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Peripheral Neurology > Lower body > Flashcards

Lower body Flashcards

1
Q

What are the ventral rami of the lumbar plexus

A

T12 - L5

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2
Q

How many branches come off each ventral rami of the lumbar plexus

A 
T12- 2
L1- 3
L2- 4
L3- 4
L4- 4
L5- 1
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3
Q

What are the branches of the T12 ventral rami?

A
  1. subcostal nerve

2. branch to L1

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4
Q

What are the branches of the L1 ventral rami?

A
  1. iliohypogastic
  2. ilioinguinal
  3. branch to genitofemoral
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5
Q

What are the branches of the L2 ventral rami?

A
  1. branch to genitofemoral
  2. brach to lateral cutaneous of the tight
  3. branch to femoral
  4. branch to obturator
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6
Q

What are the branches of the L3 ventral rami?

A
  1. branch to lateral cutaneous of the thigh
  2. branch to femoral
  3. branch to accessory obturator
  4. branch to obturator
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7
Q

What are the branches of the L4 ventral rami?

A
  1. branch to femoral nerve
  2. branch to accessory obturator
  3. branch to obturator
  4. branch to lumbosacral trunk
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8
Q

What are the branches of the L5 ventral rami?

A

lumbosacral trunk

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9
Q

What are the ventral rami of the sacral plexus?

A

L4-S4

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10
Q

What are the divisions of the sacral plexus?

A

posterior L4-S2

anterior L4-S4

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11
Q

What are the terminal branches of the divisions of the sacral plexus?

A

posterior fibular nerve L4-S2

anterior tibial nerve L4-S3

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12
Q

What branches off the posterior division of the sacral plexus?

A
  1. superior gluteal (4-1)
  2. inferior gluteal (5-2)
  3. muscular to piriformis (1-2)
  4. branch to posterior cutaneous (1-3)
  5. branch to perforating cutaneous (2-3)
  6. terminal fibular (4-2)
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13
Q

What branches of the anterior division of the sacral plexus?

A
  1. muscular to quadratus femoris and inferior gemelli (4-1)
  2. muscular to obtruatur internus and superior gemelli (5-2)
  3. branch to posterior cutaneous (1-3)
  4. branch to perforating cutaneous (2-3)
  5. pudendal (2-4)
  6. levator ani (3-4)
  7. 4th sacral
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14
Q

Where is the sclerotome referral pattern for L1?

A
  1. anteriorly-ASIS wrapping down to pubis along inguinal ligament
  2. posteriorly-PSIS with a wide swath running down from lower thoracic to hip
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15
Q

Where is the sclerotome referral pattern for L2?

A
  1. anteriorly -iliac crest into pubis and a swath across the middle of the anterior thigh
  2. posteriorly-similar to L1 but shift down a little to capture more glut
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16
Q

where is the sclerotome referral pattern for L3?

A
  1. anteriorly-lateral hip and thigh across the knee; lateral ankle
  2. posteriorly- PSIS, lateral thigh and shin
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17
Q

where is the sclerotome referral pattern for L4?

A
  1. anteriorly- front of thigh with primary spot just about the knee
  2. posteriorly-Down the central glut and outside of the tight
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18
Q

Where is the sclerotome referral pattern for L5?

A
  1. anteriorly- front of hip, pelvis and thigh running down the lateral shin
  2. posteriorly- lumbar spine region and middle of thigh
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19
Q

where is the sclerotome referral pattern for S!?

A
  1. anteriorly- front of thigh with a primary spot in the groin
  2. posteriorly- lateral pelvis, hip, thigh and shin
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20
Q

Where is the sclerotome referral pattern for S2?

A
  1. anteriorly- lateral hip and thigh with primary in the lateral thigh
  2. posteriorly-medial lumbar, glut and lateral thigh with primary spot over the medial glut
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21
Q

where is the sclerotome referral pattern for S3?

A
  1. anteriorly- medial knee

2. posterioly- medial glut with primary spont over PSIS

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22
Q

What are the cutaneous innervations of the groin along the inguinal ligament?

A

lateral -> medial

subcostal, genitofemoral, ilioinguinal

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23
Q

What are the cutaneous innervations of the anterior thigh?

A

lateral -> medial

  1. lateral femoral (lumbar plexus 2,3)
  2. intermediate femoral (femoral 2,3)
  3. medial femoral (femoral 2-4)
  4. cutaneous branch of obturator
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24
Q

What are the cutaneous innervations of the anterior knee and shin?

A

lateral knee- lateral sural (tibial SI)
medial knee- infrapatellar branch of saphenous (femoral 3,4)
lateral shin- superficial fibular
medial shin- saphenous (femoral 3,4)

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25
Q

what are the cutaneous innervations of the dorsal aspect of the foot?

A

lateral- sural (fibular SI)
mid- superfiscial fibular (4,5)
medial- saphenous (femoral 3,4)
b/w digit 1 and 2- deep fibular

26
Q

What are the cutaneous innervations of the glut region?

A

1.across the top of the illiac crest are the cutaneous branches of the subcostal nerve and dorsal rami L1-3
2.distal and medial are the cutaneous branch of S1-S3
3.preforating cutaneuos
posterior femoral cutaneous

27
Q

What are the cutaneous innervations of the posterior thigh?

A

Medial -> lateral

  1. cutaneous brach of obtruator
  2. posterior femoral cutaneous
  3. lateral femoral cutaneous
28
Q

What are the cutaneous innervations of the posterior lower leg?

A

medial -> lateral
saphenous (femoral 3,4)
sural (tibial SI)
superficial fibular (4,5)

29
Q

What nerves innervate muscles crossing the hip?

A 
inferior gluteal (sacral plexus L4-S1)
superior gluteal (sacral plexus L5-S2)
Obturator (lumbar plexus L2-L4)
femoral (lumbar plexus L2-L4)
Sciatic (L4-S2)
30
Q

What muscles does the superior gluteal innervate at the hip?

A 
gluteus medius (L4-S1)
gluteus minimus (L4-S1)
tensor fascia latae (L4-5)
31
Q

What muscles does the inferior gluteal innervate at the hip?

A
  1. gluteus maximus
32
Q

What muscles does the obturator innervate at the hip?

A

gracilis (2-3)
adductor longus (2-4)
adductor brevis (2-4)
adductor magnus (3-4) with tibial branch of sciatic (4-1)
obturator externeus (3-4)
pectineus (accessory obturator with femoral)

33
Q

What is the pathway of the gluteal nerves at the hip?

A

come off posterior division of sacral plexus

pass through greater sciatic foramen above piriformis

34
Q

What muscles does the femoral nerve innervate at the hip?

A

satorius (2-3)
rectus femoris (2-4)
iliacus (1-4)
pectineus (with accessory obturator)

35
Q

What is the pathway of the obturator nerves at the hip?

A

branch off lumbar plexus
pass through psoas major
emerges near pelvis brim
passes behind the iliac arteries running along the pelvis wall at about the path of the SIJ
passes through the obturator foremen between acetbulum and pubic symphysis
divides into anterior and posterior branches

36
Q

What muscles does the sciatic nerve innervate at the hip?

A

semitendonosus (tibial branch 4-1)
sememembranosus (tibial branch 4-1)
biceps femoris long head (tibial branch 5-2)
biceps femoris short head (fibular branch 5-2)

37
Q

What is the pathway of the femoral nerve at the hip?

A

pass through psoas major
emerges at lower end between it and illiacus
passes under the inguinal ligament dividing into anterior and posterior divisions
anterior gives off muscular and cutaneous branches
posterior gives off muscular and articular branches

38
Q

What muscles of the hip have branches directly off the lumbar plexus?

A 
psoas major (1-4)
psoas minor (1-2)
39
Q

what muscles of the hip have branches directly off the sacral plexus?

A 
piriforis (5-2)
obturator internus (5-2)
gemellus superior (5-2)
gemellus inferior (5-2)
quadratus femoris (4-2)
40
Q

What nerves innervate the hip capsule?

A 
obturator- anterior medial
femoral- anterior
sciatic- posterior
nerve to quadratus femoris- posterior medial
superior gluteal- posterior lateral
41
Q

What nerves innervate muscles crossing the knee?

A 
femoral
obturator
sciatic
tibial distal end of HS
fibular distal end of BF short head
Superior gluteal
42
Q

What muscles does the femoral nerve innervate at the knee?

A

sartorius (2-3)
quadriceps (2-4)
articularis genu (2-4)

43
Q

What muscles does the obturator innervate at the knee?

A
  1. gracillis (2-4)
44
Q

What muscles does the sciatic nerve innervate at the knee?

A
  1. semitendonosus (tibial branch 4-1)
  2. sememembranosus (tibial branch 4-1)
  3. biceps femoris long head (tibial branch 5-2)
  4. biceps femoris short head (fibular branch 5-2)
45
Q

What muscles does the tibial nerve innervate at the knee?

A

1.branches to semimenbranousus and tendonosis
2,popliteus (5,1)
3.gastroc (1,2)
4.plantaris (1,2)

46
Q

What are the articular innervations of the knee?

A
  1. tibial- posteriorly
  2. common fibular- laterally
  3. saphenous- anterior medial
  4. tibial recurrent of common fibular- anteriorly
47
Q

What are the common sites of compression for the tibial nerve?

A

popliteal fossa by a fibrous band connecting the heads of the gastroc or arch of the soleus
posterior tarsal tunnel

48
Q

What nerves innervate muscles crossing the ankle?

A
  1. tibial

2. fibular

49
Q

What muscles does the tibial nerve innervate that cross the ankle or are in the foot?

A
  1. gastroc (1,2)
  2. soleus (1,2)
  3. plantaris (1,2)
  4. tibialis posterior (5-1)
  5. FHL (2,3)
  6. FDL (2,3)
  7. AbDH, FHB, FDB, Lumbrical (medial plantar 2.3)
  8. AdDH, QP, interossi, lumbrical, FDM, AbDDM (lateral plantar 2,3)
50
Q

What are common compression sites for the fibular nerve?

A

1,fibular head

  1. fibrous arch of fibularis muscle
  2. extensor retinaculum or anterior tarsal tunnel
51
Q

What pathologies are associated with fibular nerve compression?

A
  1. ganglion cysts
  2. hematoma
  3. baker’s cyst
  4. fabellar of lateral gastroc
  5. ankle fractures or sprains
52
Q

what is the pathway of the fibular nerve after branching off sciatic?

A
  1. separates from tibial at the top of the popliteal fossa running medial to biceps formis
  2. wraps around the fibular head
  3. passes into the fibular tunnel through the fibularis longus dividing into superficial and deep
53
Q

what is the pathway of the tibial nerve after branching off sciatic?

A
  1. separates from the fibular at the top of the popliteal fossa bisecting the fossa
  2. runs dow the back of the tibia to the posterior aspect of the medial malleolus
  3. passes under the flexor retinaculum with posteior tibial artery
  4. divides into medial and lateral plantars
54
Q

What is the accessory fibular nerve and its clinical significance?

A

1.continuation of the superficial fibular that can innervate extensor digitorum brevis masking deep peroneal injuries

55
Q

What are the branches of the fibular nerve?

A
  1. superficial
  2. deep
  3. lateral sural
  4. accesory fibular
56
Q

What are the branches of the tibial nerve?

A
  1. medial sural
  2. medial plantar
  3. lateral plantar
57
Q

what is the pathway of the saphenous nerve?

A
  1. continuation of femoral descending to medial side of knee
  2. piercing facia between tendons of sartorius and gracilis becoming superficial and passing down the medial side of the tibia
  3. continues down the medial side of the foot and can join with superficial fibular
58
Q

What muscles does the fibular nerve innervate?

A
  1. superficial - FL, FB (1,2)

2. deep- TA (4,5), EDL, EDB, EHB (1,2)

59
Q

What are the cutaneous innervations of the fibular nerve?

A
  1. lateral sural (1,2)- posterior lateral lower leg and lateral foot
  2. deep fibular cutaneous- web space digits 1/2
  3. superficial peroneal- anterior lateral and dorsum of foot
60
Q

What are the cutaneous innervations of the tibial nerve?

A
  1. medial sural (1,2)- posterior lateral lower leg and lateral foot
  2. medial tibial cutaneous- medial heel
  3. lateral plantar
  4. medial plantar

Peripheral Neurology (2 decks)

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