lower extremities nerves / lumbosacral reticulopathy / neurovascular pairing Flashcards
lower extremity nerves:
- obturator nerve (L2-L4)
- femoral nerve (L2-L4)
- Common peroneal nerve (L4-S2)
- Tidial nerve (L4-S3)
- superior gluteal nerve (L4-S1)
- inferior gluteal nerve (L5-S2)
- sciatic nerve (L4-S3)
- pudendal (S2-S4)
origin of obturator nerve
L2-L4
causes of obturator nerve injury
pelvic surgery
presentation of obturator nerve injury
- decreased tight sensation (medial)
2. decreased adduction
thigh the part of the human leg between the
hip and the knee
origin of femoral nerve
L2-L4
causes of femoral nerve injury
pelvic fracture
presentation of femoral nerve injury
- decreased tight flexion
2. decreased leg extension
sciatic nerve splits into
- common peroneal nerve
2. tibial nerve
origin of common peroneal nerve
L4-S2
causes of common peroneal nerve injury
- trauma or compression of lateral aspect of leg
2. fibular neck fracture
presenation of common peroneal nerve injury
- foot drop
2. loss of sensation on dorsum foot
foot drop - mechanim
inverted and plantar-flexed at rest (loss of eversion and dorsiflexion)
foot eversion
out rotation
foot inversion
medial rotation
foot drop –>
steppage gait
origin of tibial nerve
L4-S3
causes of tibial nerve injury
- knee trauma (proximal)
- Baker cyst (proximal)
- tarsal tunnel syndrome
presenation of tibial nerve injury
- inability to curl toes
- loss of sensation on sole of foot
- foot everted at rest with loss of inversion and plantarfexion (PROXIMAL LESIONS)
origin of superior gluteal
L4-S1
causes of superior gluteal injury
iatrogenic injury during intramuscular injection to upper medial gluteal region
presentation of superior gluteal injury
Trendelenburg sign/gait
Trendelenburg sign/gait
pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction muscles
hip abduction muscles (and innervation)
medius and minimus gluteus
innervation: superior gluteal
Trendelenburg sign/gait: site of lesion
lesion is contralateral to the side of the hip that drops,
and ispilateral to extremity on which the patient stands
origin of inferior gluteal nerve
L5-S2
causes of inferior gluteal injury
posterior hip dislocation
presentation of inferior gluteal injury (and why)
difficulty in climbing stairs or rising from sited position
loss of hip extension by gluteal maximus
hip extension muscle and innervation
gluteal maximus
innervation: inferior gluteal nerve
gluteal muscles and innervations
medius gluteus (superior gluteal nerve) minimus gluteus (superior gluteal nerve) maximus gluteus (inferior gluteal nerve) superior gluteal also innervates tensor fascia latae
origin of sciatic nerve
L4-S3
sciatic nerve innervates
posterior thigh
origin of pudendal nerve
S2-S4
pudendal nerve innervates
perineum
perineum is the area
between the anus and the scrotum or vulva.
pudendal nerve importance in childbirth
can be blocked with local anesthetics during childbirth using the ischial spine as a landmark for injection
Sign of lumbosacral radiculopathy
paresthesias and weakness in distribution of specific lumbar or sacral spinal nerves
lumbosacral radiculopathy is ofte due to
intervertebral disc herniation in which the nerve association with the INFERIOR vertebral body is impinged
example: L3-L4 disc herniation affects –>
L4 spinal nerve
L3-L4 disc hernitation - findings
- weakness of knee extension
2. decreased patellar reflex
L4-L5 disc hernitation - findings
- weakness of dosroflexion
2. difficulty in heel-walking
L5-S1 disc hernitation - findings
- weakness of plantarflexion
- difficulty in toe-walking
- decreased Achilles reflex
Neurovascular pairing - naming
nerves and arteries are frequently named together by the bones/regions with which they are associated. there are some exceptions
axila/lateral thorax neurovascular paring - nerve and artery
long thoracic nerve
lateral thoracic artery
surgical neck of humerus neurovascular paring - nerve and artery
axillary nerve
posterior circumflex artery
midshaft of humerus neurovascular paring - nerve and artery
radial nerve
deep branchial
radial nerve in midshaft of humerus is passing through
spiral groove
The cubital fossa is a
triangular hollow area that lies in front of the elbow joint
distal humerus/cubital fossa neurovascular paring - nerve and artery
median nerve
branchial artery
The popliteal fossa
is a shallow depression located at the back of the knee joint (ιγνιακός βόθρος)
popliteal fossa neurovascular paring - nerve and artery
tibial nerve
popliteal artery
medial malleolus is
the medial surface of the lower extremity of tibia is prolonged downward to form a strong pyramidal process
lateral malleolus
The lower extremity of the fibula (pyramidal form)
posterior to medial malleolus neurovascular paring - nerve and artery
tibial nerve
posterior tibial
malleolus in greek
σφυρό
Tarsal tunnel is found
along the inner leg posterior to the medial malleolus.
Lumbosarcal radiculopathy - intervertebral discs direction (why)
herniate posterolaterally due to the thin posterior longitudinal ligament and thicker anterior longitudinal ligament along the midline of the vertebral bodies
site of intramascular injection
choose superolateral gluteal quardant to avoid nerve injury
superior gluteal nerve innervates
- medius gluteous
- minimus gluteus
- tensor fascia latae
presenation of proximal tibial nerve injury
foot everted at rest with loss of inversion and plantarfexion
