LE Neurological Conditions - Diagnostic Manual Flashcards
outcome measures for LE neuropathies
PSFS
LEFS
ODI
femoral neuropathy will have _____ deficits
sensory and motor
motor deficits associated with femoral neuropathy
weakness in:
hip flexion
knee extension
sensory loss associated with femoral neuropathy
anterior and medial thigh
medial lower leg
entrapment locations of femoral nerve
retroperiotneal space
crossing deep to inguinal ligament
what can cause femoral nerve injury
surgery or procedures at femoral triangle
- vascular catheterization
- anterior approach hip replacement
trauma / space occupying pathology
range of motion finding associated with femoral neuropathy
limited hip flexion and/or knee flexion AROM
- limited by weakness
muscle performance finding associated with femoral neuropathy
weakness in hip flexion
explain what entrapment location will impair hip flexion
above inguinal ligament in retroperitoneal space
explain entrapment location that will not impair hip flexion
below the inguinal ligament
palpation finding associated with femoral neuropathy
sensory deficit comparison bilaterally
- anterior thigh
- medial thigh
- medial lower leg
joint mobility finding associated with femoral neuropathy
normal
special tests associated with femoral neuropathy
femoral nerve tension test
interventions related to femoral neuropathy
removal/limiting of inciting factors
nerve mobility exercises
manual therapy
restore normal muscle function
prevent paresis
improve blood circulation to affected tissues
how to restore normal muscle function
therapeutic exercise
NMES
neuropathy of lateral femoral cutaneous nerve is also called
meralgia parasthetica
sensory deficits associated with meralgia parastethetica
pain, paresthesia, numbness and tactile hypersensitivity isolated in anterior thigh
explain the commonality of lateral femoral cutaneous neuropathy
second most common LE neuropathy
potential causes of lateral femoral cutaneous neuropathy
compression of nerve via external forces
– weight / large abdomen (pregnancy)
ascites in liver failure
acute compression from seatbelt in MVA
complication following hip surgery
range of motion finding associated with lateral femoral cutaneous neuropathy
normal
muscle performance finding associated with lateral femoral cutaneous neuropathy
normal
palpation finding associated with lateral femoral cutaneous neuropathy
anterolateral thigh pain, paresthesia, numbness and tactile hypersensitivity
joint mobility finding associated with lateral femoral cutaneous neuropathy
normal
special test associated with lateral femoral cutaneous neuropathy
femoral nerve tension test
interventions associated with lateral femoral cutaneous neuropathy
patient education
postural re-training
trunk ROM and aerobic exercises
nerve mobility exercises
manual therapy
what would patient education look like for those with lateral femoral cutaneous neuropathy
activity modification / reduction of aggravating factors
loose clothing / belts
diet/weight loss
medical interventions related to lateral femoral cutaneous neuropathy
corticosteroid injection
surgical decompression
piriformis syndrome is synonymous with
sciatic nerve entrapment
explain how piriformis syndrome presents
sensory-like symptoms in absence of true sensory or motor deficits
if there is laceration/damage to sciatic nerve, what motor loss may occur
loss of foot musculature action
explain subjective reporting of piriformis syndrome
symptoms worsen with sitting on involved side, driving, and crossing of involved leg
what is the “wallet sign”
sitting on involved butt cheek and having symptoms flare up
- piriformis syndrome of sciatic nerve
what tests/actions would increase the likelihood of symptoms to reproduce in those with piriformis syndrome
SLR with dorsiflexion
piriformis stretch
palpation/provocation of piriformis
ROM finding associated with piriformis syndrome
normal
– increased symptoms may occur with hip ADD and IR
muscle performance finding associated with piriformis syndrome
normal
– may have increased symptoms with resisted hip ER
palpation finding associated with piriformis syndrome
provocation of symptoms over piriformis
joint mobility finding associated with piriformis syndrome
normal
special tests related to piriformis syndrome
straight leg raise
physical therapy interventions related to piriformis syndrome
activity modification
entrapment reduction
strengthening
motor coordination training
explain activity modification/pt education in those with piriformis syndrome
avoid laying on involved leg (adducts and IR involved hip naturally)
crossing symptomatic leg
avoid aggressive/prolonged stretching
imaging related to piriformis syndrome
MRI for identification of compression cause
- if not responding to conservative management
what is the most common LE neuropathy
fibular
what can cause fibular nerve neuropathy
trauma to lateral knee/leg
ganglionic cyst
prolonged immobilization / habitual cross-leg sitting
where is the common fibular nerve located? if lesioned here, what deficits are seen?
at fibular head
- foot drop
- numbness of lateral lower leg / dorsum of foot
- characteristic steppage gait
why does foot drop occur
weakness of ankle dorsiflexion and foot eversion
into what and where does the common fibular nerve branch
past the fibular head, branches into
superficial fibular nerve
deep fibular nerve
explain the branching of superficial fibular nerve
medial / lateral cutaneous branches
what is the area of sensation associated with deep fibular nerve
web space between toes 1 and 2 dorsally
ROM finding associated with fibular nerve entrapment
reduced ankle dorsiflexion / foot eversion AROM
muscle performance finding associated with fibular nerve entrapment
reduced ankle dorsiflexion / foot eversion
palpation finding associated with fibular nerve entrapment
likely sensory deficits of lateral lower leg/dorsum of foot
joint mobility finding associated with fibular nerve entrapment
normal
special tests associated with fibular nerve entrapment
SLR with fib nerve bias
physical therapy interventions associated with fibular nerve entrapment
pt education
reduction of entrapment
fibular nerve mobilization
NMES for significant weakness
what random factor may attribute to a more distal fibular nerve compression
tight shoes
– loosen the laces homeslice
how to reduce entrapment of common fibular nerve
superior tibiofibular jt mobilization
fibular head soft tissue mobilization
posterior tibial neuropathy is also known as
tarsal tunnel syndrome
explain symptom findings associated with tarsal tunnel syndrome
pain, sensory loss and paresthesia over:
- medial ankle and heel
- sole of foot
- toes
sensory deficit present in lesion of medial plantar branch of tibial nerve
plantar foot of digits 1-3
sensory deficits present in lesion of lateral plantar branch of tibial nerve
plantar foot of lateral half of digit 4 and all of digit 5
what accessory symptoms may be associated with tarsal tunnel syndrome
cramping in the foot
weakness of toe flexion/abduction
what actions may aggravate tarsal tunnel syndrome
standing
walking
running
ROM finding associated with tarsal tunnel syndrome
deficit in toe flexion/abduction AROM
– if significant or long term compression
muscle performance finding associated with tarsal tunnel syndrome
atrophy of plantar foot muscles
– if significant or long term compression
palpation/neurological finding associated with tarsal tunnel syndrome
notable sensory deficits in tibial nerve distribution
joint mobility finding associated with tarsal tunnel syndrome
normal
special tests associated with tarsal tunnel syndrome
tinel test
triple compression test
PT interventions associated with tarsal tunnel syndrome
pt education
– footwear with adequate support
– unloading of tissue
entrapment reduction
therapeutic exercise
how to unload irritable tissues in those with tarsal tunnel syndrome
taping
rocker-bottom footwear
orthotics
therapeutic exercises for those with tarsal tunnel syndrome would focus on
proximal chain
- increased pronation that may cause compression at tarsal tunnel
medical interventions associated with tarsal tunnel syndrome
microsurgical decompression
- if muscle weakness and atrophy are present
what can cause morton’s neuromas
entrapment of the common plantar digital nerves and repetitive traction
subjective reporting associated with morton’s neuroma
sharp, burning localized pain to second or third web/metatarsal interspace
- level of metatarsal heads
may radiate into toes
feeling like there is a pebble in the shoe
worse when walking
what is an odd subjective report associated with morton’s neuroma
patient feeling the need to remove shoes and massage the area
what are some common examination findings associated with morton’s neuroma
cutaneous sensation decreased in distal distribution
“lateral squeeze test” is often positive with palpable/painful click
ROM finding associated with Morton’s Neuroma
no true ROM loss but could be limited due to pain
muscle performance finding associated with Morton’s Neuroma
normal
special tests associated with Morton’s Neuroma
squeeze test
PT interventions related to Morton’s Neuroma
pt edcuation
unloading irritable tissue
entrapment reduction
therapeutic exercise
how to unload irritable tissue for those with Morton’s Neuroma
rocker-bottom footwear
- shoes with wide toe-boxes
orthotics
medical interventions associated with Morton’s Neuromas
corticosteroid injection
surgical excision
