptoms
* Numbness, paraesthesia, weakness
* Pain
* Common causes (Toxic/metabolic)
* **Diabetes**
* **Alcohol**
* B12 def
* **Chemotherapy**
* Idiopathic
* Clinical symptoms
* Numbness, paraesthesia, weakness
* Pain
71
_Length dependent polyneuropathy_
* Common causes (Toxic/metabolic)
* Diabetes
* Alcohol
* ... def
* Chemotherapy
* Idiopathic
* Clinical symptoms
* N..., P.., weakness
* Pain
* Common causes (Toxic/metabolic)
* Diabetes
* Alcohol
* **B12** def
* Chemotherapy
* **Idiopathic**
* Clinical symptoms
* **Numbness, paraesthesia,** weakness
* Pain
72
_Length dependent polyneuropathy_
* 4 Clinical symptoms..
* **Numbness, paraesthesia, weakness**
* **Pain**
73
_Non-Length dependent polyneuropathy_
* ... ... syndrome
* **Guillain Barre** syndrome
74
_Guillain Barre syndrome_
* Named after French Neurologists in 2016
* Also known as ... ... demyelinating polyneuropathy
* Immune response to a preceding ...
* ... progressive (days to weeks) weakness including limbs, facial, respiratory and bulbar muscles
* Absent reflexes
* Named after French Neurologists in 2016
* Also known as **Acute inflammatory** demyelinating polyneuropathy
* Immune response to a preceding **infection**
* **Rapidly** progressive (days to weeks) weakness including limbs, facial, respiratory and bulbar muscles
* Absent reflexes
75
_Guillain Barre syndrome_
* Named after French Neurologists in 2016
* Also known as Acute inflammatory demyelinating polyneuropathy
* Immune response to a preceding infection
* Rapidly progressive (days to weeks) ... including limbs, facial, respiratory and bulbar muscles
* Absent ...
* Named after French Neurologists in 2016
* Also known as Acute inflammatory demyelinating polyneuropathy
* Immune response to a preceding infection
* Rapidly progressive (days to weeks) **weakness** including limbs, facial, respiratory and bulbar muscles
* Absent **reflexes**
76
_Neuronopathy_
* Form of polyneuropathy
* Disorders that affect specifically population of neurons.
* Motor neuronopathy
* Site of ...: ... horn cell
* Causes: ..., Polio
* Sensory neuronopathy
* Site of damage : ... root ganglion
* Causes: Sjogrens syndrome, Paraneoplastic
* Form of polyneuropathy
* Disorders that affect specifically population of neurons.
* Motor neuronopathy
* Site of **damage: Anterior** horn cell
* Causes: **ALS**, Polio
* Sensory neuronopathy
* Site of damage : **Dorsal** root ganglion
* Causes: Sjogrens syndrome, Paraneoplastic
77
_Neuronopathy_
* Form of polyneuropathy
* Disorders that affect specifically population of neurons.
* Motor neuronopathy
* Site of damage: ... ... cell
* Causes: ALS, P...
* Sensory neuronopathy
* Site of damage : Dorsal root ganglion
* Causes: ... syndrome, Paraneoplastic
* Form of polyneuropathy
* Disorders that affect specifically population of neurons.
* Motor neuronopathy
* Site of damage: **Anterior horn** cell
* Causes: ALS, **Polio**
* Sensory neuronopathy
* Site of damage : Dorsal root ganglion
* Causes: **Sjogrens** syndrome, Paraneoplastic
78
_Neuronopathy_
79
_Polyradiculopathy_
* Affects ... nerve roots.
* Causes:
* ... ...: Cervical, lumbar
* Cancer: Leptomeningeal metastases
* Infection: ..., HIV,
* Affects **multiple** nerve roots.
* Causes:
* **Spinal stenosis**: Cervical, lumbar
* Cancer: Leptomeningeal metastases
* Infection: **Lyme**, HIV,
80
_Polyradiculopathy_
* Affects multiple nerve roots.
* Causes:
* Spinal stenosis: c..., l...
* Cancer: ... metastases
* Infection: Lyme, HIV,
* Affects multiple nerve roots.
* Causes:
* Spinal stenosis: **Cervical, lumbar**
* Cancer: **Leptomeningeal** metastases
* Infection: Lyme, HIV,
81
_Polyradiculopathy_
* Affects multiple nerve roots.
* Causes:
* Spinal ...: Cervical, lumbar
* Cancer: Leptomeningeal metastases
* Infection: Lyme, ...,
* Affects multiple nerve roots.
* Causes:
* Spinal **stenosis**: Cervical, lumbar
* Cancer: Leptomeningeal metastases
* Infection: Lyme, **HIV**,
82
_Polyradiculopathy_
* Affects multiple nerve roots.
* Causes:
* Spinal stenosis: Cervical, lumbar
* ...: Leptomeningeal metastases
* ...: Lyme, HIV,
* Affects multiple nerve roots.
* Causes:
* Spinal stenosis: Cervical, lumbar
* **Cancer**: Leptomeningeal metastases
* **Infection**: Lyme, HIV,
83
_Types of peripheral neuropathies_
84
_Compartments of the leg_
85
_‘shin splints’_
* Muscle bulk increases ...% during exercise and contributes to the transient increase in intracompartmental pressure
* Anterior and lateral compartments of the lower leg are commonly affected
* Generally causes ... on and post exercise- AKA Shin Splints
* Manage with ... (rest / cooling – ice)
* Muscle bulk increases **20**% during exercise and contributes to the transient increase in intracompartmental pressure
* Anterior and lateral compartments of the lower leg are commonly affected
* Generally causes **pain** on and post exercise- AKA Shin Splints
* Manage with **RICE** (rest / cooling – ice)
86
_‘shin splints’_
* Muscle ... increases 20% during exercise and contributes to the transient increase in ... pressure
* Anterior and lateral compartments of the lower leg are commonly affected
* Generally causes pain on and post exercise- AKA Shin Splints
* Manage with RICE (rest / cooling – ice)
* Muscle **bulk** increases 20% during exercise and contributes to the transient increase in **intracompartmental** pressure
* Anterior and lateral compartments of the lower leg are commonly affected
* Generally causes pain on and post exercise- AKA Shin Splints
* Manage with RICE (rest / cooling – ice)
87
_‘shin splints’_
* Muscle bulk increases 20% during exercise and contributes to the transient increase in intracompartmental pressure
* ... and .... compartments of the lower leg are commonly affected
* Generally causes pain on and post exercise- AKA Shin Splints
* Manage with RICE (... / ... – ice)
* Muscle bulk increases 20% during exercise and contributes to the transient increase in intracompartmental pressure
* **Anterior** and **lateral** compartments of the lower leg are commonly affected
* Generally causes pain on and post exercise- AKA Shin Splints
* Manage with RICE (**rest / cooling** – ice)
88
_‘shin splints’_
* Muscle bulk increases 20% during exercise and contributes to the transient increase in intracompartmental pressure
* Anterior and lateral compartments of the lower leg are commonly affected
* Generally causes pain on and post exercise- AKA Shin Splints
* Manage with ....
* Muscle bulk increases 20% during exercise and contributes to the transient increase in intracompartmental pressure
* Anterior and lateral compartments of the lower leg are commonly affected
* Generally causes pain on and post exercise- AKA Shin Splints
* Manage with **RICE (rest / cooling – ice)**
89
_What is compartment syndrome?_
* Increase in pressure within a myofascial compartment which has limited ability to expand
* May be ... or ...
* ... compartment syndrome is a surgical emergency
* Increase in pressure within a myofascial compartment which has limited ability to expand
* May be **acute or chronic**
* **Acute** compartment syndrome is a surgical emergency
90
_What is compartment syndrome?_
* Increase in pressure within a ... compartment which has limited ability to ...
* May be acute or chronic
* Acute compartment syndrome is a ... ...
* Increase in pressure within a **myofascial** compartment which has limited ability to **expand**
* May be acute or chronic
* Acute compartment syndrome is a **surgical emergency**
91
_Where does Compartment Syndrome occur?_
* Any limb compartment
* Commonest
* ... ..., ...
* Also Hand and Foot
* Any limb compartment
* Commonest
* **Lower leg, Forearm**
* Also Hand and Foot
92
Why leg in particular ? (compartment syndrome)
we are bipedal, walk on our legs
93
What causes Compartment Syndrome ? (5)
* Fractures (1-6% Tibial Fractures)
* Crush Injuries
* Burns
* Electric Shock
* Fluid Injection
94
* Fractures (1-6% Tibial Fractures)
* Crush Injuries
* Burns
* Electric Shock
* Fluid Injection
* All causes of what syndrome?
* Compartment syndrome
95
_What causes Compartment Syndrome ?_
* Fractures (1-6% ... Fractures)
* ... Injuries
* B...
* ... Shock
* Fluid ...
* **Fractures (1-6% Tibial Fractures)**
* **Crush Injuries**
* **Burns**
* **Electric Shock**
* **Fluid Injection**
96
_What other things can cause compartment syndrome?_
* Drugs
* .../other anticoagulants
* Anabolic ... use
* ... drug use
* Disease
* Haemophilia
* External Causes
* ... splints/casts
* Tourniquet
* Drugs
* **Warfarin**/other anticoagulants
* Anabolic **Steroid** use
* **Iv** drug use
* Disease
* Haemophilia
* External Causes
* **Tight** splints/casts
* Tourniquet
97
_What other things can cause compartment syndrome?_
* Drugs
* Warfarin/other ...
* ... Steroid use
* Iv drug use
* Disease
* Haemophilia
* External Causes
* Tight .../casts
* ...
* Drugs
* Warfarin/other **anticoagulants**
* **Anabolic** Steroid use
* Iv drug use
* Disease
* Haemophilia
* External Causes
* Tight **splints**/casts
* **Tourniquet**
98
_What other things can cause compartment syndrome?_
* Drugs
* Warfarin/other anticoagulants
* Anabolic Steroid use
* Iv ... use
* Disease
* H...
* External Causes
* Tight .../...
* Tourniquet
* Drugs
* Warfarin/other anticoagulants
* Anabolic Steroid use
* Iv **drug** use
* Disease
* **Haemophilia**
* External Causes
* Tight **splints/casts**
* Tourniquet
99
_What other things can cause compartment syndrome?_
* Drugs
* Warfarin/other anticoagulants
* ... ... use
* Iv drug use
* Disease
* Haemophilia
* External Causes
* T... splints/casts
* T...
* Drugs
* Warfarin/other anticoagulants
* **Anabolic Steroid** use
* Iv drug use
* Disease
* Haemophilia
* External Causes
* **Tight splints/casts**
* **Tourniquet**
100
_Consequence of Compartment Syndrome -physiology_
* Tissue ... is proportional to the difference between the capillary ... pressure and the ... fluid pressure
* Elevated compartment pressure causes muscle and nerve ischemia
* Tissue **perfusion** is proportional to the difference between the capillary **perfusion** pressure and the **interstitial** fluid pressure
* Elevated compartment pressure causes muscle and nerve ischemia
101
_Consequence of Compartment Syndrome -physiology_
* Tissue perfusion is proportional to the difference between the ... perfusion pressure and the interstitial ... pressure
* Elevated compartment pressure causes muscle and nerve ...
* Tissue perfusion is proportional to the difference between the **capillary** perfusion pressure and the interstitial **fluid** pressure
* Elevated compartment pressure causes muscle and nerve **ischemia**
102
_Consequence of Compartment Syndrome - pathology_
* Untreated, within ...-... hours, the final result is muscle infarction, tissue necrosis, and nerve injury
* Certain tissues are more sensitive than others and this can be a clue to diagnosis
* ... nerves
* Untreated, within **6-10** hours, the final result is muscle infarction, tissue necrosis, and nerve injury
* Certain tissues are more sensitive than others and this can be a clue to diagnosis
* **Sensory** nerves
103
_Consequence of Compartment Syndrome - pathology_
* Untreated, within 6-10 hours, the final result is muscle ..., tissue ..., and nerve ...
* Certain tissues are more sensitive than others and this can be a clue to diagnosis
* Sensory nerves
* Untreated, within 6-10 hours, the final result is **muscle infarction, tissue necrosis, and nerve injury**
* Certain tissues are more sensitive than others and this can be a clue to diagnosis
* Sensory nerves
104
_Acute anterior Compartment Syndrome leg_
* ... muscles of ankle and foot
* Tibialis anterior, Extensor digitorum longus
* Extensor hallucis longus, Peroneus tertius
* ... ... artery
* Commonly injured in lateral tibial plateau fractures
* Deep ... nerve
* Sensation to the first dorsal web space
* **Dorsiflexion** muscles of ankle and foot
* Tibialis anterior, Extensor digitorum longus
* Extensor hallucis longus, Peroneus tertius
* **Anterior tibial** artery
* Commonly injured in lateral tibial plateau fractures
* Deep **peroneal** nerve
* Sensation to the first dorsal web space
105
_Acute anterior Compartment Syndrome leg_
* Dorsiflexion muscles of ankle and foot
* Tibialis anterior, Extensor ... longus
* Extensor ... longus, ... tertius
* Anterior ... artery
* Commonly injured in lateral ... plateau fractures
* Deep peroneal nerve
* Sensation to the ... dorsal web space
* Dorsiflexion muscles of ankle and foot
* Tibialis anterior, Extensor **digitorum** longus
* Extensor **hallucis** longus, **Peroneus** tertius
* Anterior **tibial** artery
* Commonly injured in lateral **tibial** plateau fractures
* Deep peroneal nerve
* Sensation to the **first** **dorsal** web space
106
_Acute posterior Compartment Syndrome Leg_
* Superficial posterior
* ... ... of foot:
* Gastrocnemius
* Plantaris
* Soleus
* ... nerve
* Sensation to lateral aspect of the foot and distal calf
* Superficial posterior
* **Plantar flexors** of foot:
* Gastrocnemius
* Plantaris
* Soleus
* **Sural** nerve
* Sensation to lateral aspect of the foot and distal calf
107
_Acute posterior Compartment Syndrome Leg_
* Superficial posterior
* Plantar flexors of foot:
* G..
* P..
* S...
* Sural nerve
* Sensation to ... aspect of the foot and ... calf
* Superficial posterior
* Plantar flexors of foot:
* **Gastrocnemius**
* **Plantaris**
* **Soleus**
* Sural nerve
* Sensation to **lateral** aspect of the foot and **distal** calf
108
_What are the signs of Compartment Syndrome?_
* ...! (out of proportion to the original injury)
* ... +++ on passive stretching
* ... limb
* Decreased function of the compartment muscles
* Distal neurologic compromise
* Reduced distal pulses
* **Pain**! (out of proportion to the original injury)
* **Pain** +++ on passive stretching
* **Tense** limb
* Decreased function of the compartment muscles
* Distal neurologic compromise
* Reduced distal pulses
109
_What are the signs of Compartment Syndrome?_
* Pain! (out of proportion to the original injury)
* Pain +++ on passive stretching
* Tense limb
* Decreased function of the ... muscles
* Distal ... compromise
* Reduced ... pulses
* Pain! (out of proportion to the original injury)
* Pain +++ on passive stretching
* Tense limb
* Decreased function of the **compartment** muscles
* Distal **neurologic** compromise
* Reduced **distal** pulses
110
_Investigations - Compartment Syndrome_
* Clinical ... is all important
* Measuring of intra-... pressures can be useful
* Creatine ... (CK) of 1000-5000 U/mL
* Myoglobinuria
* Clinical **suspicion** is all important
* Measuring of intra-**compartmental** pressures can be useful
* Creatine **kinase** (CK) of 1000-5000 U/mL
* Myoglobinuria
111
_Investigations - Compartment Syndrome_
* Clinical suspicion is all important
* Measuring of intra-compartmental ... can be useful
* ... ... (CK) of 1000-5000 U/mL
* Myo...
* Clinical suspicion is all important
* Measuring of intra-compartmental **pressures** can be useful
* **Creatine kinase** (CK) of 1000-5000 U/mL
* **Myoglobinuria**
112
_Management of acute Compartment Syndrome_
* Genuine confirmed CS is an emergency
* Often ... is required
* Aim is to lay open the ... compartment and diminish intra-compartmental ...
* However don’t forget to look for external causes
* Tight casts/ splints
* Dressings
* Genuine confirmed CS is an emergency
* Often **surgery** is required
* Aim is to lay open the **myofascial** compartment and diminish intra-compartmental **pressure**
* However don’t forget to look for external causes
* Tight casts/ splints
* Dressings
113
_Management of acute Compartment Syndrome_
* Genuine confirmed CS is an ...
* Often surgery is required
* Aim is to lay open the myofascial compartment and diminish intra-.. pressure
* However don’t forget to look for external causes
* ... casts/ ...
* Dressings
* Genuine confirmed CS is an **emergency**
* Often surgery is required
* Aim is to lay open the myofascial compartment and diminish intra-**compartmental** pressure
* However don’t forget to look for external causes
* **Tight casts/ splints**
* Dressings
114
_Treatment of compartment syndrome_
* Acute compartment syndrome must be treated in hospital using a surgical procedure called an emergency ...
* The doctor or surgeon makes an ... to cut open your skin and ... surrounding the muscles to immediately relieve the ... inside the muscle compartment.
* Acute compartment syndrome must be treated in hospital using a surgical procedure called an emergency **fasciotomy**
* The doctor or surgeon makes an **incision** to cut open your skin and **fascia** surrounding the muscles to immediately relieve the **pressure** inside the muscle compartment.
115
_Complications of mismanagement of Compartment Syndrome_
* If fasciotomy is performed within ...-... hours following onset of acute CS, the prognosis is good
* Little or no return of function can be expected when diagnosis and treatment are delayed
* ... - Renal Failure
* ... Loss
* If fasciotomy is performed within **25-30** hours following onset of acute CS, the prognosis is good
* Little or no return of function can be expected when diagnosis and treatment are delayed
* **Rhabdomyolysis** - Renal Failure
* **Limb** Loss
116
_Complications of mismanagement of Compartment Syndrome_
* If fasciotomy is performed within 25-30 hours following onset of acute CS, the prognosis is ...
* Little or no return of function can be expected when diagnosis and treatment are delayed
* Rhabdomyolysis - ... ...
* Limb Loss
* If fasciotomy is performed within 25-30 hours following onset of acute CS, the prognosis is **good**
* Little or no return of function can be expected when diagnosis and treatment are delayed
* Rhabdomyolysis - **Renal Failure**
* Limb Loss
117
_Delayed Fasciotomy_
118
If fasciotomy is performed within ...-... hours following onset of acute CS, the prognosis is good
If fasciotomy is performed within **25-30** hours following onset of acute CS, the prognosis is good
