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Lower Limb Nerve Injuries Flashcards

1
Q

Organisation of Lower Limb nerves

  • Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between … and L2)
  • Below - cauda … - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
A
  • Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and L2)
  • Below - cauda equina - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
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2
Q

Organisation of Lower Limb nerves

  • Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and …)
  • Below - … equina - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L…/L4 - below spinal cord end)
A
  • Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and L2)
  • Below - cauda equina - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
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3
Q

Organisation of Lower Limb nerves

  • Lower limb nerves starts in … horn cell within spinal cord (spinal cord stops between L1 and L2)
  • Below - cauda equina - … puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
A
  • Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and L2)
  • Below - cauda equina - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
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4
Q

Organisation of Lower Limb nerves

  • Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and L2)
  • Below - cauda equina - lumbar puncture go below end of spinal cord (lie laterally, … crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
A
  • Lower limb nerves starts in anterior horn cell within spinal cord (spinal cord stops between L1 and L2)
  • Below - cauda equina - lumbar puncture go below end of spinal cord (lie laterally, iliac crest - 1 or 2 spaces above would be L3/L4 - below spinal cord end)
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5
Q

Cauda equina vs conus lesions

A
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6
Q

Landmarks for lumbar puncture

  • Below end of … … - lie laterally, find iliac … - 1 or 2 spaces above = below spinal cord which will be around L3,L4 (spinal cord ends at …)
A
  • Below end of spinal cord - lie laterally, find iliac crest - 1 or 2 spaces above = below spinal cord which will be around L3,L4 (spinal cord ends at L1/L2)
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7
Q

Cauda equina vs conus medullaris

A
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8
Q

Cauda equina vs conus medullaris

A
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9
Q

Cauda equina vs conus medullaris

A
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10
Q

Causes of Cauda equina

  • Disc …
  • … fracture
  • T…
A
  • Disc herniation
  • Spinal fracture
  • Tumours
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11
Q

3 causes of cauda equina are…

A
  • Disc herniation
  • Spinal fracture
  • Tumours
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12
Q

Causes of Conus medullaris

  • Disc …, T..
  • … conditions (e.g. Chronic Inflammatory Demyelinating Polyradiculopathy ,Sarcoidosis)
  • … (E.g. CMV, HSV, EBV, Lyme, TB)
A
  • Disc herniation, tumour,
  • Inflammatory conditions (e.g. Chronic Inflammatory Demyelinating Polyradiculopathy ,Sarcoidosis)
  • Infection (E.g. CMV, HSV, EBV, Lyme, TB)
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13
Q

Causes of Conus medullaris (4)

A
  • Disc herniation
  • Tumour
  • Inflammatory conditions (Chronic Inflammatory Demyelinating Polyradiculopathy Sarcoidosis)
  • Infection (e.g. CMV, HSV, EBV, Lyme, TB)
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14
Q

This shows a …

A

L5/S1 disc herniation compressing cauda equina

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15
Q

Nerve Root Entrapment – ‘sciatica

  • Compression- Disc- posterior central, lateral Bone- osteophyte Ligaments
  • Small canal- stenosis
  • Sciatica – usually L…, S… n. root impingement
  • L… n. root – exits between L…/ S…vertebral bodies S… n. root exits between S… / S… vertebral bodies
  • Pain may be felt in dermatome (sharp/ superficial) or myotome (deep ache)
A
  • Compression- Disc- posterior central, lateral Bone- osteophyte Ligaments
  • Small canal- stenosis
  • Sciatica – usually L5, S1 n. root impingement
  • L5 n. root – exits between L5/ S1 vertebral bodies S1 n. root exits between S1 / S2 vertebral bodies
  • Pain may be felt in dermatome (sharp/ superficial) or myotome (deep ache)
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16
Q

Nerve Root Entrapment – ‘sciatica

  • Compression- Disc- posterior central, lateral Bone- osteophyte Ligaments
  • Small canal- stenosis
  • Sciatica – usually L5, S1 n. root …
  • L5 n. root – exits between L5/ S1 vertebral bodies S1 n. root exits between S1 / S2 vertebral bodies
  • Pain may be felt in … (sharp/ superficial) or … (deep ache)
A
  • Compression- Disc- posterior central, lateral Bone- osteophyte Ligaments
  • Small canal- stenosis
  • Sciatica – usually L5, S1 n. root impingement
  • L5 n. root – exits between L5/ S1 vertebral bodies S1 n. root exits between S1 / S2 vertebral bodies
  • Pain may be felt in dermatome (sharp/ superficial) or myotome (deep ache)
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17
Q

Nerve Root Entrapment – ‘sciatica

  • Compression- …- posterior central, lateral Bone- osteophyte Ligaments
  • Small canal- stenosis
  • Sciatica – usually L5, S1 n. … impingement
  • L5 n. root – exits between L5/ S1 vertebral bodies S1 n. root exits between S1 / S2 vertebral bodies
  • Pain may be felt in dermatome (s…/ s…) or myotome (… ache)
A
  • Compression- Disc- posterior central, lateral Bone- osteophyte Ligaments
  • Small canal- stenosis
  • Sciatica – usually L5, S1 n. root impingement
  • L5 n. root – exits between L5/ S1 vertebral bodies S1 n. root exits between S1 / S2 vertebral bodies
  • Pain may be felt in dermatome (sharp/ superficial) or myotome (deep ache)
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18
Q

Lower Limb Root Lesions - reflex and sensory loss

  • Lower limb dermatomes more variable than upper limb
  • L1 … area
  • L2 front of … (front pocket)
  • L3 front of …
  • L4 front- inner/ medial leg
  • L5 outer leg, dorsum of foot, inner sole
  • S1 little toe, rest of sole, back of leg
  • S2 thigh to top of buttock (back pocket)
  • S3-S5 concentric rings round anus/ genitalia
    • Knee jerk L4, Ankle jerk S1
A
  • Lower limb dermatomes more variable than upper limb
  • L1 inguinal area
  • L2 front of thigh (front pocket)
  • L3 front of knee
  • L4 front- inner/ medial leg
  • L5 outer leg, dorsum of foot, inner sole
  • S1 little toe, rest of sole, back of leg
  • S2 thigh to top of buttock (back pocket)
  • S3-S5 concentric rings round anus/ genitalia
    • Knee jerk L4, Ankle jerk S1
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19
Q

Lower Limb Root Lesions - reflex and sensory loss

  • Lower limb dermatomes more variable than upper limb
  • L1 inguinal area
  • L2 front of thigh (front pocket)
  • L3 front of knee
  • L4 front- inner/ … leg
  • L5 … leg, … of foot, inner …
  • S1 … toe, rest of …, back of leg
  • S2 thigh to top of … (back pocket)
  • S3-S5 concentric rings round anus/ genitalia
    • Knee jerk L4, Ankle jerk S1
A
  • Lower limb dermatomes more variable than upper limb
  • L1 inguinal area
  • L2 front of thigh (front pocket)
  • L3 front of knee
  • L4 front- inner/ medial leg
  • L5 outer leg, dorsum of foot, inner sole
  • S1 little toe, rest of sole, back of leg
  • S2 thigh to top of buttock (back pocket)
  • S3-S5 concentric rings round anus/ genitalia
    • Knee jerk L4, Ankle jerk S1
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20
Q

Lower Limb Root Lesions - reflex and sensory loss

  • Lower limb dermatomes more variable than upper limb
  • L1 … area
  • L2 front of thigh (… pocket)
  • L3 front of knee
  • L4 front- inner/ medial leg
  • L5 outer leg, dorsum of foot, inner sole
  • S1 little toe, rest of sole, back of leg
  • S2 … to top of buttock (… pocket)
  • S3-S5 … rings round anus/ genitalia
    • Knee jerk L4, Ankle jerk S1
A
  • Lower limb dermatomes more variable than upper limb
  • L1 inguinal area
  • L2 front of thigh (front pocket)
  • L3 front of knee
  • L4 front- inner/ medial leg
  • L5 outer leg, dorsum of foot, inner sole
  • S1 little toe, rest of sole, back of leg
  • S2 thigh to top of buttock (back pocket)
  • S3-S5 concentric rings round anus/ genitalia
    • Knee jerk L4, Ankle jerk S1
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21
Q

Lower Limb Root Lesions - reflex and sensory loss

  • Lower limb dermatomes more variable than upper limb
  • L1 inguinal area
  • L2 front of thigh (front pocket)
  • L3 front of …
  • L4 front- inner/ medial leg
  • L5 outer leg, dorsum of foot, inner sole
  • S1 little toe, rest of sole, back of leg
  • S2 thigh to top of buttock (back pocket)
  • S3-S5 concentric rings round …/ …
    • … jerk L4, … jerk S1
A
  • Lower limb dermatomes more variable than upper limb
  • L1 inguinal area
  • L2 front of thigh (front pocket)
  • L3 front of knee
  • L4 front- inner/ medial leg
  • L5 outer leg, dorsum of foot, inner sole
  • S1 little toe, rest of sole, back of leg
  • S2 thigh to top of buttock (back pocket)
  • S3-S5 concentric rings round anus/ genitalia
    • Knee jerk L4, Ankle jerk S1
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22
Q

Lower Limb Root Lesions - weakness

  • L1/2 … flexion
  • L3/4 … extension
  • L4 … inversion
  • L5 Knee flexion Ankle …
    • Toe extension
    • Foot inversion and eversion
  • S1 Knee flexion
    • Ankle plantar flexion
    • Toe flexion Foot eversion
A
  • L1/2 Hip flexion
  • L3/4 Knee extension
  • L4 Foot inversion
  • L5 Knee flexion Ankle dorsiflexion
    • Toe extension
    • Foot inversion and eversion
  • S1 Knee flexion
    • Ankle plantar flexion
    • Toe flexion Foot eversion
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23
Q

Lower Limb Root Lesions - weakness

  • L1/2 Hip flexion
  • L3/4 Knee extension
  • L4 Foot inversion
  • L5 … flexion … dorsiflexion
    • … extension
    • Foot … and …
  • S1 Knee flexion
    • Ankle plantar flexion
    • Toe flexion Foot eversion
A
  • L1/2 Hip flexion
  • L3/4 Knee extension
  • L4 Foot inversion
  • L5 Knee flexion Ankle dorsiflexion
    • Toe extension
    • Foot inversion and eversion
  • S1 Knee flexion
    • Ankle plantar flexion
    • Toe flexion Foot eversion
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24
Q

Lower Limb Root Lesions - weakness

  • L1/2 Hip flexion
  • L3/4 Knee extension
  • L4 Foot inversion
  • L5 Knee flexion Ankle dorsiflexion
    • Toe extension
    • Foot inversion and eversion
  • S1 … flexion
    • Ankle … flexion
    • Toe … Foot …
A
  • L1/2 Hip flexion
  • L3/4 Knee extension
  • L4 Foot inversion
  • L5 Knee flexion Ankle dorsiflexion
    • Toe extension
    • Foot inversion and eversion
  • S1 Knee flexion
    • Ankle plantar flexion
    • Toe flexion Foot eversion
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25
Q

Lower Limb Root Lesions - weakness

  • …/… Hip flexion
  • …/… Knee extension
  • … Foot inversion
  • … Knee flexion Ankle dorsiflexion
    • Toe extension
    • Foot inversion and eversion
  • … Knee flexion
    • Ankle plantar flexion
    • Toe flexion Foot eversion
A
  • L1/2 Hip flexion
  • L3/4 Knee extension
  • L4 Foot inversion
  • L5 Knee flexion Ankle dorsiflexion
    • Toe extension
    • Foot inversion and eversion
  • S1 Knee flexion
    • Ankle plantar flexion
    • Toe flexion Foot eversion
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26
Q

Lower Limb Root Lesions - weakness

  • L1/2 Hip flexion
  • L3/4 Knee …
  • L4 Foot …
  • L5 Knee … Ankle dorsiflexion
    • Toe …
    • Foot inversion and …
  • S1 Knee …
    • Ankle plantar flexion
    • Toe flexion Foot eversion
A
  • L1/2 Hip flexion
  • L3/4 Knee extension
  • L4 Foot inversion
  • L5 Knee flexion Ankle dorsiflexion
    • Toe extension
    • Foot inversion and eversion
  • S1 Knee flexion
    • Ankle plantar flexion
    • Toe flexion Foot eversion
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27
Q

Lower Limb Root Lesions - weakness

  • L1/2 … flexion
  • L3/4 … extension
  • L4 Foot inversion
  • L5 Knee flexion … dorsiflexion
    • Toe extension
    • … inversion and eversion
  • S1 Knee flexion
    • … plantar flexion
    • Toe flexion … eversion
A
  • L1/2 Hip flexion
  • L3/4 Knee extension
  • L4 Foot inversion
  • L5 Knee flexion Ankle dorsiflexion
    • Toe extension
    • Foot inversion and eversion
  • S1 Knee flexion
    • Ankle plantar flexion
    • Toe flexion Foot eversion
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28
Q

Lumbar plexus

A
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29
Q

Sacral plexus

A
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30
Q

Lumbosacral Plexus Lesions

  • … (large head, prolonged labour)- esp … n., numbness inner thigh, pudendal n.
  • Structural
    • … (on Warfarin)
    • Abscess
    • … – infiltration
    • Trauma
  • Non structural
    • Inflammatory
    • Diabetes
    • Vasculitis
    • Radiotherapy
A
  • Childbirth (large head, prolonged labour)- esp obturator n., numbness inner thigh, pudendal n.
  • Structural
    • Haematoma (on Warfarin)
    • Abscess
    • Malignancy – infiltration
    • Trauma
  • Non structural
    • Inflammatory
    • Diabetes
    • Vasculitis
    • Radiotherapy
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31
Q

Lumbosacral Plexus Lesions

  • Childbirth (large .., prolonged ..)- esp obturator n., numbness inner thigh, pudendal n.
  • Structural
    • Haematoma (on Warfarin)
    • A…
    • Malignancy – infiltration
    • Trauma
  • Non structural
    • I…
    • D…
    • Vasculitis
    • Radiotherapy
A
  • Childbirth (large head, prolonged labour)- esp obturator n., numbness inner thigh, pudendal n.
  • Structural
    • Haematoma (on Warfarin)
    • Abscess
    • Malignancy – infiltration
    • Trauma
  • Non structural
    • Inflammatory
    • Diabetes
    • Vasculitis
    • Radiotherapy
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32
Q

Lumbosacral Plexus Lesions

  • Childbirth (large head, prolonged labour)- esp obturator n., … inner thigh, pudendal n.
  • Structural
    • Haematoma (on W…)
    • Abscess
    • Malignancy – infiltration
    • T…
  • Non structural
    • Inflammatory
    • Diabetes
    • V…
    • R..
A
  • Childbirth (large head, prolonged labour)- esp obturator n., numbness inner thigh, pudendal n.
  • Structural
    • Haematoma (on Warfarin)
    • Abscess
    • Malignancy – infiltration
    • Trauma
  • Non structural
    • Inflammatory
    • Diabetes
    • Vasculitis
    • Radiotherapy
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33
Q

Femoral Nerve Organisation

  • Hip …, Iliopsoas affected if proximal damage (above inguinal Ligament)
  • Only knee … if below inguinal ligament (preserve hip flexion)
  • Distal lesion may produce a pure motor or pure … syndrome
A
  • Hip flexors, Iliopsoas affected if proximal damage (above inguinal Ligament)
  • Only knee extension if below inguinal ligament (preserve hip flexion)
  • Distal lesion may produce a pure motor or pure sensory syndrome
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34
Q

Femoral Nerve Organisation

  • Hip flexors, … affected if proximal damage (above … Ligament)
  • Only knee extension if below … ligament (preserve hip …)
  • … lesion may produce a pure motor or pure sensory syndrome
A
  • Hip flexors, Iliopsoas affected if proximal damage (above inguinal Ligament)
  • Only knee extension if below inguinal ligament (preserve hip flexion)
  • Distal lesion may produce a pure motor or pure sensory syndrome
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35
Q

Femoral / Lateral Cutaneous Nerves

  • Femoral N.
    • Weakness
    • Femoral nerve responsible for Hip … (iliacus)
    • Femoral nerve responsible for Knee …
    • Loss of Knee Jerk
    • Can’t do …
A
  • Femoral N.
    • Weakness
    • Femoral nerve responsible for Hip flexion (iliacus)
    • Femoral nerve responsible for Knee Extension
    • Loss of Knee Jerk
    • Can’t do stair
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36
Q

Femoral / Lateral Cutaneous Nerves

  • Femoral N.
    • …
    • Femoral nerve responsible for Hip flexion (iliacus)
    • Femoral nerve responsible for Knee Extension
    • Loss of Knee …
    • Can’t do stair
A
  • Femoral N.
    • Weakness
    • Femoral nerve responsible for Hip flexion (iliacus)
    • Femoral nerve responsible for Knee Extension
    • Loss of Knee Jerk
    • Can’t do stair
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37
Q

Femoral N. damage

  • Femoral …
  • Childbirth
  • S…
  • Gynae procedures, esp …, femoral a. bypass/ puncture)
A
  • Femoral fracture
  • Childbirth
  • Surgery
  • Gynae procedures, esp hysterectomy, femoral a. bypass/ puncture)
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38
Q

Femoral N. damage

  • Femoral …
  • C…
  • Surgery
  • … procedures, esp hysterectomy, femoral a. bypass/ puncture)
A
  • Femoral fracture
  • Childbirth
  • Surgery
  • Gynae procedures, esp hysterectomy, femoral a. bypass/ puncture)
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39
Q

Sciatica

  • Pain in sciatic n. distrib
  • Nerve root entrapment (usually L… / S…)
  • Differential diagnosis: … – pain may radiate not below knee, Sacroiliac joints
  • Causes:
    • Trauma
    • H…
    • Rarely sciatic nerve compression per se (P.. synd)
    • Or misplaced IM injections
A
  • Pain in sciatic n. distrib
  • Nerve root entrapment (usually L5 / S1)
  • Differential diagnosis: Hip – pain may radiate not below knee, Sacroiliac joints
  • Causes:
    • Trauma
    • Haematoma
    • Rarely sciatic nerve compression per se (Piriformis synd)
    • Or misplaced IM injections
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40
Q

Sciatica

  • Pain in sciatic n. distrib
  • Nerve root … (usually L5 / S1)
  • Differential diagnosis: Hip – pain may radiate not below knee, Sacroiliac joints
  • Causes:
    • T…
    • Haematoma
    • Rarely sciatic nerve … per se (Piriformis synd)
    • Or misplaced … injections
A
  • Pain in sciatic n. distrib
  • Nerve root entrapment (usually L5 / S1)
  • Differential diagnosis: Hip – pain may radiate not below knee, Sacroiliac joints
  • Causes:
    • Trauma
    • Haematoma
    • Rarely sciatic nerve compression per se (Piriformis synd)
    • Or misplaced IM injections
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41
Q

Sciatica

  • Pain in sciatic n. distrib
  • Nerve … entrapment (usually L5 / S1)
  • Differential diagnosis: Hip – pain may radiate not below knee, S… joints
  • Causes:
    • Trauma
    • Haematoma
    • Rarely sciatic nerve compression per se (… synd)
    • Or misplaced IM injections
A
  • Pain in sciatic n. distrib
  • Nerve root entrapment (usually L5 / S1)
  • Differential diagnosis: Hip – pain may radiate not below knee, Sacroiliac joints
  • Causes:
    • Trauma
    • Haematoma
    • Rarely sciatic nerve compression per se (Piriformis synd)
    • Or misplaced IM injections
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42
Q

Sciatica

  • Pain in sciatic n. distrib
  • Nerve root entrapment (usually L5 / S1)
  • Differential diagnosis: Hip – pain may radiate not below …, Sacroiliac joints
  • Causes:
    • Trauma
    • Haematoma
    • … sciatic nerve compression per se (Piriformis synd)
    • Or misplaced IM …
A
  • Pain in sciatic n. distrib
  • Nerve root entrapment (usually L5 / S1)
  • Differential diagnosis: Hip – pain may radiate not below knee, Sacroiliac joints
  • Causes:
    • Trauma
    • Haematoma
    • Rarely sciatic nerve compression per se (Piriformis synd)
    • Or misplaced IM injections
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43
Q

Pain from … radiates from the buttock down the leg and can travel as far as to the feet and toes

A

Pain from sciatica radiates from the buttock down the leg and can travel as far as to the feet and toes

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44
Q

? Piriformis Syndrome

  • Controversial as to whether muscle … per se can cause tingling in … and down … (eg after exercise or straining, or prolonged sitting)
  • Probably may rarely occur in those with anatomical predisposition.
  • No consensus on criteria Diagnosis of …
A
  • Controversial as to whether muscle compression per se can cause tingling in buttock and down leg (eg after exercise or straining, or prolonged sitting)
  • Probably may rarely occur in those with anatomical predisposition.
  • No consensus on criteria Diagnosis of exclusion
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45
Q

? Piriformis Syndrome

  • Controversial as to whether muscle compression per se can cause tingling in buttock and down leg (eg after … or straining, or prolonged …)
  • Probably may rarely occur in those with … predisposition.
  • No consensus on criteria Diagnosis of exclusion
A
  • Controversial as to whether muscle compression per se can cause tingling in buttock and down leg (eg after exercise or straining, or prolonged sitting)
  • Probably may rarely occur in those with anatomical predisposition.
  • No consensus on criteria Diagnosis of exclusion
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46
Q

Sciatic N. Injury

  • Apart from: Hip … Knee … Hip … (femoral nerve first 2 and obturator …)
  • Sciatic nerve or its branches, are motor to virtually all other muscle groups in the leg
  • Isolated Hip … – sciatic n. Pelvic/ sacral fracture – sacral plexus)
A
  • Apart from: Hip flexion Knee extension Hip adduction (femoral nerve first 2 and obturator adduction)
  • Sciatic nerve or its branches, are motor to virtually all other muscle groups in the leg
  • Isolated Hip fracture – sciatic n. Pelvic/ sacral fracture – sacral plexus)
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47
Q

Sciatic N. Injury

  • Apart from: Hip flexion Knee extension Hip adduction ((… nerve first 2 and … adduction))
  • Sciatic nerve or its branches, are motor to virtually all other muscle groups in the leg
  • Isolated Hip fracture – sciatic n. Pelvic/ sacral fracture – sacral plexus)
A
  • Apart from: Hip flexion Knee extension Hip adduction (femoral nerve first 2 and obturator adduction)
  • Sciatic nerve or its branches, are motor to virtually all other muscle groups in the leg
  • Isolated Hip fracture – sciatic n. Pelvic/ sacral fracture – sacral plexus)
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48
Q

2 compartments of sciatic N.

  • The sciatic nerve usually divides into the … … and … nerves at the level of the lower thigh.
  • These two nerves usually arise separately from the sacral plexus.
  • Beware Partial sciatic n. damage can look like … … or … n. damage
A
  • The sciatic nerve usually divides into the common peroneal and tibial nerves at the level of the lower thigh.
  • These two nerves usually arise separately from the sacral plexus.
  • Beware Partial sciatic n. damage can look like Common peroneal or Tibial n. damage
49
Q

Sciatic Nerve Major Divisions

  • The sciatic nerve usually divides into the common … and … nerves at the level of the lower thigh.
  • These two nerves usually arise separately from the … plexus.
A
  • The sciatic nerve usually divides into the common peroneal and tibial nerves at the level of the lower thigh.
  • These two nerves usually arise separately from the sacral plexus.
50
Q

Tibial Nerve- Behind knee (injury)

  • Can’t stand on ….
  • Weak foot …
  • Painful numb …
  • Causes:
    • Trauma: Haemorrhage
    • … cyst
    • Nerve …
    • Entrapment by the tendinous arch at the soleus muscle.
  • In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
A
  • Can’t stand on tiptoes
  • Weak foot inversion
  • Painful numb sole
  • Causes:
    • Trauma: Haemorrhage
    • Bakers cyst
    • Nerve tumour
    • Entrapment by the tendinous arch at the soleus muscle.
  • In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
51
Q

Tibial Nerve- Behind knee (injury)

  • Can’t stand on tiptoes
  • Weak … inversion
  • Painful numb sole
  • Causes:
    • Trauma: …
    • Bakers …
    • Nerve tumour
    • Entrapment by the tendinous arch at the … muscle.
  • In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
A
  • Can’t stand on tiptoes
  • Weak foot inversion
  • Painful numb sole
  • Causes:
    • Trauma: Haemorrhage
    • Bakers cyst
    • Nerve tumour
    • Entrapment by the tendinous arch at the soleus muscle.
  • In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
52
Q

Tibial Nerve- Behind knee (injury)

  • Can’t stand on tiptoes
  • Weak foot inversion
  • Painful numb sole
  • Causes:
    • …: Haemorrhage
    • Bakers cyst
    • … tumour
    • … by the tendinous arch at the soleus muscle.
  • In the … fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
A
  • Can’t stand on tiptoes
  • Weak foot inversion
  • Painful numb sole
  • Causes:
    • Trauma: Haemorrhage
    • Bakers cyst
    • Nerve tumour
    • Entrapment by the tendinous arch at the soleus muscle.
  • In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
53
Q

Tibial Nerve- Behind knee (injury)

  • Can’t stand on …
  • Weak foot …
  • … numb sole
  • Causes:
    • Trauma: …
    • … cyst
    • Nerve tumour
    • Entrapment by the tendinous arch at the soleus muscle.
  • In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
A
  • Can’t stand on tiptoes
  • Weak foot inversion
  • Painful numb sole
  • Causes:
    • Trauma: Haemorrhage
    • Bakers cyst
    • Nerve tumour
    • Entrapment by the tendinous arch at the soleus muscle.
  • In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris, and the sural nerve.
54
Q

Tibial N.- lower leg/ ankle

  • … … - tibial nerve passes through
  • Sole pain worse …/ walking - Not heel pain
  • Differential - Morton’s neuroma
A
  • Tarsal Tunnel - tibial nerve passes through
  • Sole pain worse standing/ walking - Not heel pain
  • Differential - Morton’s neuroma
55
Q

Tibial N.- lower leg/ ankle

  • Tarsal Tunnel - tibial nerve passes through
  • Sole pain worse standing/ … - Not heel pain
  • Differential - … neuroma
A
  • Tarsal Tunnel - tibial nerve passes through
  • Sole pain worse standing/ walking - Not heel pain
  • Differential - Morton’s neuroma
56
Q

Tibial N.- lower leg/ ankle

  • … Tunnel - tibial nerve passes through
  • … pain worse standing/ walking - Not … pain
  • Differential - Morton’s neuroma
A
  • Tarsal Tunnel - tibial nerve passes through
  • Sole pain worse standing/ walking - Not heel pain
  • Differential - Morton’s neuroma
57
Q

Tibial N.- lower leg/ ankle

  • Tarsal Tunnel - tibial nerve passes through
  • Sole pain worse standing/ walking - Not heel pain
  • Differential - … neuroma
A
  • Tarsal Tunnel - tibial nerve passes through
  • Sole pain worse standing/ walking - Not heel pain
  • Differential - Morton’s neuroma
58
Q

Sural nerve

  • It is made up of branches of the … nerve and … … nerve (the medial cutaneous branch from the … nerve, and the lateral cutaneous branch from the … … nerve.)
A
  • It is made up of branches of the tibial nerve and common fibular nerve (the medial cutaneous branch from the tibial nerve, and the lateral cutaneous branch from the common fibular nerve.)
59
Q

Sural Nerve – superficial, sensory

  • Nerve … useful - but damages the nerve, so use a superficial and sensory nerve (little bit of … but will help with diagnosis)
A
  • Nerve biopsy useful - but damages the nerve, so use a superficial and sensory nerve (little bit of numbness but will help with diagnosis)
60
Q

Common Peroneal Nerve

  • May also be damaged by tight … casts, leg …, Weight loss- … palsy
  • Sensory loss -… of foot and outer aspect lower leg
  • Weakness of -dorsiflexion and eversion of foot
A
  • May also be damaged by tight plaster casts, leg crossing, Weight loss- slimmers palsy
  • Sensory loss -dorsum of foot and outer aspect lower leg
  • Weakness of -dorsiflexion and eversion of foot
61
Q

Common Peroneal Nerve

  • May also be damaged by tight plaster casts, leg crossing, Weight loss- slimmers …
  • Sensory loss -dorsum of foot and … aspect … leg
  • Weakness of -dorsiflexion and … of foot
A
  • May also be damaged by tight plaster casts, leg crossing, Weight loss- slimmers palsy
  • Sensory loss -dorsum of foot and outer aspect lower leg
  • Weakness of -dorsiflexion and eversion of foot
62
Q

Weakness of -dorsiflexion and eversion of foot usually indicates problem with what nerve?

A

common peroneal nerve

63
Q

Sensory loss -dorsum of foot and outer aspect lower leg indicates problem with what nerve?

A

common peroneal nerve

64
Q

Neurogenic Foot drop

  • Upper motor neuron (brain/ spinal cord)
  • Conus
  • L4/L5
  • … equina
  • … plexus
  • … n.
  • Common peroneal n.
A
  • Upper motor neuron (brain/ spinal cord)
  • Conus
  • L4/L5
  • Cauda equina
  • Sacral plexus
  • Sciatic n.
  • Common peroneal n.
65
Q

Neurogenic Foot drop

  • …. motor neuron (brain/ spinal cord)
  • Co…
  • L…/L…
  • Cauda equina
  • Sacral plexus
  • Sciatic n.
  • Common … n.
A
  • Upper motor neuron (brain/ spinal cord)
  • Conus
  • L4/L5
  • Cauda equina
  • Sacral plexus
  • Sciatic n.
  • Common peroneal n.
66
Q

Polyneuropathy

  • Polyneuropathy – generalised relatively homogeneous process affecting many … nerves with the … nerves affected most prominently.
A
  • Polyneuropathy – generalised relatively homogeneous process affecting many peripheral nerves with the distal nerves affected most prominently.
67
Q

Polyneuropathy

  • Polyneuropathy – generalised relatively … process affecting many peripheral nerves with the distal nerves affected most prominently.
A
  • Polyneuropathy – generalised relatively homogeneous process affecting many peripheral nerves with the distal nerves affected most prominently.
68
Q

… … – refers to any disorder of the peripheral nervous system including radiculopathies and mononeuropathies

A

Peripheral neuropathy – refers to any disorder of the peripheral nervous system including radiculopathies and mononeuropathies

69
Q

Distribution of Peripheral Neuropathy

70
Q

Length dependent polyneuropathy

  • Common causes (Toxic/metabolic)
    • D…
    • A…
    • B12 def
    • C…
    • Idiopathic
  • Clinical symptoms
    • Numbness, paraesthesia, weakness
    • Pain
A
  • Common causes (Toxic/metabolic)
    • Diabetes
    • Alcohol
    • B12 def
    • Chemotherapy
    • Idiopathic
  • Clinical symptoms
    • Numbness, paraesthesia, weakness
    • Pain
71
Q

Length dependent polyneuropathy

  • Common causes (Toxic/metabolic)
    • Diabetes
    • Alcohol
    • … def
    • Chemotherapy
    • Idiopathic
  • Clinical symptoms
    • N…, P.., weakness
    • Pain
A
  • Common causes (Toxic/metabolic)
    • Diabetes
    • Alcohol
    • B12 def
    • Chemotherapy
    • Idiopathic
  • Clinical symptoms
    • Numbness, paraesthesia, weakness
    • Pain
72
Q

Length dependent polyneuropathy

  • 4 Clinical symptoms..
A
  • Numbness, paraesthesia, weakness
  • Pain
73
Q

Non-Length dependent polyneuropathy

  • … … syndrome
A
  • Guillain Barre syndrome
74
Q

Guillain Barre syndrome

  • Named after French Neurologists in 2016
  • Also known as … … demyelinating polyneuropathy
  • Immune response to a preceding …
  • … progressive (days to weeks) weakness including limbs, facial, respiratory and bulbar muscles
  • Absent reflexes
A
  • Named after French Neurologists in 2016
  • Also known as Acute inflammatory demyelinating polyneuropathy
  • Immune response to a preceding infection
  • Rapidly progressive (days to weeks) weakness including limbs, facial, respiratory and bulbar muscles
  • Absent reflexes
75
Q

Guillain Barre syndrome

  • Named after French Neurologists in 2016
  • Also known as Acute inflammatory demyelinating polyneuropathy
  • Immune response to a preceding infection
  • Rapidly progressive (days to weeks) … including limbs, facial, respiratory and bulbar muscles
  • Absent …
A
  • Named after French Neurologists in 2016
  • Also known as Acute inflammatory demyelinating polyneuropathy
  • Immune response to a preceding infection
  • Rapidly progressive (days to weeks) weakness including limbs, facial, respiratory and bulbar muscles
  • Absent reflexes
76
Q

Neuronopathy

  • Form of polyneuropathy
  • Disorders that affect specifically population of neurons.
  • Motor neuronopathy
    • Site of …: … horn cell
    • Causes: …, Polio
  • Sensory neuronopathy
    • Site of damage : … root ganglion
    • Causes: Sjogrens syndrome, Paraneoplastic
A
  • Form of polyneuropathy
  • Disorders that affect specifically population of neurons.
  • Motor neuronopathy
    • Site of damage: Anterior horn cell
    • Causes: ALS, Polio
  • Sensory neuronopathy
    • Site of damage : Dorsal root ganglion
    • Causes: Sjogrens syndrome, Paraneoplastic
77
Q

Neuronopathy

  • Form of polyneuropathy
  • Disorders that affect specifically population of neurons.
  • Motor neuronopathy
    • Site of damage: … … cell
    • Causes: ALS, P…
  • Sensory neuronopathy
    • Site of damage : Dorsal root ganglion
    • Causes: … syndrome, Paraneoplastic
A
  • Form of polyneuropathy
  • Disorders that affect specifically population of neurons.
  • Motor neuronopathy
    • Site of damage: Anterior horn cell
    • Causes: ALS, Polio
  • Sensory neuronopathy
    • Site of damage : Dorsal root ganglion
    • Causes: Sjogrens syndrome, Paraneoplastic
78
Q

Neuronopathy

79
Q

Polyradiculopathy

  • Affects … nerve roots.
  • Causes:
    • … …: Cervical, lumbar
    • Cancer: Leptomeningeal metastases
    • Infection: …, HIV,
A
  • Affects multiple nerve roots.
  • Causes:
    • Spinal stenosis: Cervical, lumbar
    • Cancer: Leptomeningeal metastases
    • Infection: Lyme, HIV,
80
Q

Polyradiculopathy

  • Affects multiple nerve roots.
  • Causes:
    • Spinal stenosis: c…, l…
    • Cancer: … metastases
    • Infection: Lyme, HIV,
A
  • Affects multiple nerve roots.
  • Causes:
    • Spinal stenosis: Cervical, lumbar
    • Cancer: Leptomeningeal metastases
    • Infection: Lyme, HIV,
81
Q

Polyradiculopathy

  • Affects multiple nerve roots.
  • Causes:
    • Spinal …: Cervical, lumbar
    • Cancer: Leptomeningeal metastases
    • Infection: Lyme, …,
A
  • Affects multiple nerve roots.
  • Causes:
    • Spinal stenosis: Cervical, lumbar
    • Cancer: Leptomeningeal metastases
    • Infection: Lyme, HIV,
82
Q

Polyradiculopathy

  • Affects multiple nerve roots.
  • Causes:
    • Spinal stenosis: Cervical, lumbar
    • …: Leptomeningeal metastases
    • …: Lyme, HIV,
A
  • Affects multiple nerve roots.
  • Causes:
    • Spinal stenosis: Cervical, lumbar
    • Cancer: Leptomeningeal metastases
    • Infection: Lyme, HIV,
83
Q

Types of peripheral neuropathies

84
Q

Compartments of the leg

85
Q

‘shin splints’

  • Muscle bulk increases …% during exercise and contributes to the transient increase in intracompartmental pressure
  • Anterior and lateral compartments of the lower leg are commonly affected
  • Generally causes … on and post exercise- AKA Shin Splints
  • Manage with … (rest / cooling – ice)
A
  • Muscle bulk increases 20% during exercise and contributes to the transient increase in intracompartmental pressure
  • Anterior and lateral compartments of the lower leg are commonly affected
  • Generally causes pain on and post exercise- AKA Shin Splints
  • Manage with RICE (rest / cooling – ice)
86
Q

‘shin splints’

  • Muscle … increases 20% during exercise and contributes to the transient increase in … pressure
  • Anterior and lateral compartments of the lower leg are commonly affected
  • Generally causes pain on and post exercise- AKA Shin Splints
  • Manage with RICE (rest / cooling – ice)
A
  • Muscle bulk increases 20% during exercise and contributes to the transient increase in intracompartmental pressure
  • Anterior and lateral compartments of the lower leg are commonly affected
  • Generally causes pain on and post exercise- AKA Shin Splints
  • Manage with RICE (rest / cooling – ice)
87
Q

‘shin splints’

  • Muscle bulk increases 20% during exercise and contributes to the transient increase in intracompartmental pressure
  • … and …. compartments of the lower leg are commonly affected
  • Generally causes pain on and post exercise- AKA Shin Splints
  • Manage with RICE (… / … – ice)
A
  • Muscle bulk increases 20% during exercise and contributes to the transient increase in intracompartmental pressure
  • Anterior and lateral compartments of the lower leg are commonly affected
  • Generally causes pain on and post exercise- AKA Shin Splints
  • Manage with RICE (rest / cooling – ice)
88
Q

‘shin splints’

  • Muscle bulk increases 20% during exercise and contributes to the transient increase in intracompartmental pressure
  • Anterior and lateral compartments of the lower leg are commonly affected
  • Generally causes pain on and post exercise- AKA Shin Splints
  • Manage with ….
A
  • Muscle bulk increases 20% during exercise and contributes to the transient increase in intracompartmental pressure
  • Anterior and lateral compartments of the lower leg are commonly affected
  • Generally causes pain on and post exercise- AKA Shin Splints
  • Manage with RICE (rest / cooling – ice)
89
Q

What is compartment syndrome?

  • Increase in pressure within a myofascial compartment which has limited ability to expand
  • May be … or …
  • … compartment syndrome is a surgical emergency
A
  • Increase in pressure within a myofascial compartment which has limited ability to expand
  • May be acute or chronic
  • Acute compartment syndrome is a surgical emergency
90
Q

What is compartment syndrome?

  • Increase in pressure within a … compartment which has limited ability to …
  • May be acute or chronic
  • Acute compartment syndrome is a … …
A
  • Increase in pressure within a myofascial compartment which has limited ability to expand
  • May be acute or chronic
  • Acute compartment syndrome is a surgical emergency
91
Q

Where does Compartment Syndrome occur?

  • Any limb compartment
  • Commonest
    • … …, …
  • Also Hand and Foot
A
  • Any limb compartment
  • Commonest
    • Lower leg, Forearm
  • Also Hand and Foot
92
Q

Why leg in particular ? (compartment syndrome)

A

we are bipedal, walk on our legs

93
Q

What causes Compartment Syndrome ? (5)

A
  • Fractures (1-6% Tibial Fractures)
  • Crush Injuries
  • Burns
  • Electric Shock
  • Fluid Injection
94
Q
  • Fractures (1-6% Tibial Fractures)
  • Crush Injuries
  • Burns
  • Electric Shock
  • Fluid Injection
    • All causes of what syndrome?
A
  • Compartment syndrome
95
Q

What causes Compartment Syndrome ?

  • Fractures (1-6% … Fractures)
  • … Injuries
  • B…
  • … Shock
  • Fluid …
A
  • Fractures (1-6% Tibial Fractures)
  • Crush Injuries
  • Burns
  • Electric Shock
  • Fluid Injection
96
Q

What other things can cause compartment syndrome?

  • Drugs
    • …/other anticoagulants
    • Anabolic … use
    • … drug use
  • Disease
    • Haemophilia
  • External Causes
    • … splints/casts
    • Tourniquet
A
  • Drugs
    • Warfarin/other anticoagulants
    • Anabolic Steroid use
    • Iv drug use
  • Disease
    • Haemophilia
  • External Causes
    • Tight splints/casts
    • Tourniquet
97
Q

What other things can cause compartment syndrome?

  • Drugs
    • Warfarin/other …
    • … Steroid use
    • Iv drug use
  • Disease
    • Haemophilia
  • External Causes
    • Tight …/casts
    • …
A
  • Drugs
    • Warfarin/other anticoagulants
    • Anabolic Steroid use
    • Iv drug use
  • Disease
    • Haemophilia
  • External Causes
    • Tight splints/casts
    • Tourniquet
98
Q

What other things can cause compartment syndrome?

  • Drugs
    • Warfarin/other anticoagulants
    • Anabolic Steroid use
    • Iv … use
  • Disease
    • H…
  • External Causes
    • Tight …/…
    • Tourniquet
A
  • Drugs
    • Warfarin/other anticoagulants
    • Anabolic Steroid use
    • Iv drug use
  • Disease
    • Haemophilia
  • External Causes
    • Tight splints/casts
    • Tourniquet
99
Q

What other things can cause compartment syndrome?

  • Drugs
    • Warfarin/other anticoagulants
    • … … use
    • Iv drug use
  • Disease
    • Haemophilia
  • External Causes
    • T… splints/casts
    • T…
A
  • Drugs
    • Warfarin/other anticoagulants
    • Anabolic Steroid use
    • Iv drug use
  • Disease
    • Haemophilia
  • External Causes
    • Tight splints/casts
    • Tourniquet
100
Q

Consequence of Compartment Syndrome -physiology

  • Tissue … is proportional to the difference between the capillary … pressure and the … fluid pressure
  • Elevated compartment pressure causes muscle and nerve ischemia
A
  • Tissue perfusion is proportional to the difference between the capillary perfusion pressure and the interstitial fluid pressure
  • Elevated compartment pressure causes muscle and nerve ischemia
101
Q

Consequence of Compartment Syndrome -physiology

  • Tissue perfusion is proportional to the difference between the … perfusion pressure and the interstitial … pressure
  • Elevated compartment pressure causes muscle and nerve …
A
  • Tissue perfusion is proportional to the difference between the capillary perfusion pressure and the interstitial fluid pressure
  • Elevated compartment pressure causes muscle and nerve ischemia
102
Q

Consequence of Compartment Syndrome - pathology

  • Untreated, within …-… hours, the final result is muscle infarction, tissue necrosis, and nerve injury
  • Certain tissues are more sensitive than others and this can be a clue to diagnosis
    • … nerves
A
  • Untreated, within 6-10 hours, the final result is muscle infarction, tissue necrosis, and nerve injury
  • Certain tissues are more sensitive than others and this can be a clue to diagnosis
    • Sensory nerves
103
Q

Consequence of Compartment Syndrome - pathology

  • Untreated, within 6-10 hours, the final result is muscle …, tissue …, and nerve …
  • Certain tissues are more sensitive than others and this can be a clue to diagnosis
    • Sensory nerves
A
  • Untreated, within 6-10 hours, the final result is muscle infarction, tissue necrosis, and nerve injury
  • Certain tissues are more sensitive than others and this can be a clue to diagnosis
    • Sensory nerves
104
Q

Acute anterior Compartment Syndrome leg

  • … muscles of ankle and foot
    • Tibialis anterior, Extensor digitorum longus
    • Extensor hallucis longus, Peroneus tertius
  • … … artery
    • Commonly injured in lateral tibial plateau fractures
  • Deep … nerve
    • Sensation to the first dorsal web space
A
  • Dorsiflexion muscles of ankle and foot
    • Tibialis anterior, Extensor digitorum longus
    • Extensor hallucis longus, Peroneus tertius
  • Anterior tibial artery
    • Commonly injured in lateral tibial plateau fractures
  • Deep peroneal nerve
    • Sensation to the first dorsal web space
105
Q

Acute anterior Compartment Syndrome leg

  • Dorsiflexion muscles of ankle and foot
    • Tibialis anterior, Extensor … longus
    • Extensor … longus, … tertius
  • Anterior … artery
    • Commonly injured in lateral … plateau fractures
  • Deep peroneal nerve
    • Sensation to the … dorsal web space
A
  • Dorsiflexion muscles of ankle and foot
    • Tibialis anterior, Extensor digitorum longus
    • Extensor hallucis longus, Peroneus tertius
  • Anterior tibial artery
    • Commonly injured in lateral tibial plateau fractures
  • Deep peroneal nerve
    • Sensation to the first dorsal web space
106
Q

Acute posterior Compartment Syndrome Leg

  • Superficial posterior
  • … … of foot:
    • Gastrocnemius
    • Plantaris
    • Soleus
  • … nerve
    • Sensation to lateral aspect of the foot and distal calf
A
  • Superficial posterior
  • Plantar flexors of foot:
    • Gastrocnemius
    • Plantaris
    • Soleus
  • Sural nerve
    • Sensation to lateral aspect of the foot and distal calf
107
Q

Acute posterior Compartment Syndrome Leg

  • Superficial posterior
  • Plantar flexors of foot:
    • G..
    • P..
    • S…
  • Sural nerve
    • Sensation to … aspect of the foot and … calf
A
  • Superficial posterior
  • Plantar flexors of foot:
    • Gastrocnemius
    • Plantaris
    • Soleus
  • Sural nerve
    • Sensation to lateral aspect of the foot and distal calf
108
Q

What are the signs of Compartment Syndrome?

  • …! (out of proportion to the original injury)
  • … +++ on passive stretching
  • … limb
  • Decreased function of the compartment muscles
  • Distal neurologic compromise
  • Reduced distal pulses
A
  • Pain! (out of proportion to the original injury)
  • Pain +++ on passive stretching
  • Tense limb
  • Decreased function of the compartment muscles
  • Distal neurologic compromise
  • Reduced distal pulses
109
Q

What are the signs of Compartment Syndrome?

  • Pain! (out of proportion to the original injury)
  • Pain +++ on passive stretching
  • Tense limb
  • Decreased function of the … muscles
  • Distal … compromise
  • Reduced … pulses
A
  • Pain! (out of proportion to the original injury)
  • Pain +++ on passive stretching
  • Tense limb
  • Decreased function of the compartment muscles
  • Distal neurologic compromise
  • Reduced distal pulses
110
Q

Investigations - Compartment Syndrome

  • Clinical … is all important
  • Measuring of intra-… pressures can be useful
  • Creatine … (CK) of 1000-5000 U/mL
  • Myoglobinuria
A
  • Clinical suspicion is all important
  • Measuring of intra-compartmental pressures can be useful
  • Creatine kinase (CK) of 1000-5000 U/mL
  • Myoglobinuria
111
Q

Investigations - Compartment Syndrome

  • Clinical suspicion is all important
  • Measuring of intra-compartmental … can be useful
  • … … (CK) of 1000-5000 U/mL
  • Myo…
A
  • Clinical suspicion is all important
  • Measuring of intra-compartmental pressures can be useful
  • Creatine kinase (CK) of 1000-5000 U/mL
  • Myoglobinuria
112
Q

Management of acute Compartment Syndrome

  • Genuine confirmed CS is an emergency
  • Often … is required
  • Aim is to lay open the … compartment and diminish intra-compartmental …
  • However don’t forget to look for external causes
    • Tight casts/ splints
    • Dressings
A
  • Genuine confirmed CS is an emergency
  • Often surgery is required
  • Aim is to lay open the myofascial compartment and diminish intra-compartmental pressure
  • However don’t forget to look for external causes
    • Tight casts/ splints
    • Dressings
113
Q

Management of acute Compartment Syndrome

  • Genuine confirmed CS is an …
  • Often surgery is required
  • Aim is to lay open the myofascial compartment and diminish intra-.. pressure
  • However don’t forget to look for external causes
    • … casts/ …
    • Dressings
A
  • Genuine confirmed CS is an emergency
  • Often surgery is required
  • Aim is to lay open the myofascial compartment and diminish intra-compartmental pressure
  • However don’t forget to look for external causes
    • Tight casts/ splints
    • Dressings
114
Q

Treatment of compartment syndrome

  • Acute compartment syndrome must be treated in hospital using a surgical procedure called an emergency …
  • The doctor or surgeon makes an … to cut open your skin and … surrounding the muscles to immediately relieve the … inside the muscle compartment.
A
  • Acute compartment syndrome must be treated in hospital using a surgical procedure called an emergency fasciotomy
  • The doctor or surgeon makes an incision to cut open your skin and fascia surrounding the muscles to immediately relieve the pressure inside the muscle compartment.
115
Q

Complications of mismanagement of Compartment Syndrome

  • If fasciotomy is performed within …-… hours following onset of acute CS, the prognosis is good
  • Little or no return of function can be expected when diagnosis and treatment are delayed
  • … - Renal Failure
  • … Loss
A
  • If fasciotomy is performed within 25-30 hours following onset of acute CS, the prognosis is good
  • Little or no return of function can be expected when diagnosis and treatment are delayed
  • Rhabdomyolysis - Renal Failure
  • Limb Loss
116
Q

Complications of mismanagement of Compartment Syndrome

  • If fasciotomy is performed within 25-30 hours following onset of acute CS, the prognosis is …
  • Little or no return of function can be expected when diagnosis and treatment are delayed
  • Rhabdomyolysis - … …
  • Limb Loss
A
  • If fasciotomy is performed within 25-30 hours following onset of acute CS, the prognosis is good
  • Little or no return of function can be expected when diagnosis and treatment are delayed
  • Rhabdomyolysis - Renal Failure
  • Limb Loss
117
Q

Delayed Fasciotomy

118
Q

If fasciotomy is performed within …-… hours following onset of acute CS, the prognosis is good

A

If fasciotomy is performed within 25-30 hours following onset of acute CS, the prognosis is good

Year 2 Medicine (162 decks)

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