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Regional Anatomy > Clinical Anatomy of Sciatica and femoral hernia > Flashcards

Clinical Anatomy of Sciatica and femoral hernia Flashcards

1
Q

What is sciatica and what is the typical presentation of it

A
  • A term used to describe the symptoms that present within the distribution of the sciatic nerve.
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2
Q

What is sciatica most commonly presented as and what are some common symptoms

A
  • Most commonly presents as pain radiating down the leg
  • Pain
  • Numbness
  • Tingling
  • Weakness of movement of the knee and ankle.
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3
Q

What are the 5 causes sciatica

A
  • Herniation of an IVD
  • Entrapment
  • Spinal pathology
  • Malignancy
  • Infection
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4
Q

How does herniation of an IVD cause sciatica

A
  • The herniated IVD will compress the roots that form the sciatic nerve. These are L4-S3 however L5 and S1 are the nerves that are most commonly compressed.
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5
Q

What can cause sciatica by entrapping the sciatic nerve

A
  • The piriformis muscle, when it is overused.
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6
Q

What are some treatments for sciatica

A
  • Physical therapy & pain relief
  • NSAIDs (reduce inflammation)
  • Steroid injections
  • Surgical Repair
  • Microdiscectomy (removing of IVD)
  • Laminectomy (removing part of the lamina)
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7
Q

Describe the categories of spinal nerves and how they leave the vertebral column

A
  • Split into cranial nerves and spinal (cervical, thoracic, lumbar and sacral nerves)
  • Spinal nerves C1-C7 exit the vertebral column above vertebrae
  • Spinal nerves C8-S3 exit the vertebral column above the vertebrae
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8
Q

What spinal levels make up the conus medullaris and cauda equina

A
  • T12-L1
  • L2- Sacrum
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9
Q

What structures make up the anterior, posterior, inferior and superior boundaries of the intravertebral foramen

A
  • Anterior - Posterior longitudinal ligament, body of 2 vertebrae and IVD
  • Posterior - Ligamentum flavum and capsule of facet joint
  • Superior - Pedicle of vertebrae above
  • Inferior - Pedicle of vertebrae below
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10
Q

What type of joint is an IVD

A
  • Secondary Cartilaginous joint
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11
Q

What makes an IVD a secondary cartilaginous joint

A
  • It is made up of fibrocartilage and then covered by hyaline cartilage
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12
Q

What are the 3 components of an IVD and what is each component made of

A
  • Vertebral endplate (hyaline cartilage)
  • Annulus fibrosis (alternating collagen fibre lamellae)
  • Nucleus pulposus (hydrated gel)
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13
Q

Nerve roots from what part of the spinal cord will pass several spinal levels before leaving the vertebral column

A
  • Cauda Equina
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14
Q

Which ramii form spinal plexuses

A
  • Ventral (anterior) rami of mixed spinal nerves
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15
Q

What spinal nerves form each of the plexus and trunks of the body and what do the spinal nerves that do not form plexuses form instead

A
  • Cervical - C1-C5
  • Brachial - C5-T1
  • Intercostal Nerves - T2-T12
  • Lumbar - L1-L4
  • Lumbosacral trunk - L4-L5
  • Sacral - L4-L5 & S1-S4
  • Coccygeal Plexus - S5 and coccygeal nerve
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16
Q

What are the 2 components of the lumbosacral plexus that make up the sciatic nerve

A
  • Common Fibula nerve
  • Tibial nerve
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17
Q

What makes up the tibial nerve

A
  • Anterior divisions of ventral rami L4, L5, S1, S2, S3
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18
Q

What makes up the common fibula nerve

A
  • Posterior divisions of ventral rami L4, L5, S1, S2
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19
Q

Describe the course of the sciatic nerve down the lower limb

A
  • Comes out below the piriformis muscle through the greater sciatic foramina.
  • Down and past 4 muscles (obturator internus, 2 gemelli, quadratus femoris)
  • Into the posterior aspect of the thigh behind the long head of the biceps in front of the adductor magnus,
  • Separates into 2 terminal branches at the apex of the popliteal fossa.
  • Tibial nerve goes straight down into the back of the leg
  • Common (peroneal) fibular winds around the fibula and enters the anterolateral compartment
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20
Q

What are the 3 occasions that would cause piriformis syndrom

A
  • Sciatic nerve separating earlier and common fibula piercing piriformis.
  • Sciatic nerve separating earlier and common fibula extending superiorly to piriformis muscle to enter greater sciatic foramen
  • Sciatic nerve piercing piriformis.
21
Q

What are the muscles supplied by the tibial component of the sciatic nerve

A
  • Posterior thigh muscles - (Except for short head of biceps femoris)
22
Q

What are the posterior muscles of the thigh also known as in lay terms and what are the names of the muscles in this category

A
  • Hamstrings
  • Biceps Femoris
  • Semimembranosus
  • Semitendinosus
  • Adductor magnus
23
Q

What are the muscles supplied by the common fibial component of the sciatic nerve

A
  • Short head of the biceps femoris
24
Q

What are the muscles that are innervated by the tibial nerve

A
  • Posterior muscles of the leg
25
Q

What are the names of the posterior muscles of the leg

A
  • Plantaris
  • Gastrocnemius
  • Popliteus
  • Soleus
  • Tibialis posterior
  • Flexor digitorum longus
  • Flexor hallucis longus
26
Q

What are the muscles that are innervated by the common fibula nerve

A
  • Anterior muscles of the leg
  • Lateral muscles of the leg
27
Q

What are the names of the anterior muscles of the leg

A

IDK

28
Q

What are the names of the lateral muscles of the leg

A

IDK

29
Q

What muscles in the foot does the tibial nerve innervate

A
  • Abductor hallucis
  • Flexor digitorum brevis
  • Flexor hallucis brevis
  • Lumbricals
30
Q

What muscles in the foot does the common fibula nerve innervate

A
  • Extensor digitorum brevis
31
Q

Why are dermatomes important in the clinic

A
  • Can be used to localise neurological levels in radiculopathies.
  • Viral infections pain along dermatomes
32
Q

What is the difference between dermatomes and myotomes

A

Dermatomes - area of skin innervated by a single pair of spinal nerves.

Myotomes - Group of muscles innervated by a single pair of spinal nerves.

33
Q

What happens of the pair of spinal nerves of a myotome are damaged and how can the damage of these nerves be assessed

A
  • They cause weakness of the muscles of that myotome, doctors can test for the function of muscles to assess damage to spinal nerves.
34
Q

What are the movements that can assess for damage of the L4, L5 and S1 spinal nerves

A
  • Extension of the knee - L4
  • Plantar flexion - S1
  • Dorsi flexion - L5
35
Q

What is the effect of a disc hernia occurring in the central zone

A
  • Will compress medial traversing nerves, symptoms will occur at multiple levels
36
Q

What is the effect of a disc hernia occurring in the paracentral zone

A
  • Will compress medial traversing nerves and maybe exiting nerves, symptoms will occur at multiple levels
37
Q

What is the effect of a disc hernia occurring in the far lateral zone

A
  • Will only effect exiting nerves, symptoms will occur at only that level.
38
Q

What is an abdominal hernia

A
  • Abdominal protrusion of abdominal viscera or part of the viscera through potentially weak areas.
39
Q

Give some examples of rare abdominal hernias

A
  • Hernia of Linea alba
  • Post operative (incisional) hernia
  • Hernia at Linea semilunaris
40
Q

Give some examples of common abdominal hernias

A
  • Inguinal hernia
  • Umbilical hernia
  • Femoral hernia
41
Q

What are the 3 stages of an abdominal hernia

A
  • Reducible - Contents of hernia return spontaneously to the abdominal cavity after increase in intraabdominal pressure (can be pushed back easily by patient)
  • Incarcerated - Irreducible. May cause bowel obstruction. Should not attempt to reduce it forcibly
  • Strangulated - Reduced blood supply due to compression. Requires emergency surgical intervention to avoid necrosis of the contents of the hernia.
42
Q

What is a Ritcher’s hernia

A
  • When only a part of the bowel wall is herniated
43
Q

What are the boundaries of the femoral triangle

A
  • Superiorly - inguinal ligament
  • Laterally - Sartorius
  • Medially - medial border of abductor longus
44
Q

What is the contents of the femoral triangle and how do you remember them

A
  • NAVEL - (Laterally to medially)
  • Femoral Nerve
  • Femoral Artery
  • Femoral Vein
  • Empty space
  • Lymph nodes
45
Q

What structures in the femoral triangle are within the femoral sheath

A
  • Femoral Artery
  • Femoral Vein
  • Empty space
46
Q

What 2 fascia make up the femoral sheath

A
  • Fascia transversalis anteriorly
  • Fascia liliaceous posteriorly
47
Q

What are the 3 compartments of the femoral sheath and what do each of them contain

A
  • Lateral - Femoral Artery
  • Intermediate - Femoral Vein
  • Medial - Empty space known as femoral canal (site for femoral hernia, and continuous with abdominal cavity)
48
Q

Why are abdominal hernias more common in women

A
  • Wider pelvis

Regional Anatomy (13 decks)

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