lower limb (11) distribution, symptoms, cause Flashcards
What nerve is associated with the most common nerve disorder in the foot?
interdigital nerve
condition: Morton’s neuroma
What does the sciatic nerve divide into and where?
tibial and common fibular nerve
@ popliteal fossa
What are the differentials for adductor muscle strain?
- osteitis pubis
- stress fx of pelvis
- inguinal ligament entrapment
- lateral cutaneous nerve entrapment in thigh
- inguinal hernia
what is the most common mononeuropathy in lower extremity?
common fibular nerve neuropathy
What are the most common causes of obturator tunnel syndrome?
- adductor muscle strain
- pregnancy
-osteitis pubis - pelvic trauma
- compression of nerve during labour
- entrapment following hip arthroplasties
- malposition of leg for extended periods
- entrapment in adductor magnus in athletes
what does the obturator nerve supply?
motor branch supplies adductor brevis, adductor longus and gracilis
What are the signs and symptoms of sciatic nerve neuropathy?
- pain / paresthesia along course of nerve
- deep ache in gluteal region
- sensory loss of entire foot except for small region supplied by saphenous nerve
- impaired ankle reflex
- weakness of toe extension, flexion, ankle DF & PF, ankle inv & ev;
- SLR pain at 25 deg
what does the femoral nerve supply?
superficial branch: cutanoues inn anterior thigh
deep branch: quads
gives rise to saphenous nerve - cutaneous sensation to medial thigh, leg and foot
what are the signs and symptoms of superficial fibular nerve (L5 - S1) entrapment?
pain /paresthesia along lateral leg/dorsum of foot
- pain / paresthesia over dorsum of foot with resisted DF & evr
- passive PF/eversion - stretches nerve with percussion / compression over tunnel
what does the sciatic nerve supply?
motor and sensory inn of posterior thigh & entire leg apart from medial leg supplied by saphenous nerve
What nerve supplies lower fibres of transverse abdominal muscle and internal obliques?
iliohypogastric nerve
what are the common causes of sciatic nerve injury?
- nerve compression in pelvic cavity (tumour - bowel/prostate);
- bone exostosis in pelvic rim/sacrum;
- vascular compression;
- hip/femur fx;
- piriformis syndrome.
- Fibular division more susceptible to injury - lateral & superficial in butt/ less blood supply; fixed btn sciatic notch & fibular head; tibial fixed only at sciatic notch
what does the obturator tunnel syndrome involve?
- pain from pubic symphysis to knee
- medial thigh hyperesthesia
- posteomedial knee pain
- leg adductor paresis
- medial thigh muscle atrophy
- adductor group pain & spasm
- -circumduction gait on involved side
What are the signs and symptoms of Morton’s neuroma?
- hypoesthesia/
analgesia over trigger point (metatarsal heads) - pain btn 3rd & 4th metatarsal head
- inc pain with compression of metatarsal heads
- inc pain with walking (esp bearfoot or on hard surfaces)
- sudden sharp pain from sprinting, jumping, squatting, hopping;
-inc forefoot pain with hyperext - intermittent dull ache or cramping sensation on plantar aspect of 2nd/3rd interspace
- vague discomfort / numbness/ burning /occasional shooiting pain inv toes
- symptoms improve with rest
- night pain rare
- pain may radiate proximally as condition progresses
- bilateral uncommon
- pain on deep interdigital palpation or single leg hop = loads forefoot
what are signs and symptoms of obturator nerve compression?
difficulty walking –> unstable leg
- exercise related groin pain - deep ache in adductor region, may radiate down medial aspect of thigh to knee
- reduced ability to jump
- gait externally rotated
- muscle wasting
- diminished sensation along distal medial thigh
-
what is the most common cause of lateral femoral cutaneous nerve issues?
entrapment at inguinal ligament
-ddx for lumbar radiculopathy
discogenic
nerve root L2/3 compression
what does ilioinguinal nerve supply?
sensory branches: pubic symphysis
superior & medial femoral triangle
root of penis / anterior scrotum / mons pubis / labia majora
what are the most common causes of posterior tibial nerve pain?
- pronation syndrome
- varus heels
- tendonitis
- medial malleolus fx
- varicose veins
- RA, AS
- hyperlipidemia
- diabetes
-edema - pregnancy
- peripheral vascular disease
- ganglion cyst
what is anterior tarsal tunnel syndrome?
deep fibular nerve (L5 - S1)
burning pain localized to dorsal web bn great toe & 2nd toe.
- blunt forefoot pain
- nocturnal exacerbation
- +ve tinel’s over deep fibular nerve at inferior extensor retinaculum
- abnormal ext digitorum brevis
- inc pain with ankle PF
- metatarsal osteopenia
what nerve is associated with meralgia paresthetica?
lateral femoral cutaneous nerve L2 - 3
what is the path of the posterior tibial nerve?
what does it supply?
sciatic divides into common fibular & tibial nerve at popliteal fossa
- tibial nerve: gastroc, enters tarsal tunnel; branches medial (abd hallicus & skin of 3 1/2 toes)
lateral: abd digitquinti & lateral 1 1/2 toes.
what are symptoms of common fibular nerve entrapment?
L4 - S2 sensory disturbance anterolateral leg - may radiate to thigh
-inc pain with pressure on tunnel
- DF paresis
- foot drop
- foot inversion weakness
- inc pain passive inv
- neurotrophic bony changes in foot (neuropathic arthopathy)
What are the most common causes of femoral nerve issues?
- diabetic amyotrophy (m/c femoral nerve neuropathy)
- trauma - penetrating injuries
- entrapment neuropathies below inguinal lig;
- hip arthoplasty;
- pelvic fx;
- acute hypertension;
- difficult birth
- vertebral / pelvic tumours
- vascular damage
how many branches of the common fibular nerve are there?
what do they supply?
superficial: supplies foot evertors; sensation to lateral calf & dorsum of foot
deep: supplies foot and toe DF; small sensory skin web space btn 1st & 2nd toes
leaves sciatic nerve in distal thigh, runs lateral btn origins of fibularis longus
