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Module 204 MSK & Immune system > T2 L18 Lower limb nerve injuries > Flashcards

T2 L18 Lower limb nerve injuries Flashcards

(67 cards)

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1
Q

Describe how a lumbar puncture is done

A

Patient in lateral position, palpate iliac crests which are at level of L4/L5
Done in between L3/L4 as spinal cord ends at L1/L2

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2
Q

Compare the pain severity in cauda equina and conus medullaris

A

Cauda equina - radicular, more severe

Conus medullaris - less severe

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3
Q

Compare the location of pain in cauda equina and conus medullaris

A

Cauda equina - unilateral / asymmetric. Perineum, thighs, legs
Conus medullaris - bilateral, perineum, thighs

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4
Q

Compare the sensory distribution in cauda equina and conus medullaris

A

Cauda equina - saddle, unilateral / asymmetric

Conus medullaris - bilateral saddle distribution

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5
Q

Compare the motor loss in cauda equina and conus medullaris

A

Cauda equina - asymmetric, atrophy

Conus medullaris - symmetric

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6
Q

Compare the reflexes in cauda equina and conus medullaris

A

Cauda equina - ankle and knee reduced

Conus medullaris - ankle reduced

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7
Q

Compare the effects on bowel / bladder in cauda equina and conus medullaris

A

Cauda equina - late

Conus medullaris - early

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8
Q

What can cause damage to the cauda equina?

A

Disc herniation - L5/S1
Spinal fracture
Tumours

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9
Q

What can cause damage to the conus medullaris?

A

Disc herniation
Tumour
Inflammatory conditions - chronic inflammatory myelinating polyradiculopathy, sarcoidosis
Infection - CMV, HSV, EBV, lyme, TB

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10
Q

What can cause compression of a nerve?

A

Disc herniation
Formation of osteophytes
Ligaments
Small canal - stenosis

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11
Q

What pain is produced in a dermatome?

A

Sharp / superficial

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12
Q

What pain is produced in a myotome?

A

Deep ache

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13
Q

What is L1 dermatome?

A

Inguinal area

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14
Q

What dermatome supplies front of thigh?

A

L2

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15
Q

What dermatome supplies front of knee?

A

L3

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16
Q

What dermatome supples front-inner/medial leg?

A

L4

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17
Q

What area of skin is supplied by L5?

A

outer leg
dorsum of foot
inner sole

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18
Q

What area of skin is supplied by S1?

A

Little toe
Rest of sole
Back of leg

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19
Q

What area of skin is supplied by S2?

A

Thigh to top of buttocks

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20
Q

What dermatome supplies the concentric rings around the anus / genitalia?

A

S3-S5

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21
Q

What spinal root is the knee jerk reflex?

A

L4

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22
Q

What spinal root is the ankle jerk reflex?

A

S1

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23
Q

What spinal root allows hip flexion?

A

L1/2

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24
Q

What spinal root allows knee extension?

A

L3/4

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25
What spinal root allows foot inversion?
L4
26
What movement does L5 allow?
``` Knee flexion Ankle dorsiflexion Toe extension Foot inversion Foot eversion ```
27
What movement does S1 allow?
Knee flexion Ankle plantar flexion Toe flexion Foot eversion
28
What are some causes of lumbrosacral plexus lesions?
``` Childbirth (large head, prolonged labour) Structural - haematoma (on warfarin) - abscess - malignancy - trauma Non-structural - inflammatory - diabetes - vasculitis - radiotherapy ```
29
What muscles are affected if there is proximal damage (above inguinal ligament) to the femoral nerve?
Hip flexors | Ilipsoas
30
What movement is affected if there is damage to the femoral nerve below the inguinal ligament?
Knee extension
31
What symptoms does damage to the femoral nerve cause?
``` Weakness Poor hip flexion Poor knee extension Loss of knee jerk Difficulty standing from seated Difficulty up stairs Knees buckle ```
32
What do patients often complain of if there is damage to the lateral cutaneous nerve?
Tingling in outer aspect of thigh which is relieved by sitting
33
Why is the lateral cutaneous nerve commonly affected in obesity?
It is superficial so the excess adipose tissue can push on it
34
What can cause femoral nerve damage?
Trauma e.g. pelvic fracture Childbirth Gynae procedures e.g. hysterectomy Femoral artery bypass / puncture
35
Describe the sciatic nerve distribution of pain
From buttock | Down leg as far as feet and toes
36
What is sciatica?
Pain in sciatic nerve distribution
37
What can cause sciatica?
Trauma Haematoma Sciatic nerve compression (rare) Misplaced IM injections
38
What is piriformis syndrome?
Compression of piriformis muscle causing tingling in buttocks and down leg Diagnosed by exclusion
39
What movements are not affected in sciatic nerve injury?
Hip flexion Knee extension Hip adduction
40
Describe the distribution of the tibial nerve
In popliteal fossa Gives branches to gastrocnemius, popliteus, soles and plantaris Branches to sural nerve
41
What are indications that the tibial nerve is injured?
Can't stand on tiptoes Weak foot inversion Painful, numb sole
42
What can cause injury of the tibial nerve?
Trauma - haemorrhage Baker's cyst Nerve tumour Entrapment of tendinous arch by soleus muscle
43
What is tarsal tunnel?
Compression of tibial nrve Sole pain which is worse when walking / standing No heal pain
44
What is a differential diagnosis instead of tarsal tunnel?
Morton's neuroma
45
Why is the sural nerve often biopsied?
It is a sensory nerve so damaging it won't cause loss of function It is relatively superficial so easy to access
46
What are the symptoms of damage to the common peroneal nerve?
Sensory loss to dorsum of foot and outer aspect of lower leg | Weakness of dorsiflexion and eversion of foot
47
What can cause neurogenic foot drop?
Damage to: - upper motor neuron - conus - L4/L5 - cauda equina - sacral plexus - sciatic nerve - common peroneal nerve
48
What is polyneuropathy?
Generalised relatively homogenous process affecting many peripheral nerves with distal nerves affected most prominently
49
What is peripheral neuropathy?
Any disorder of peripheral nervous system including radiculopathies and mononeuropathies
50
What are the common causes of length dependent polyneuropathy?
Toxic / metabolic causes - diabetes - alcohol - B12 deficiency - chemotherapy - idiopathic
51
What are the clinical symptoms of length-dependent polyneuropathy?
Numbness, paraesthesia, weakness | Pain
52
What is Gullain-Barre syndrome?
Autoimmune condition - immune response to preceding infection Also known as acute inflammatory demyelinating polyneuropathy Rapidly progressive weakness Absent reflexes
53
What is neuronopathy?
Form of polyneuropathy | Disorders that affect specific population of neurons
54
What is damaged in motor neuronopathy and what are the causes?
Damage to anterior horn cell | Causes: ALS, polio
55
What is damaged in sensory neuronopathy and what are the causes?
Damage to dorsal root ganglia | Causes: Sjogren's syndrome, paraneoplastic
56
What is polyradiculopathy and what are the causes?
``` Affects multiple nerve roots Causes: - spinal stenosis - cancer (leptomeningeal metastases) - infection (Lyme disease, HIV) ```
57
What compartments are in the leg?
Anterior muscle compartment Lateral muscle compartment Medial muscle compartment Posterior muscle compartment
58
What are shin splints?
Muscle bulk increases by 20% during exercise leading to transient increase in intra-compartmental pressure Anterior and lateral compartments of lower leg are commonly affected Causes pain during and post exercise
59
What is compartment syndrome?
Increase in pressure within a myofascial compartment which has limited ability to expand
60
What are the causes of compartment syndrome?
``` Fractures Crush injuries Burns Electric shock Fluid injection Drugs - warfarin, anabolic steroid use, IV drug use Disease - haemophilia External causes - tight splints / casts ```
61
What is the consequence of compartment syndrome?
``` Elevated compartment pressure leads to pressure on blood vessels including arteries Reduced blood flow Muscle and nerve ischaemia Cytotoxic oedema More swelling and pressure ```
62
What is affected in acute anterior CS of the leg?
Dorsiflexion of muscles of ankle and foot - tibialis anterior, extensor digitorum longs, extensor hallucis longs, peroneus tertius Anterior tibial artery Deep peroneal nerve
63
What is affected in acute posterior CS of the leg?
Plantar flexors of foot - gastrocnemius, planters, soleus | Sural nerve - loss of sensation to lateral aspect of foot and distal calf
64
What are the signs of compartment syndrome?
Pain (out of proportion to original injury) Pain which is severe on passive stretching Tense limb Decreased function of compartment muscles Distal neurologic compromise Reduced distal pulses
65
What are the investigations for compartment syndrome?
Clinical suspicion Measure intra-compartmental pressure Measure CK Check for myoglobulinuria
66
What is the management of acute CS?
Surgery to release the pressure - fasciotomy | Check for external causes
67
What are the complications of mismanagement of acute CS?
Little or no return of function Rhabdomyolysis Limb loss

Module 204 MSK & Immune system (44 decks)

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