Lower Limb Mononeuropathy Flashcards
What is sciatic neuropathy
Damage or dysfunction of sciatic nerve, the largest nerve in the body
Motor and sensory disturbance. Primarily affect posterior thigh, leg and foot
L4-S3
Mc cause:
Sciatica.
Trauma like Hip dislocation or
fracture
Compression or irritation of the nerve from prolonged sitting and deep gluteal px syndrome
Diabetic neuropathy
Post surgery issues
Tumour
herniated disc
bone spurs
spinal stenosis
Symptoms:
Pain
Numbness of tingling
Distant leg Weakness
Sensory loss
Drop foot (perineal division) weakness of proximal hamstring and plantar flexors and inversion. Mc issues with DORSI FLEXORS
Dysesthesia of the sole, dorsum of the foot, posterolateral lower leg
L5, S1, S2 (L4, S3)
2 major divisions
Laterallyt and superficially is Peronist nerve
Medial is tibial nerve
What is perineal neuropathy
L4,L5, S1, S2
Area between anus and genitals
MC LLneuropathy
Causes:
Trauma to fibular head
Nerve compression (cycling)
Chronic inflammation like pelvic inflammatory disease
Diabetes
Tumours or cysts
MS
Childbirth
Prolonged sitting or straining
Symptoms:
Pain
Foot drop
Weak eversion
Sensory loss in lat leg and dorsal of foot
Numbness or tingling
Weakness (b and b issues)
Sexual dysfunction
Incontinence
Perineal or genital discomfort
Weak dorsiflexion and Eversion
Affects Tibialis anterior and extensor hallucus digitorum
Stoppage gait, hip compensation to lift the foot
Foot slap
Diminished sensation of dorsum of foot and lateral distal half of the leg
What is tibial neuropathy
Back of thigh behind knee and through tarsal tunnel (medial ankle)
Supplied muscles for plantar flexion and sensation to sole of foot and parts of lower leg
Cause: trauma
Compression like tarsal tunnel or tumour
Diabetes
Prolonged pressure
Latriogenic
S&S
Numbness
Tingling
Burning or shooting px
Motor weakmredd, difficulty plantar flexion
Atrophy
What is compartment syndrome
Increased pressure in a closed compartment compromising the circulation and function of the tissues. Such as muscles, nerves, blood vessels
Medical emergency
Mc it is seem in the lower leg. Exterior compartment. Contains Tibialis anterior, extensor halicus longus, extensor digitorum longus and deep peritoneal nerve
Can also get it in forearm after fractures, trauma or cast or in thigh, foot, hand and buttocks
Each compartment is bound by non-expansive fascia.
Trauma, bleeding, swelling or edema increases the pressure. Is he a of mus cles and nerves, tissue necrosis
Causes: fractures, crush injuries, tight casts, burns, intensive exercise
S and s of acute:
Px
Parenthesis
Tense
Swollen
Pallor
Low pulse
Chronic is often seen in young athletes. Pain, cramping, tightness in exercise that resolves with rest
Chronic physical therapy, surgery or activity modification
What is tarsal tunnel syndrome
Distal tibial entrapment neuropathy
Trapped nerve in tarsal tunnel which is located inside the ankle
Causes: fractures
Ankle sprain
Foot deformities, RA
Tenosynovitis
Local swelling
Burning pain and numbness sole of foot (not lat)
Plantar surface atrophy
What is ganglion
Benign cysts or lump that forms along tendon or joints
Dat tissues
Jelly luke fluid usually round or oval shape
What is bakers cysts
Popliteal cysts is a fluid filed sac that forms in the popliteal fossa. Build up of synovial fluid which is the lubricating fluid around the knee joint,
Causes:
Knee injury
Arthritis
Joint inflammation
Swelling
Pain
Tightness or stiffness
Pop or clicking
What is osteoma
Benign tumour made from new bone growth
Mc grow from the surface of the bone. Slow growing and often don’t cause symptoms unless on nerve, tissue or structure
What is schwannoma
Benign tumour that arises from Schwann cells which form myelin sheath around nerves in peripheral nervous system
Typically grows on nerves mc in head, neck, limbs
It is located near surface of the skin. May be felt as a firm round lub
What is latrogenic injury
Complication resulting from medical procedures or healthcare interventions like meds
What is femoral neuropathies
L2-L4
Travels between ilipsoas and iliacus muscles proximal to inguinal ligament
it exits the pelvis beneath medial inguinal ligament and enters the fem triangle
Then separates into ant and post
Uncommon
Surgery, childbirth, abscess, artery puncture
Symptoms:
Limited hip flexion
Hip flexion weakness
Diminished or absent patellar reflex
Ant medial thigh sensory symtpsm
What is meralgia parenthetica
A condition caused by the compression or irritation of the lateral femoral cutaneous nerve which gives sensation to the lateral thigh
Usually unilateral
Often in overweight, after wight gain, blunt force trauma
Agg is standing or working for periods
(Lateral Medial to ASIS
Entrapped mononeurpay of lateral
What is obturator neuropathy
L2,L3,L4
Obturator nerve damage or compression
Provides motor function and sensation to parts of inner thigh and groin
Adductor muscles and posterior medial thigh cutaneous innovation
Trauma
Compression
Chronic pressure
Inflammation and infection
Birth injuries
Diabetes
What is the iliohypogastric neuropathy
T12, L1
Supplies internal oblique and TA
Sensory symptoms
Lateral iliac crease and suprapubic region
Causes:
Lower abdominal surger
Pe;vic surgery
What os ilioinguinal neuropathy
L1
Sensory deficit, along inguinal lig over pubic symphysis and anterior scrotum
With or without associated pain
Causes: childbirth, lower ab surgery
What is genitofemoral neuropathy
L1, L2
Pain, numbness and parathestias of labia or scrotum
Standing or hip flexion can exag symptoms
Surgery like appendectomy
Define myotome
Group fo muscles that a single spinal nerve root innervates
Controlled by the motor fibres of a specific spinal nerve
Define dermatome
Area of skin that is mainly supplied by sensory fibres of a single spinal nerve root
Describe how you would test bicep reflex
C5
Ask pt to relax and palp
Ask pt to flex
Palp tendon
Tap my thumb with hammer
Look for visible contraction
Red flags of DVT
Unilateral leg swelling
Px or tenderness
Warmth
Superficial vein distension
Skin disxioloiuratiin
Red flags of cauda equine
B abd b dysfunction
Sensory loss of legs
Saddle anesthesia
Sexual dysfunction
Bilateral sciatica
