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Z YEAR 2 Clinical Skills > Lower Limb 2 > Flashcards

Lower Limb 2 Flashcards

1
Q

What is a dermatome?

A

an area of skin supplied by a single spinal nerve root of the spinal cord segment

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2
Q

What is a myotome?

A

innervated region of a skeletal muscle

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3
Q

On the skin do the adjacent dermatomes overlap?

A

adjacent dermatomes (for example L2, L3, L4, L5) overlap considerably

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4
Q

How would you detect a loss of a single spinal nerve root?

A

at least three adjacent dermatomes should be affected

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5
Q

When is there no overlap?

A

(for example S2 and L3 or L4) across the axial lines of the limb

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6
Q

What do peripheral nerves do?

A

carry nerve components from several spinal segments (or roots) to muscles and overlying skin areas

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7
Q

What would damage to a peripheral nerve result in?

A
  • a wide ranging effect on more than one dermatomal areas or myotomal segments
  • may affect large areas of skin and several muscles
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8
Q

Where are sensory receptors?

A

both somatic and visceral areas of the body

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9
Q

What sensations can you test?

A
  1. light touch
  2. localization of touch
  3. two point tactile discrimination
  4. pain
  5. pressure
  6. temperature
  7. vibration
  8. sterognosis
  9. passive joint movement
  10. postural sensibility
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10
Q

How do you detect light touch in lower limb?

A
  1. Use a wisp of cotton wool to elicit light touch sensation on the lower limb dermatomal areas
  2. First demonstrate light touch with a wisp of cotton wool to your colleague, by touching a normal area of skin, just above the clavicle
  3. ask your colleague to close their eyes
  4. . examine individual dermatomal areas methodically
  5. find out whether they could feel the touch sensation as normal, dull or none at all
  6. Repeat the test on the opposite limb and compare.
    - choose the areas middle of a dermatome rather than at the boundaries
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11
Q

What does dermatome L1 correspond to?

A

Area over inguinal ligament

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12
Q

What does dermatome L2 correspond to?

A

Lateral side of thigh

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13
Q

What does dermatome L3 correspond to?

A

Lower medial side of thigh

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14
Q

What does dermatome L4 correspond to?

A
  • Medial side of leg
  • Medial foot
  • Great toe
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15
Q

What does dermatome L5 correspond to?

A
  • Lateral side of leg
  • Mid dorsum of foot
  • Middle three toes
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16
Q

What does dermatome S1 correspond to?

A
  1. Little toe
    2 Lateral foot
  2. Sole foot print area (where you stand)
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17
Q

What does dermatome S2 correspond to?

A
  1. Back of upper leg

2. Whole thigh

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18
Q

What does dermatome S3 correspond to?

A

Area over gluteal fold (where you sit)

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19
Q

What dermatomal segment is related to peripheral nerve posterior rami (over buttock region)?

A

L1, L2, L3

S1, S2, S3

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20
Q

What dermatomal segment is related to peripheral nerve of obturator?

A

L2, L3, L4

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21
Q

What dermatomal segment is related to peripheral nerve of femoral?

A

L2, L3, L4

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22
Q

What dermatomal segment is related to peripheral nerve of common fibular (part of sciatic nerve)?

A

L4, L5, S1, S2

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23
Q

What dermatomal segment is related to peripheral nerve of tibial (part of sciatic nerve)?

A

L4, L5, S1, S2, S3

24
Q

What does the patella tendon reflex test?

A

spinal segment/nerve roots L2, L3 & L4 (via femoral nerve)

25
Q

What does the achilles tendon reflex test?

A

pinal segment/nerve roots S1 & S2

via tibial nerve

26
Q

What is a reflex?

A

an involuntary response to a stimulus

27
Q

What does a reflex pathway consist of?

A

1) afferent (sensory) neurones conveying impulses from sensory receptors in the muscle spindle to the spinal cord (CNS)
2) efferent (motor) neurones running from the anterior grey columns of the spinal cord (CNS) to the effector organ which is the limb muscle

28
Q

What are two types of reflex arc?

A

monosynaptic or multisynaptic

29
Q

What type of reflex arc is the myotatic reflex arc?

A

monosynaptic

30
Q

What happens when the tendon of a muscle is tapped with a tendon hammer?

A
  1. stretching of the muscle spindles
  2. stimulus travels to the spinal cord, which then stimulates the efferent motor neurones in the anterior grey columns (horns)
  3. esults in involuntary contraction of the main muscle whose tendon was stretched by tapping.
31
Q

What are some methods of reinforcement for the reflex?

A
  1. clenching the teeth while interlocking the flexed fingers of both hands and pull apart strongly (Jendrassik manoeuvre)
  2. the patient voluntarily dorsiflexing the foot strongly whilst the knee jerk test is performed on the same lower limb
32
Q

How do you carry out a knee jerk?

A
  1. Patient sits with knees bent to 90 degrees (over the edge of the couch fully relaxed)
  2. Examiner stands in front / side
  3. Examiner locates patellar ligament and gently taps it directly with the tendon hammer
  4. Test both sides
33
Q

What do you expect with the knee jerk?

A
  • Brisk extension of the knee

- Contraction of quadriceps can be palpated on front of thigh

34
Q

How do you carry out the ankle jerk?

A
  1. Patient sits with knees bent to 90 degrees (over the edge of the couch) fully relaxed
  2. Examiner stands in front/side
  3. Examiner located the calcaneal tendon and taps it directly with the tendon hammer (foot should be held horizontal or slightly dorsifelxed)
35
Q

What do you expect with the ankle jerk?

A
  • plantar flexion at the ankle joint

- contraction of gastrocnemius can be seen

36
Q

Is briskness of reflexes variable?

A

yes

37
Q

In the same limb can flexor and extensor muscles contract simultaneously?

A

no

38
Q

What is important about the afferent nerves responsible for the flexor reflex muscle action?

A

must have branches to synapse with the extensor motor neurons of the same limb to inhibit the extensor muscle contraction

39
Q

What does abnormally exaggerated myotatic reflex mean?

A

upper motor neurone lesion

40
Q

What does it mean if there is a complete absence of reflexes?

A

disorder in any of the components of the reflex arc (muscle spindles, afferent sensory neurones, efferent motor neurones and the effector organs - the muscle itself)

41
Q

What are the main nerves arising from the lumbo-sacral plexus?

A

1) Femoral nerve
2) Obturator nerve
3) Common fibular nerve
(part of sciatic nerve)
4) Tibial nerve
(part of sciatic nerve)

42
Q

What would be the motor effect of a femoral nerve injury?

A
  1. Quadriceps paralysis
  2. Weakness of knee
  3. Difficulty climbing up or down stairs
43
Q

What would be the sensory effect of a femoral nerve injury?

A
  1. Sensory loss to anterior and medial thigh
  2. Sensory loss Medial side of leg
  3. Sensory loss at medial border of foot (not big toe)
44
Q

What is the motor effect of an obturator nerve injury?

A
  1. Paralysis of all adductors (except hamstring part of adductor magnus)
  2. “cross leggin” effect
45
Q

What is the sensory effect of an obturator nerve injury?

A
  1. Insignificant sensory loss on the medial side of the thigh
  2. Pelvic disease
  3. Ovarian tumours may cause pain on medial thigh
46
Q

What is the motor effect of common fibular injury?

A
  1. Foot extensors and evertors paralysed

2. Foot in “foot drop” position (plantar flexed and inverted as tibalis posterior active)

47
Q

What are the sensory effect of common fibular nerve injury?

A

Loss in anterior and lateral side of leg and dorsum of foot

48
Q

What is the motor effect of tibial nerve injury?

A
  1. Hamstrings and all muscles of back of leg and sole of foot
  2. Foot in dorsiflexed and everted position
49
Q

What is the sensory effect of tibial nerve injury?

A

Sole of foot

50
Q

When might there be a while sciatic nerve injury?

A
  • pelvic fractures
  • hip joint dislocation/surgery
  • penetrating injuries
  • both tibial and fibular nerves are involved
51
Q

What is the motor effect of whole sciatic nerve injury?

A
  1. Hamstrings and all muscle below the knee are paralysed
  2. Knee flexion affected
  3. Foot in plantar flexed position (foot drop) due to its own weight
52
Q

What is the sensory effect of whole sciatic nerve injury?

A

Loss below the knee except on a narrow area on the medial side of the leg and foot (saphenous nerve area), not the big toe

53
Q

What is sciatica?

A

Pain radiating from lower back into buttock, posterior/lateral thigh and into the leg

54
Q

What is the cause if sciatica?

A

Herniated lumbar intervertebral disc (L4/L5 or L5/S1) which compresses the L5-S1 component of the sciatic nerve

55
Q

What is often misdiagnosed as sciatica?

A

pelvic girdle pain during pregnancy

Z YEAR 2 Clinical Skills (12 decks)

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