26: Sciatic Nerve Injury - Mahoney

Question 1

pt stands on heel, but not tiptoes

stand on tiptoes, but not heel

Answer 1

CNS tumor

Peripheral neuropathy

• general rules

Question 2

sharp/dull =

Answer 2

lateral spinothalamic

Question 3

diabetic neuropathy of a single nerve

Answer 3

diabetic mononeuropathy

Question 4

what is normal NCV in the leg?

Answer 4

50-60 m/sec

distinguishes demyelinating (slowed, normal amp, prolonged latency) from axonal (not slowed, amp lower, latency normal) low)diseases

Question 5

fibrillations suggest…

Answer 5

acute denervation
acute metabolic neuropathies
polymyositis

Question 6

tx sciatic n. injury from injection

Answer 6

• inject 3-5 ml of normal saline into subgluteal space
• consider early PT with strengthening exercises and use of flexible dropfoot brace
• consider neuropathy drugs (gabapentin, pregabalin, duloxetine)

consider surgical neurolysis if pain persists greater than 3 mo

Question 7

**can you administer NSAIDs to an asthmatic?

Answer 7

CONTRAINDICATED

you can give COX2 selective

by blocking COX pathway, NSAIDS shift pathway to production of leukotrienes which can cause bronchospasm

Question 8

mechanism of nerve injury?

Answer 8

wallerian degeneration

antegrade degeneration of the axons and their accompanying myelin sheaths following proximal axonal or neuronal cell body injury

Question 9

do NSAIDs interfere with bone healing?

Answer 9

questionable - only animal studies

may suppress healing

Question 10

***where is the proper site to administer a gluteal IM injection?

Answer 10

ventrogluteal area NOT dorsogluteal area

upper outer quadrant of butt ( lateral area) - trying to avoid sciatic n.