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Cuccurullo Book > Ch 5 - EDX: Lower Limb Mononeuropathy > Flashcards

Ch 5 - EDX: Lower Limb Mononeuropathy Flashcards

1
Q

Describe the course of the lateral femoral cutaneous nerve

A

Pass over the iliacus

toward the anterior iliac spine, tunnels under the inguinal ligament to provide sensation for the lateral thigh

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2
Q

What is meralgia parasthetica?

A

Lateral cutaneous neuropathy

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3
Q

What are etiologies of lateral femoral cutaneous neuropathy?

A 
Protuberant abdomen
Pregnancy
Tight clothing
DM
Tumor
Infection
Rapid weight loss
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4
Q

What is the clinical presentation of lateral femoral cutaneous neuropathy?

A

Sensory complaints in lateral thigh exacerbated with hip extension or hyperflexion, prolonged sitting/squatting, or
driving

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5
Q

What is the origin of the femoral nerve?

A

L2, L3, L4 roots into posterior division of lumbar plexus

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6
Q

Describe the course of the femoral nerve.

A

Runs through psoas, under the inguinal ligament lateral to femoral artery and through femoral triangle

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7
Q

What does the femoral nerve innervate?

A 
Iliacus
Pectineus (1/2)
Sartorius
Quadriceps muscles
Saphenous nerve
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8
Q

What are etiologies of femoral neuropathy?

A

Compressive lesion in the pelvis from trauma, fracture, retroperitoneal hematoma, tumor, inguinal ligament compression, or cardiac catheterization

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9
Q

What is the clinical presentation of femoral neuropathy?

A

Weakness of KE
Knee instability
Dec sensation over the anterior thigh and medial leg
HF weakness if lesion proximal to inguinal ligament

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10
Q

What is the MCC of femoral neuropathy?

A

Diabetic amyotrophy

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11
Q

How is the femoral nerve injured in Diabetic Amyotrophy?

A

ABN of vaso-nevorum d/t DM

Amyotrophy noted after marked weight loss

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12
Q

What is the clinical presentation of Diabetic Amyotrophy?

A

Asymmetric thigh pain
KE weakness
Femoral innervated muscle atrophy
Loss of patellar reflex

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13
Q

What does the Saphenous nerve innervate?

A

Sensation to the medial aspect of the leg, the medial malleolus, and medial arch of the foot

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14
Q

What is the largest and longest branch of the femoral nerve?

A

Saphenous nerve

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15
Q

How can the Saphenous nerve be injured?

A

Entrapped in the subsartorial (Hunter’s) canal or b/w sartorius and gracilis
Knee arthroscopy
Vascular surgery

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16
Q

What is the clinical presentation of Saphenous neuropathy?

A

Pure sensory syndrome
Medial knee pain (infrapatellar branch)
ABN sensation along medial leg and foot

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17
Q

What is the origin of the obturator nerve?

A

L2, L3, L4 roots continue as anterior portion of lumbar plexus

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18
Q

What is the course of the obturator nerve?

A

Anterior to SI joint through psoas major muscle through obturator foramen

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19
Q

What does the obturator nerve innervate?

A 
Pectineus (1/2)
Adductor brevis
Adductor longus
Adductor magnus
Obturator externus
Gracilis
Cutaneous branch
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20
Q

What are etiologies of obturator neuropathy?

A

Pelvic fx or hernia w/in obturator foramen

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21
Q

What is the clinical presentation of obturator neuropathy?

A

Hip adduction/IR weakness
Circumduction gait
Dec sensation along medial thigh

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22
Q

What is the origin of the sciatic nerve?

A

L4, L5, S1, S2 and S3 roots continue as posterior division of lumbar plexus

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23
Q

Describe the course of the sciatic nerve.

A

Exits pelvis through greater sciatic foramen b/w lesser trochanter and ischial tuberosity thru posterior leg to popliteal fossa

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24
Q

What does the sciatic nerve splint into at the popliteal fossa?

A

Tibial (medial) nerve

Peroneal/Fibular (lateral) nerve

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25
Q

What does the peroneal division of sciatic nerve innervate?

A

Short head of biceps femoris

26
Q

What does the tibial division of sciatic nerve innervate?

A

Long head of the biceps femoris
Semitendinosus
Semimembranosus
Adductor magnus (also obturator nerve)

27
Q

What are etiologies of Sciatic neuropathy?

A 
Hip trauma
Injection
Hematoma
Pelvic fx
Penetrating wounds
Gravid uterus
Piriformis syndrome
28
Q

Which portion of the Sciatic nerve is largest?

A

Peroneal division outer 2/3 of nerve

29
Q

Why is the peroneal division of the Sciatic nerve most vulnerable?

A

More fixated in the pelvis
Adheres distally to fibular head
Larger fascicles w/ less protective epineural tissue

30
Q

What is the clinical presentation of sciatic neuropathy?

A

KF weakness
Hamstring and Achilles reflex ABN
Peroneal and tibial sensory loss

31
Q

Describe the course of the tibial nerve in the leg.

A

Distal 1/3 of thigh runs posterior to knee to soleus and continues on as posterior tibial nerve to run under flexor retinaculum and divides into 3 branches (medial and lateral plantar nerves, calcaneal nerve)

32
Q

What does the tibial nerve innervate at the posterior knee?

A 
Plantaris
Medial gastrocnemius
Lateral gastrocnemius
Popliteus
Soleus
33
Q

What does the posterior tibial nerve innervate?

A 
Tibialis posterior (TP)
Flexor digitorum longus (FDL)
Flexor hallucis longus (FHL)
34
Q

What does the medial plantar nerve innervate?

A 
Abductor hallucis
Flexor digitorum brevis
Flexor hallucis brevis
Lumbrical
Sensory branch
35
Q

What does the lateral plantar nerve innervate?

A 
Lumbricals
Abductor digiti minimi
Quadratus plantae
Interossei
Adductor hallucis
Sensory branches
36
Q

What does the Calcaneal nerve innervate?

A

Sensory branch

37
Q

What runs through the tarsal tunnel?

A

Tibialis posterior
Flexor digitorium longus
Posterior tibial artery/vein/nerve
Flexor hallucis longus

38
Q

What is the clinical presentation of tarsal tunnel syndrome?

A

Intrinsic foot weakness
Perimalleolar pain, numbness, and paresthesias may extend to the toes and soles.
Reproduced by ankle inversion

39
Q

What does the superficial peroneal nerve innervate?

A

Peronues longus
Peroneus brevis
Medial and lateral cutaneous nerves

40
Q

What does the deep peroneal nerve innervate?

A 
Tibialis anterior (TA)
Extensor digitorum longus (EDL)
Extensor hallucis longus (EHL)
Peroneus tertius
Extensor digitorum brevis (EDB)
First dorsal interossei
Dorsal distal cutaneous nerve
41
Q

What is an accessory peroneal nerve?

A

An anomalous nerve branch from the superficial peroneal (fibular) nerve that travels posterior to the lateral malleolus to innervate some or all of the EDB.
1/3 of the population

42
Q

How is accessory peroneal nerve diagnosed on EDX?

A

Lower peroneal (fibular) CMAP (recording at EDB) with stim at the ankle compared to stim at the knee. Confirmed by stim behind the lateral malleolus, which will also elicit a CMAP from the EDB

43
Q

What can be spared with an accessory peroneal nerve?

A

EDB can be spared even with a deep peroneal (fibular) nerve injury

44
Q

What are etiologies of peroneal neuropathy at the fibular head?

A 
Prolonged leg crossing
Weight loss
Poor positioning during surgery
Poor cast application,
Prolonged squatting position (strawberry pickers’ palsy)
DM
45
Q

What is the clinical presentation of peroneal neuropathy at the fibular head?

A

Foot drop and steppage gait
Short head biceps femoris spared
Sensory loss over deep and superficial peroneal nerves

46
Q

What differentiates a peroneal neuropathy from an L5 radiculopathy?

A

Peroneal neuropathy: weakness of dorsiflexors and evertors

L5 radiculopathy: Includes ankle invertors

47
Q

What is anterior tarsal tunnel syndrome?

A

Injury to deep peroneal nerve under extensor retinaculum

48
Q

What is the clinical presentation of anterior tarsal tunnel syndrome?

A

Foot weakness
EDB atrophy
Numbness in 1st and 2nd web space
Pain over dorusm of foot relieved with motion

49
Q

What are etiologies of superficial peroneal neuropathy?

A

Trauma
Ankle sprain
Compartment syndrome
Lipoma

50
Q

What is the clinical presentation of superficial peroneal neuropathy?

A

Peroneus longus and brevis weakness

Numbness in superficial peroneal nerve distribution

51
Q

Describe the course of the sural nerve.

A

Orignates from tibial and peroneal nerves to proxmial posterior calf to lateral malleolus

52
Q

What does the sural nerve innervate?

A

Sensation to lateral calf and foot

53
Q

What are etiologies of sural neuropathy?

A

Tight sock
Baker’s cyst
Laceration

54
Q

What is the origin and course of the superior gluteal nerve?

A

Originate from L4-S1 roots in pelvic region pass through sciatic notch superior to piriformis

55
Q

What does the superior gluteal nerve innervate?

A

Gluteus medius
Gluteus minimus
Tensor fascia lata (TFL)

56
Q

What is the origin and course of the Inferior gluteal nerve?

A

L5-S2 nerve roots in pelvic region

57
Q

What does the inferior gluteal nerve innervate?

A

Gluteus maximus

58
Q

How are superior/inferior gluteal nerves injured?

A

Hip joint replacement
Improper IM injection
Pelvic masses

59
Q

What is the clinical presentation of superior gluteal neuropathy?

A

Weakness of hip abduction and ER. A Trendelenburg gait demonstrating a pelvic tilt to the strong side

60
Q

What is the clinical presentation of inferior gluteal neuropathy?

A

Weakness of hip extension

Sensation is spared

61
Q

What is mononeuritis multiplex?

A

Multifocal peripheral neuropathy where damage occurs in two or more different nerve areas

62
Q

What are etiologies of mononeuritis multiplex?

A 
Axonal injury can be caused by multiple etiologies, including inflammation (vasculitis),
vascular compromise (occlusion), compression, and infection

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