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Year 2 MIS > Lower Limb Nerve Injuries and Compartment Syndromes > Flashcards

Lower Limb Nerve Injuries and Compartment Syndromes Flashcards

1
Q

In an upper and lower motor neuron lesion, what would we expect to see in muscle tone and muscle wasting?

A
  • UMN = spasticity and no atrophy with normal muscle bulk

- LMN = reduced tone with reduced muscle bulk

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2
Q

In an upper and lower motor neuron lesion, what would we expect to see in muscle reflex?

A
  • UMN = increased reflex

- LMN = decreased reflex

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3
Q

In an upper and lower motor neuron lesion, what would we expect to see in fasciculation’s?

A
  • UMN = not present

- LMN = present

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4
Q

In an upper and lower motor neuron lesion, what would we expect to see in Babinski response?

A
  • UMN = extension of toes POSITIVE

- LMN - flexion of toes NEGATIVE (same as a normal test)

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5
Q

Which nerve root supplies the hip flexors?

1 - T1-T4
2 - L1-2
3 - L4-L5
4 - S1-S2

A

2 - L1-2

- Iliopsoas, rectus fermoris

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6
Q

Which nerve root supplies the knee extension?

1 - T1-T4
2 - L1-2
3 - L3-L4
4 - S1-S2

A

3 - L3-L4

- quadriceps, sartorius

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7
Q

Which nerve root supplies the foot inversion?

1 - T1
2 - L1
3 - L4
4 - S2

A

3 - L4

- anterior compartment of leg (tibialis anterior)

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8
Q

Which nerve root supplies the knee flexion, ankle dorsiflexion, toe extension, foot inversion and eversion?

1 - L3
2 - L4
3 - L5
4 - S2

A

3 - L5

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9
Q

Which nerve root supplies the knee flexion, ankle plantar flexion, toe flexion, foot eversion?

1 - L3
2 - L4
3 - L5
4 - S1

A

4 - S1

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10
Q

What are the nerve roots for the knee reflex?

1 - L2-L3
2 - L3-L4
3 - L5-S1
4 - S2-S3

A

2 - L3-L4

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11
Q

What are the nerve roots for the ankle reflex?

1 - L2-L3
2 - L3-L4
3 - L5-S1
4 - S1-S2

A

4 - S1-S2

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12
Q

When remembering the dermatomes for the lower regions we can use stand on ….. and sit on …….. What dermatomes are we missing?

A
  • stand on S1
  • sit on S2-5

- sit on S3

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13
Q

When remembering the dermatomes for the lower regions we can use L…. to the knee and L… to the floor. What do they rhyme with that are missing?

A
  • L3 to the knee
  • L4 to the floor

- L4 to the floor (medial)

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14
Q

When remembering the dermatomes for the lower regions what 2 dermatomes are present on the outside of the anterior leg?

A
  • L2 thigh
  • L5 leg
  • BOTH are lateral
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15
Q

What dermatome runs up the back of the leg from the calcaneus to the gluteus maximus?

1 - L5
2 - S1
3 - S2
4 - S3

A

3 - S2

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16
Q

Label the dermatomes for the lower limbs using the labels below:

L3
L4
L5
S1
S2
A 
1 - S2
2 - S1
3 - L4
4 - L5
5 - L3
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17
Q

What is the name given to the end of the spinal cord where it is bundled, tapered and marks the end of the spinal cord nerves?

1 - filium
2 - conus medullaris
3 - cauda equina
4 - sacrum

A

2 - conus medullaris

- it looks like a cone

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18
Q

What level of the vertebral column does the spinal cord terminate forming the conus medularis?

1 - L2
2 - L1
3 - S1
4 - S4

A

2- L1

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19
Q

What level of the vertebral column does the cauda aquinas run?

1 - L2-S3
2 - L1-S2
3 - S1-S4
4 - S4-S5

A

1 - L2-S3

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20
Q

What can damage to the cauda equina and conus medullaris have on the speed of pain?

Mnemonic: Conus rhymes with ANUS

  1. periAnal localized
  2. Nimble (fast and early involvement)
  3. Upper motor neuron involvement
  4. Symmetric involvement
A
  • cauda equina = spontaneous and severe asymmetrical pain

- conus medullaris = spontaneous pain is not common

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21
Q

What can damage to the cauda equina and conus medullaris have on motor findings?

Mnemonic: Conus rhymes with ANUS

  1. periAnal localized
  2. Nimble (fast and early involvement)
  3. Upper motor neuron involvement
  4. Symmetric involvement
A
  • cauda equina = unilateral commonly

- conus medullaris = commonly bilateral

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22
Q

What can damage to the cauda equina and conus medullaris have on sensory findings?

Mnemonic: Conus rhymes with ANUS

  1. periAnal localized
  2. Nimble (fast and early involvement)
  3. Upper motor neuron involvement
  4. Symmetric involvement
A
  • cauda equina = asymmetrical saddle distribution

- conus medullaris = bilateral, symmetrical saddle distribution

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23
Q

What can damage to the cauda equina and conus medullaris have on knee and ankle reflexes?

A
  • cauda equina = late and less severe

- conus medullaris = may be present or ankle only lost

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24
Q

What can damage to the cauda equina and conus medullaris have on sphincter reflex?

A
  • cauda equina = late and less severe

- conus medullaris = early and marked

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25
Q

What can damage to the cauda equina and conus medullaris have on sexual function?

A
  • cauda equina = less severe impairment

- conus medullaris = impaired early

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26
Q

In the MRI below, we can see that there is a disc protrusion at L4-L5. Would this affect the L4 or L5 nerve and why?

A
  • L4 nerve root

- nerve roots leave below the vertebrae (except for C1-C7)

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27
Q

What nerve roots make up the lumbar plexus?

1 - T8 - L4
2 - T11 - L5
3 - T12 - L5
4 - T12 - S2

A

3 - T12 - L5

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28
Q

What nerve roots make up the sacral plexus?

1 - L1 - L5
2 - L2 - S1
3 - L4 - S4
4 - S1 - S5

A

3 - L4 - S4

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29
Q

The iliopsoas and rectus femoris are innervated by which nerve?

1 - lateral cutaneous nerve
2 - obturator nerve
3 - femoral nerve
4 - pudendal nerve

A

3 - femoral nerve

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30
Q

What are the nerve roots of the femoral nerve?

1 - L1 - L4
2 - L2 - S1
3 - L2 - L5
4 - L2 - L4

A

4 - L2 - L4

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31
Q

The adductor longus and adductor magnus are innervated by which nerve?

1 - lateral cutaneous nerve
2 - obturator nerve
3 - femoral nerve
4 - pudendal nerve

A

2 - obturator nerve

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32
Q

What are the nerve roots of the obturator nerve?

1 - L1 - L3
2 - L2 - S1
3 - L2 - L5
4 - L2 - L4

A

4 - L2 - L4

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33
Q

Which nerve supplies the sensations to the lateral thigh?

1 - lateral cutaneous nerve
2 - obturator nerve
3 - femoral nerve
4 - pudendal nerve

A

1 - lateral cutaneous nerve

34
Q

What are the nerve roots of the lateral cutaneous nerve?

1 - L1 - L2
2 - L2 - S1
3 - L2 - L5
4 - L2 - L4

A

1 - L1 - L2

35
Q

What is the large nerve that originates from the sacral plexus?

1 - pudendal nerve
2 - sciatica nerve
3 - obturator nerve
4 - femoral nerve

A

2 - sciatica nerve

- L4-S3

36
Q

What are the nerve roots of the sciatica nerve?

1 - L1 - L3
2 - L2 - S1
3 - L2 - S2
4 - L4 - S3

A

4 - L4 - S3

37
Q

The sciatica goes on to form 2 key nerves in the leg. What are these 2 nerves?

1 - pudendal and tibial nerve
2 - common peroneal and tibial nerve
3 - common peroneal and inferior gluteal nerve
4 - tibial nerve and superior gluteal nerve

A

2 - common peroneal and tibial nerve

38
Q

The femoral nerve innervates the hip flexors, Iliopsoas and rectus femoris. If hip flexion is ok, but knee extension is affected, would damage be above or below the inguinal ligament, which is where the femoral nerve would pass to innervate the rectus femoris?

A
  • below inguinal ligament

- where femoral nerve begins

39
Q

What are 5 of the most common causes of a femoral lesion?

A 
1 - trauma
2 - medication (anti-coagulants)
3 - surgery
4 - gynae procedures/prolonged lithotomy position
5 - femoral artery bypass
40
Q

Below are the 5 of the most common causes of a femoral lesion. Which is the most common cause?

1 - trauma
2 - medication (anti-coagulants)
3 - surgery
4 - gynae procedures/prolonged lithotomy position
5 - femoral artery bypass
A

5 - femoral artery bypass or cardiac based interventions through femoral artery

41
Q

What is the most commonly damaged nerve during childbirth?

1 - inferior gluteal nerve
2 - superior gluteal nerve
3 - femoral nerve
4 - obturator nerve

A

4 - obturator nerve

- femoral may also be damaged

42
Q

The sciatic nerve innervates all muscles of the lower limb except for which 3 groups of muscles? (flexors, extensors etc…)

A

1 - hip flexors
2 - hip adduction
3 - knee extension

43
Q

Sciatica is pain associated with the sciatic nerve. Although symptoms can present in the lower limbs, where is most likely to be affected?

1 - Entrapment at pelvis
2 - entrapment at L5-S1
3 - entrapment at inguinal ligament
4 - entrapment at S1-S4

A

2 - entrapment at L5-S1

44
Q

Sciatica is pain associated with the sciatic nerve. Although symptoms can present in the lower limbs it is most likely to be entrapment at L5-S1. What are the 4 most common causes of sciatica?

A

1 - disc protrusion
2 - tumour
3 - haematoma
4 - trauma

45
Q

There are 3 main divisions of the sciatic nerve that occur superiorly to the popliteal fossa are:

1 - tibial, common peroneal and sural nerves
2 - pudendal, tibial and sural nerves
3 - tibia, common peroneal and sural nerves
4 - pudendal, tibial and common peroneal nerves

A

3 - tibia, common peroneal and sural nerves

46
Q

There are 3 main divisions of the sciatic nerve that occur at the superior to the popliteal fossa tibia, common peroneal and sural nerves. If there is compression at the L5-S1 vertebrae, what might we see in the leg and foot?

A
  • weakness in ankle dorsi-flexion, inversion, eversion and extensor hallucis longus
47
Q

There are 3 main divisions of the sciatic nerve that occur at the superior to the popliteal fossa tibia, common peroneal and sural nerves. If there is entrapment at the common peroneal nerve, what might we expect to see in the leg and foot?

A
  • weakness of knee flexion, ankle dorsiflexion, eversion and extensor hallucis longus
48
Q

What are the nerve roots of the tibial nerve?

1 - L5 - S2
2 - L3 - S3
3 - L5 - S1
4 - L5 - S3

A

1 - L5 - S2

49
Q

The tibial nerve comes from nerve roots L5 - S2. What muscles in the leg does this nerve innervate?

1 - tibialis anterior, popliteus, soleus and plantaris and the sural nerve
2 - gastrocnemius, soleus and plantaris and the sural nerve
3 - gastrocnemius, popliteus and plantaris and the sural nerve
4 - tibialis anterior, popliteus, soleus and plantaris and the sural nerve

A

3 - gastrocnemius, popliteus, soleus and plantaris and the sural nerve
- plantarflexor muscles

50
Q

What is the most common location for damaged to the common peroneal (fibular) nerve to occur?

1 - pelvis
2 - posterior head of the fibula
3 - popliteal fossa
4 - ankle

A

2 - posterior head of the fibula

- wraps around the head of the fibula

51
Q

What is the action that the common peroneal nerve innervates?

1 - ankle dorsi-flexion and eversion
2 - ankle plantar-flexion and eversion
3 - ankle dorsi-flexion and inversion
4 - ankle plantar-flexion and inversion

A

1 - ankle dorsi-flexion and eversion

52
Q

What is the most common cause of damage to the peroneal (fibula) nerve?

1 - fractured talus, patient placed in a cast that compressed the nerve
2 - fractured tibia, patient placed in a cast that compressed the nerve
3 - fractured fibula, patient placed in a cast that compressed the nerve
4 - fractured femur, patient placed in a cast that compressed the nerve

A

3 - fractured fibula, patient placed in a cast that compressed the nerve

53
Q

The most common cause of damage to the peroneal nerve is a fracture to the fibula and patient places in a cast, which then compresses the nerve. What are 2 other common causes?

1 - obesity and weight loss
2 - weight loss and alcoholics
3 - weight loss and alcoholics
4 - tradesmen and obesity

A

3 - weight loss and alcoholics

  • weight loss reduces fat pad side, compressing the nerves
  • alcoholics (sleep in funny positions and compress the nerve)
54
Q

What sensory information does the common peroneal nerve provide?

1 - dorsum of the foot and lateral aspect of lower foot
2 - plantar of the foot and lateral aspect of lower foot
3 - plantar of the foot and medial aspect of lower foot
1 - dorsum of the foot only

A

1 - dorsum of the foot and lateral aspect of lower foot

55
Q

The sural nerve provides sensory information only. What skin does this nerve provide sensory information for?

1 - all toes
2 - lateral side of posterior foot
3 - plantar of foot
4 - dorsum of foot

A

2 - lateral side of posterior foot

56
Q

The sural nerve provides sensory information only to the lateral side of posterior foot. What is the clinical importance about this site?

1 - most common location of loss of sensation
2 - most common location of severe pain
3 - common biopsy site for peripheral neuropathy
4 - achilles tendon sensory location

A

3 - common biopsy site for peripheral neuropathy

- can leave funny sensation on this part of the foot following biopsy

57
Q

What does radiculopathy refer to?

1 - pinched nerve at root level
2 - pinched nerve at peripheral level
3 - pinched nerve at dorsal horn
4 - pinched nerve at ventral horn

A

1 - pinched nerve at root level

58
Q

What is peripheral neuropathy?

A
  • a lower motor neuron disease

- disease of the peripheral nerves

59
Q

What is peripheral polyneuropathy?

A
  • several peripheral nerves are affected
  • mainly affects distal nerves like in diabetes
  • more likely in lower limbs as more distal
60
Q

What is peripheral mononeuropathy?

1 - nerves of a single joint are affected
2 - single peripheral nerve is affected
3 - peripheral nerve for a single muscle is affected
4 - peripheral nerve for a single sensation is affected

A

2 - single peripheral nerve is affected

- median nerve in carpal tunnel syndrome

61
Q

What is mononeuritis multiplex?

1 - nerves of a 2 or more joints are affected
2 - 2 or more separate peripheral nerve are affected
3 - peripheral nerve for 2 or more muscles are affected
4 - peripheral nerve for a 2 or more sensations are affected

A

2 - 2 or more separate peripheral nerve are affected
- causes pain, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas

62
Q

When we talk about peripheral neuropathies, there are 2 parts where a nerve can be damaged. What are they?

A
  • axon

- nerve cell body or axonal terminal

63
Q

Below is some of the most common causes of peripheral neuropathies affected the axonal body. What is the most common?

  • diabetes
  • B12 deficiency (treatable)
  • chemotherapy or other drugs
  • inherited (Hereditary Sensory Motor Neuropathies)
  • HIV
  • vasculitis(ANCA, Churg-Strauss)
  • hypothyroidism (motor)
  • idiopathic - MOST COMMON
A
  • diabetes
64
Q

What are some of the most common causes of peripheral neuropathies affecting the myelination?

A
  • acute Idiopathic Demyelinating Neuropathy = Guillain Barre Syndrome
  • chronic Idiopathic Demyelinating Neuropathy (CIDP)
  • paraproteinamic neuropathy (IgM)
  • inherited – Hereditary Motor Sensory Neuropathy – Charcot Marie Tooth Disease type 1
  • Post - diptheria

ALL BUT INHERITED CAN BE TREATED

65
Q

Label the distribution of peripheral neuropathy using the labels below:

plexopathy
multiplex type
distal symmetric
mononeuropathy

A

1 - distal symmetric
2 - mononeuropathy
3 - multiplex type
4 - plexopathy

66
Q

There are 4 compartments of the leg, what are they:

1 - superior, inferior, Superficial Posterior, Deep Posterior
2 - Anterior, Lateral, Superficial Posterior, Deep Posterior
3 - Anterior, Lateral, superior Posterior, inferior Posterior
4 - Inferior, Lateral, Superficial Posterior, Deep Posterior

A

2 - Anterior, Lateral, Superficial Posterior, Deep Posterior

67
Q

There are 4 compartments of the leg, Anterior, Lateral, Superficial Posterior, Deep Posterior. What 3 muscles are contained within the anterior compartment?

1 - tib anterior, peroneus and soleus
2 - tib anterior, tib posterior, extensor hallucis longus
3 - tib anterior, extensor hallucis longus, extensor digitorum longus
4 - tib anterior, plantaris, extensor hallucis longus

A

3 - tib anterior, extensor hallucis longus, extensor digitorum longus

68
Q

There are 4 compartments of the leg, Anterior, Lateral, Superficial Posterior, Deep Posterior. What muscle 2 muscles are contained within the lateral compartment?

1 - tibialis anterior
2 - tibialis posterior
3 - fibularis longus and brevis
4 - soleus

A

3 - fibularis longus and brevis

69
Q

There are 4 compartments of the leg, Anterior, Lateral, Superficial Posterior, Deep Posterior. What 3 muscles are contained within the superficial layer of the posterior compartment?

1 - tibialis anterior, soleus and plantaris
2 - tibialis posterior, gastrocnemius and plantaris
3 - peroneus, gastrocnemius and plantaris
4 - soleus, gastrocnemius and plantaris

A

4 - soleus, gastrocnemius and plantaris

70
Q

There are 4 compartments of the leg, Anterior, Lateral, Superficial Posterior, Deep Posterior. Label the 4 muscles are contained within the deep posterior compartment?

flexor hallucis longus
flexor digitorum longus
tibialis posterior
popliteus

A

1 - popliteus
2 - tibialis posterior
3 - flexor digitorum longus
4 - flexor hallucis longus

71
Q

What is compartment syndrome?

A
  • increased pressure within myofascial compartment
  • can be acute or chronic (acute compartmental syndrome is a medial emergency)
  • essentially the myofascial is like tights holding in muscles
72
Q

Compartment syndrome is an increased pressure within myofascial compartment. This can be acute or chronic, with an acute compartmental syndrome being a medial emergency. What are the most common causes of this?

A
  • trauma causing internal bleeding
  • crush injuries
  • burns (skin becomes tight and compresses the leg)
  • electric shock
  • fluid injections
73
Q

Compartment syndrome is an increased pressure within myofascial compartment. This can be acute or chronic, with an acute compartmental syndrome being a medial emergency. What medications can cause this?

1 - anti-coagulants, anabolic steroid use, IV drugs
2 - anabolic steroid use, IV drugs, NSAIDS
3 - anti-coagulants, anabolic steroid use, NSAIDS
4 - anti-coagulants, NSAIDS, IV drugs

A

1 - anti-coagulants, anabolic steroid use, IV drugs

74
Q

Compartment syndrome is an increased pressure within myofascial compartment. This can be acute or chronic, with an acute compartmental syndrome being a medial emergency. Anywhere can be affected that contains compartments, but where are the 2 most common?

A

1 - forearm

2 - lower leg

75
Q

Compartment syndrome is an increased pressure within myofascial compartment. This can be acute or chronic, with an acute compartmental syndrome being a medial emergency. How can this present?

A
  • excruciating pain is most common and obvious
  • pain upon stretching
  • tense limbs
  • decreased muscle function
  • numbness and tingling
  • reduced distal pulses
76
Q

Although compartment syndrome relies heavily on medical history and examination, with the symptoms below

  • excruciating pain is most common and obvious
  • pain upon stretching
  • tense limbs
  • decreased muscle function
  • numbness and tingling
  • reduced distal pulse

There are 2 biochemistry measures we can requested. What are they?

1 - CK and LDH
2 - CK and RF
3 - CK and myoglobinuria
4 - myoglobinuria and LDH

A
  • Creatine Kinase) 1000-5000 U/ml
  • Myoglobinuria

BOTH ASSOCIATED WITH MUSCLE DAMAGE

77
Q

If compartment syndrome is confirmed, how would this be treated?

A
  • surgical incision is made

- for good outcomes surgery is required in 2-3 hours

77
Q

If compartment syndrome is confirmed, how would this be treated?

A
  • surgical incision is made called a fasciotomy

- site is left open for a few days until pressure returns to normal

78
Q

What are the 2 key criteria that a patient has a neurological foot drop?

1 - inability to lift the foot (plantar-flexers) and neurological in cause
2 - inability to lift the foot (dorsi-flexers) and non-neurological in cause
3 - inability to lift the foot (plantar-flexers) and non-neurological in cause
4 - inability to lift the foot (dorsi-flexers) and neurological in cause

A

4 - inability to lift the foot (dorsi-flexers) and neurological in cause

79
Q

The 2 key criteria that a patient has a neurological foot drop are the inability to lift the foot (dorsi-flexers) and neurological in cause. What is the most common lesion site that can cause a neurological foot drop?

1 - Conus
2 - Caudate aquinas
3 - Common peroneal (fibular) nerve palsy (specifically deep fibular nerve)
4 - Sciatic nerve

A

3 - Common peroneal (fibular) nerve palsy (specifically deep fibular nerve)
- branch from common peroneal nerve, the deep peroneal nerve innervates the anterior compartment of the leg including tibialis anterior, extensor digitorum longus and extensor hallucis longus

80
Q

Damage to which nerve is the most common cause of foot drop?

1 - tibialis posterior
2 - tibialis anterior
3 - superficial nerve
4 - deep fibular (peroneal) nerve

A

4 - deep fibular (peroneal) nerve

Year 2 MIS (48 decks)

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