Hip Flashcards
What does the iliohypogastric nerve innervate (sensory, motor)?
Sensory: suprapubic region
Motor: transverse abdominis, internal oblique
How does the iliohypogastric nerve get injured?
Abdominal surgery
Symptoms of iliohypogastric nerve damage
Burning/tingling pain in surgical incision site radiating to inguinal & supra pubic region
Sensory and motor innervation of genitofemoral nerve
Sensory: scrotum/labia majora, medial thigh
Motor: cremaster
How does injury to the genitofemoral nerve occur?
Laparoscopic surgery
Symptoms of injury to genitofemoral nerve
Decreased upper medial and anterior thigh sensation beneath inguinal ligament (lateral part of femoral triangle)
Absent cremasteric reflex
Innervation of lateral femoral cutaneous
Sensory: anterior & lateral thigh
Causes of injury to lateral femoral cutaneous nerve
Tight clothes, obesity, pregnancy, pelvic procedures
Presentation of injury to lateral femoral cutaneous nerve
Decreased thigh sensation (anterior, lateral)
Meralgia paresthetica: compression of nerve results in tingling, numbness, burning pain in anterolateral thigh
Sensory and motor innervation of obturator nerve
Sensory: medial thigh
Motor: obturator externus, adductors longus + magnus + brevis, gracilis, pectineus
Damage to obturator nerve
Pelvic surgery
Symptoms of obturator nerve damage
Decreased thigh sensation (medial) and adduction
Sensory & motor innervation of femoral nerve
Sensory: anterior thigh, medial leg
Motor: quadriceps, iliacus, pectineus, sartorius
Causes of injury to femoral nerve
Pelvic fracture
Symptoms of femoral nerve injury
Decreased leg extension (decreased patellar reflex)
Innervation of sciatic nerve
Motor: semitendinosus, semimembranosus, biceps femoris, adductor magnus
Causes of injury to sciatic nerve
Herniated disc, posterior hip dislocation
What does the sciatic nerve branch into
Common peroneal & tibial nerves
Superficial and deep innervation of common (fibular) peroneal nerve
Superficial -
Sensory: dorsum of foot (except bw hallux & 2nd digit)
Motor: peroneus longus & brevis
Deep -
Sensory: webspace bw hallux & 2nd digit
Motor: tibialis anterior
Causes of injury to common peroneal
Trauma/compression of lateral aspect of leg, fibula neck fracture
Symptoms of common peroneal damage
Loss of sensation on dorsum of foot
Foot drop: inverted & plantarflexed at rest, loss of eversion & dorsiflexion; “steppage gait”
Sensory & motor innervation of tibial nerve
Sensory: sole of foot
Motor: biceps femoris (long head), triceps surae (gastrocnemius, soleus), plantaris, popliteus, flexor muscles of the foot
Causes of injury to tibial nerve
Knee trauma, Baker’s cyst (proximal lesion), tarsal tunnel syndrome (distal lesion)
Symptoms of tibial nerve damage
Inability to curl toes & loss of sensation on sole
In proximal lesions (baker’s cyst), foot everted at rest w weakened inversion & plantarflexion
Innervation of superior gluteal nerve
Motor: Gluteus medius & minimus, tensor fascia lata
Causes of injury to superior gluteal nerve
Iatrogenic injury during IM injection to superomedial gluteal region (need to aim for anterolateral region)
Signs of superior gluteal nerve damage
Trendelenberg gait: pelvis tilts because weight-bearing leg can’t maintain alignment of pelvis through hip abduction
Lesion is contralateral to the side of the hip that drops, ipsilateral to extremity on which the patient stands
Innervation of inferior gluteal nerve
Motor: gluteus maximus
Causes of injury to inferior gluteal nerve
Posterior hip dislocation
Presentation of inferior gluteal nerve injury
Difficulty climbing stairs, rising from seated position
Loss of hip extension
Sensory and motor innervation of pudendal nerve
Sensory: perineum
Motor: external urethral & anal sphincters
Symptoms of pudendal nerve injury
Decreased sensation in perineum & genital area; can cause fecal &/or urinary incontinence
Can be blocked w local anesthetic during childbirth using ischial spine as landmark
Attachments of ACL
Lateral femoral condyle to anterior tibia
Attachments of PCL
Medial femoral condyle to posterior tibia
What is the anterior drawer sign
Bend knee at 90 degrees, increased anterior gliding of tibia anteriorly due to ACL injury
Lachman test is more specific and done at 30 degrees
What is the posterior drawer sign and what does it indicate?
Bend knee at 90 degrees, increased posterior gliding of tibia due to PCL injury
Describe abnormal passive abduction in the knee
Aka valgus stress test
Knee extended at 30 degree, lateral (valgus) force results in medial space widening of tibia = MCL injury
Describe abnormal passive adduction in the knee
Aka varus stress test
Knee at 30 degrees, medial (varus) force causes lateral space widening of tibia = LCL injury
How is the McMurray Test conducted
During flexion/extension of the knee w rotation of tibia/foot (LIME)
- pain, “popping” on internal rotation & varus force = lateral meniscus tear
- pain, “popping” on external rotation & valgus force = medial meniscal tear
