Anatomical Correlates of the lower limb- Wilson Flashcards
The lower limb can act as the upper limb. How so?
It is capable of doing many other things as the anatomy is there to do so
Given the range of anatomical durability, how do you know what normal muscle strength and sensory sensitivity is?
you look for symmetry in the patient
Patient serves as his/her own control.
-structure
-sensory innervation
muscular strength
What symptoms can you get with peripheral nerve lesions?
peripheral nerve lesions are damages to a part of the neurons
can results in sensory and/or motor symptoms
What are examples of sensory symptoms?
-Anesthesia (no sensation)
-Hypothesia (reduced sensation)
-Parathesia (abnormal sensation)
(eg, burning, tingling, and/or pens & needles)
What are examples of motor symptoms?
- flaccid paralysis: LOWER motor neuron injury; no muscle tone
- paresis: partial paralysis or muscle weakness; relative strength of muscle has been reduced
- muscle atrophy (Wasting of muscle)
- fasciulations
What are fasciculations?
during nerve damage before atrophy sets in, you get spontaneous twitches
its just individual motor units that are twitching which you can observe under the skin
What muscles can mask paralysis of the trapezius?
levator scapulae
test muscle action if you suspect partial loss of the innervation; and test against resistance to unmask weakness, as well using the patient as his/her own control ; the bulk of the muscle should be palpated
What is the point of reflexes?
testing fundamental circuits of the NS
What does each reflex test?
- patellar reflex
- achilles reflex
- plantar response
Patellar reflex: testing femoral nerve (L2-4); stretching the muscle spindle and getting brisk contraction of quadriceps
achilles reflex: testing S1 and S2 for the soleus and gastrocnemius
plantar response: testing CUTANEOUS innervations (L4-S2); can have Babinski sign (plantar flexion of hallux) which is acquired as an adult due to cortex suppressing the primitive (infant) response dorsiflexion of hallux; with cortex lesion you lose this suppression
In what steps of the reflex arc can the reflex be modulated?
at the place of integration the reflex can be easily modulated
Lesions in which steps of the reflex arc will change the reflex?
AT ANY STEP OF THE REFLEX will change the reflex
What is the cremaster reflex?
- test L1-2
- there is skeletal muscle that rubs against the testes
- pulls the testes up towards the body when you stroke against the inner thigh (testes are vulnerable in their position so may be used to protect it)
How can peripheral nerves be lesioned?
A. compression which can occur through:
- joint fracture: sciatic nerve (posterior dislocation of the hip)
- vessel aneurism: thin walls can balloon out due to high pressure which can compress the nerve nearby
- fractures
- herniated discs
- entrapment syndromes: muscle compressed as it goes through muscle muscle hypertrophy
B. Cutting and tearing
-stab, bullet, shrapnel, fractures
C. Evulsion/Avulsion: nerves literally pulled out of the SC
D. Repetitive motion
E. Bacterial or viral infections (polio and leprosy)
F. Demyelination (MS, Guillain-barre)
G. Neuropathy (DM: the very fat large axons are susceptible DM and you start to lose sensation from these large axons)
Where are exogenous substances taken up in the NS?
synapses is where exogenous substance can be taken up from the synaptic cleft and transported through retrograde axonal transport
- retrograde transport shuttles molecules away from axon termini toward the cell body
- exogenous substances such as herpesvirus, poliovirus, rabies, and tetanus toxin affect neuron as a result of retrograde axonal transport
What is another name for Guillian-barre disease and what can it be caused by? What are its characteristics in terms of levels of protein and leukocytes?
acute idiopathic polyneuritis
- caused by viral infection of respirator or GI tract
- can be triggered by HIV and getting flu-innoculation
- affects motor (usually distal motor fibers) more than sensory nerves
- PROTEIN levels in CSF is pretty HIGH!!
- leukocytes is NORMAL
What is Spinal Poliomyelitis – 79%?
a result of polio virus where there is muscle atrophy because muscles have lost their innervation
retrograde transport
How is polio different from AIDP?
- NORMAL protein level in CSF
- high level of leukocytes
AIDP (Guillian-Barre) has albuminocytologic dissociation without pleocytosis
Shingles (herpes zoster)
virus distributed by a dermatome of a single spinal nerve and are in the cell body and go out through ANTEROGRADE to synapse and be released to the skin
What is sciatica?
compression of roots of the sciatic nerve that produces radicular pain
-radicular pain is pain that radiates or extends along the course of the sciatic nerve
Describe herniations of intervertebral disc, that will compress cord and roots.
If you know the muscles and dermatome of each spinal nerve, you can localize the injury.
nucleus pulposus (NP) are remnants of the notocord in the adult: a gelatinous type of substance; acts as a shock absorber; overtime the annulus fibrosus can be come weakened allowing NP to herniate out and usually DORSOLATERALLY
depending on what level you get a herniation, that herniation can put stress directly on the spinal nerve as they exit the intervertebral foramen and it can also cause displacement of the SC at higher levels or levels above L2; but at lower levels the pressure is going to be directly on the nerve
Is it necessary for a herniated disc to come in contact with the nerve to cause compression?
No
herniation can evoke an inflammatory response and the edema and inflammation in the intervertebral foramen can compress the axons, causing sciatica in the lumbosacral region
Usually when you have a herniated disc in the lower lumbar region, what nerve is affected?c
the nerve that will be affected is the nerve exiting at a lower level, not the nerve in between
-the nerve in between that runs across the herniation
Cauda equina are nerves going to the lower limb exiting the genitalia or pelvic structure.
What is Cauda Equina Syndrome?
-can present as a number of symptoms: LOW BACK PAIN, sciatica, lower limb paresis (gait disturbances), SADDLE ANESTHESIA (part of saddle is innervated by sacral spinal nerve), LOSS OF SPHINCTER CONTROL, LOSS OF SEXUAL FUNCTION
BOLDED ONES are the hallmark symptoms of cauda equina syndrome
What are causes of Cauda Equina Syndrome?
- spinal stenosis: bone spurs form
- trauma
- fractures (burst fractures)
- inflammation and scarring
- spondylolisthesis (posterior side of vertebra body displaced anteriorly)
anything that changes size of canal or produces scarring is a cause of cauda equina syndrome
What is the relationship of the piriformis and the sciatic nerve?
- Generally, the common fibular nerve passes inferior to the piriformis.
- Occasionally, the common fibular nerve passes through the piriformis.
This muscle is most likely to cause entrapment of the sciatic nerve.
professional bike riders use this muscle very often which can produce spasms of piriformis and cause compression of the sciatic nerve producing sciatica
How can we verify a herniated disc is the cause of the sciatica?
contralateral SLR from 35 to about 75 degrees
normally you should be able to raise the leg up to 75 degrees without any pain
if pain is present, there is a herniated disc
-contralateral SLR= CROSSED SLR