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peripheral nerve detailed > lower limb (11) distribution, symptoms, cause > Flashcards

lower limb (11) distribution, symptoms, cause Flashcards

1
Q

What nerve is associated with the most common nerve disorder in the foot?

A

interdigital nerve
condition: Morton’s neuroma

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2
Q

What does the sciatic nerve divide into and where?

A

tibial and common fibular nerve
@ popliteal fossa

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3
Q

What are the differentials for adductor muscle strain?

A
  • osteitis pubis
  • stress fx of pelvis
  • inguinal ligament entrapment
  • lateral cutaneous nerve entrapment in thigh
  • inguinal hernia
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4
Q

what is the most common mononeuropathy in lower extremity?

A

common fibular nerve neuropathy

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5
Q

What are the most common causes of obturator tunnel syndrome?

A
  • 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
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6
Q

what does the obturator nerve supply?

A

motor branch supplies adductor brevis, adductor longus and gracilis

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7
Q

What are the signs and symptoms of sciatic nerve neuropathy?

A
  • 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
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8
Q

what does the femoral nerve supply?

A

superficial branch: cutanoues inn anterior thigh
deep branch: quads
gives rise to saphenous nerve - cutaneous sensation to medial thigh, leg and foot

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9
Q

what are the signs and symptoms of superficial fibular nerve (L5 - S1) entrapment?

A

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

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10
Q

what does the sciatic nerve supply?

A

motor and sensory inn of posterior thigh & entire leg apart from medial leg supplied by saphenous nerve

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11
Q

What nerve supplies lower fibres of transverse abdominal muscle and internal obliques?

A

iliohypogastric nerve

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12
Q

what are the common causes of sciatic nerve injury?

A
  1. nerve compression in pelvic cavity (tumour - bowel/prostate);
  2. bone exostosis in pelvic rim/sacrum;
  3. vascular compression;
  4. hip/femur fx;
  5. piriformis syndrome.
  6. 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
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13
Q

what does the obturator tunnel syndrome involve?

A
  • 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
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14
Q

What are the signs and symptoms of Morton’s neuroma?

A
  • 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
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15
Q

what are signs and symptoms of obturator nerve compression?

A

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
-

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16
Q

what is the most common cause of lateral femoral cutaneous nerve issues?

A

entrapment at inguinal ligament
-ddx for lumbar radiculopathy
discogenic
nerve root L2/3 compression

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17
Q

what does ilioinguinal nerve supply?

A

sensory branches: pubic symphysis
superior & medial femoral triangle
root of penis / anterior scrotum / mons pubis / labia majora

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18
Q

what are the most common causes of posterior tibial nerve pain?

A
  • pronation syndrome
  • varus heels
  • tendonitis
  • medial malleolus fx
  • varicose veins
  • RA, AS
  • hyperlipidemia
  • diabetes
    -edema
  • pregnancy
  • peripheral vascular disease
  • ganglion cyst
19
Q

what is anterior tarsal tunnel syndrome?

A

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

20
Q

what nerve is associated with meralgia paresthetica?

A

lateral femoral cutaneous nerve L2 - 3

21
Q

what is the path of the posterior tibial nerve?
what does it supply?

A

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.

22
Q

what are symptoms of common fibular nerve entrapment?

A

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)

23
Q

What are the most common causes of femoral nerve issues?

A
  • 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
24
Q

how many branches of the common fibular nerve are there?
what do they supply?

A

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

25
Q

what are the symptoms of irritation of iliohypogastric nerve?

A

burning, lacinating pain in inguinal & suprapubic region
DDX trochanteric bursitis

26
Q

what are most common causes of common fibular nerve entrapment?

A

direct compression at fibular neck
- isolated, acute repetitive strain eg kicking, dancing,
- short casts or braces around area
- fibular fx
- blunt trauma
- knee dislocation during ankle inv strain
- stretch injury - prolonged squatting

27
Q

What are the common etiologies of Morton’s neuroma?

A
  • pregnancy
  • osteochrondritis
  • rheumatic inflammatory disease
  • pronation
  • prolonged crouching
  • flexion contractures of hip & knee
  • poor fitting shoes
28
Q

what are the symptoms of lateral femoral cutaneous nerve issues?

A
  • hyperesthesia over lateral thigh
  • pain by pressure medial to ASIS or inguinal lig
  • standing hip ext may reprod symptoms
  • no motor deficit
29
Q

What are symptoms of posterior tibial nerve pain?

A
  • more common in medial plantar nerve distribution
  • exacerbated by extended periods of standing or walking
  • pain in soles of feet
  • symptoms inc with walking & pronation
  • +ve tinels sign posterior to medial malleolus
  • loss of 2 point discrimination & hypothesia
  • pain with toe abd / passive eve / DF
  • local anhidrosis/reduced foot swelling
30
Q

what are most common causes of iliohypogastric nerve pain?

A

post surgery / operative entrapment in scar
- muscles tear in lower abdomen
- pregnancy

31
Q

what are the signs and symptoms of ilioinguinal nerve issues?

A

inguinal and/or hip region pain
- inc pain with abdominal wall tension (standing straight)
- inguinal pain with anterior ASIS pressure
- hyper/dysthesia along inguinal ligament
- abdominal muscle weakness/atrophy
- protrusion of abdomen over inguinal lig during abdominal contraction
- difficulty rising from supine

32
Q

what are common causes of Morton’s neuroma?

A

compression of nerve as passes under transverse intermetatarsal ligament as weight transferred to ball of foot when toes dorsiflex in last stance phase
- interdigital nerve compressed btn plantar foot and edge of intermetatarsal lig

33
Q

what is the demographic for trochanteric bursitis?

A

middle aged/ elderly women
- assoc with overuse injury; fall/bump
- scolioisis
- lumbar arthritis
- leg length discrepancy
-ra
- bone spurs/calcium deposits

anteromedial thigh; - - pain inc with hip ext
- relieved with ER of hip
-+ve reverse SLR
- sensory loos medial aspect of leg below knee - saphenous distribution

34
Q

what is lateral femoral cutaneous nerve issues associated with?

A

leg length discrepancy
- trunk /leg hyperextension
- prolonged standing
- acute or chronic stretching
- gun / tool belt / tight waist belt or strap

35
Q

what are the symptoms of meralgia paresthetica?

A

anterolateral thigh pain
- paresthesia & tingling
- sensitive to clothing contact & leg extension
+ve reverse SLR
- trophic changes on skin in distribution
- focal pressure on inguinal leg may inc symptoms
- no motor signs

36
Q

what skin area does the lateral cutaneous nerve supply?

A

skin from greater trochanter to mid thigh

37
Q

What is the most common cause of iolioinguinal nerve issues?

A

lower abdominal incision eg pregnancy
- femoral catheter
- urinogenital pathology
-renal pathology
-inguinal hernia
- hip OA
- heavy weight lifiting

38
Q

what are the signs and symptoms of pudendal nerve issues?

A

pain & hyperasthesia in perianal region
- difficulty with bladder and bowel action
- impotence

39
Q

what is the most common cause of pudendal nerve damage?

A
  • compression - traction, stretching
  • perianal tear during birthing
  • pelvic surgery / tumour
  • non-mechanical = viral infection, herpes zoster, HIV, DM, MS
40
Q
A
41
Q

what muscles evert the foot?

A

Fibularis longus & brevis
Extensor digitorum longus

42
Q

what muscles invert the foot?

A

Tibialias posterior
tibialis anterior
Extensor hallicus longus
flexor digitorum longus
flexor hallicus longus

43
Q
A

peripheral nerve detailed (2 decks)

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