Lower and upper limb injury Flashcards
How might a patient injure their femoral nerve?
Compressed on iliacus during childbirth
Femoral triangle
What nerve is damaged if a patient has these signs?
Weak/absent knee extension and patella ligament reflex
Weakened hip flexion
Problems with stairs/inclines/rising from seated position
Patient pushes thigh back with hand when walking
Femoral nerve damage - ant thigh
What nerve is damaged if a patient has these signs?
Instability/weakness during gait
Circumducting wide based gait
External rotation & abduction during walking
Lack of propulsion during running
‘Groin’ pain reported in compression
Obturator nerve injury - medial thigh (adductors and gracilis)
What is Hilton’s law?
A mobile joint is innervated by the nerve innervating the muscle acting on the joint and also the nerve innervating the skin covering the joint – This can be a mechanism for pain referral
What might cause obturator nerve injury/compression?
ovarian cysts/ tumour/ovulation can result in hip, medial thigh or knee pain Pelvic brim (childbirth) Pelvic cavity (surgery) Fascial entrapment
What nerve is damaged if a patient has these signs?
Weak knee flexion
Absent ankle & digit plantarflexion & dorsiflexion
Foot deformity/collapse
Leg brace can assist walking – need to watch foot placement
Sciatic nerve injury - posterior thigh
How might the Sciatic nerve be injured?
Gluteal region (penetrating injury)
Piriformis entrapment
Posterior hip dislocation
Posterior thigh
What nerve is damaged if a patient has these signs?
Weak dorsiflexion = foot slap whilst walking (flat foot landing)
Absent dorsiflexion = foot drop
Absent foot/subtalar (ankle) eversion = ? prone to inversion injury/sprain/#
Common fibular nerve
Anterior & lateral leg compartments
How might the common fibular nerve be injured?
Popliteal fossa (inferior to biceps tendon) Lateral aspect of fibula head/neck
What nerve is damaged if a patient has these signs?
Weak/absent plantarflexion (proximal injury)
Slower speed of walking & shorter stride length
Minimal arch support – foot may deform/flatten
Digits may splay on weight-bearing
Tibial nerve injury - posterior leg comp and intrinsic foot muscles
How might the tibial nerve be injured?
Gluteal region
Posterior hip dislocation
Popliteal fossa
Posterior to the medial malleolus in the tarsal tunnel
What hand sign would you see if the median nerve was injured?
Hand of Benediction
How can you tell the difference if the median nerve was injured at the elbow vs compression at wrist?
Elbow: No forearm pronation, Weak wrist flexion that deviates to adduction + all of wrist signs
Wrist: Thenar wasting & thumb opposition not possible
Thumb laterally rotated & adducted (looks like a finger)
Digits 2 & 3 lag in fist making as lumbricals 1 & 2 paralysed
Sensory: Palm spared in carpal tunnel syndrome
Palm included with volar distal forearm laceration
What nerve injury can cause a claw hand deformity?
Ulnar nerve injury
What is the ulnar nerve paradox?
Damage at elbow - slight clawing of digits 4 and 5 due to lack of Flexor Digitorum Profundus (FDP)
Damage at wrist - worse clawing as FDP still works and exacerbates IP joint flexion
