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Module 204: Musculoskeletal system > lower nerve injuries > Flashcards

lower nerve injuries Flashcards

1
Q

Cauda equina symptoms

  • Pain severity
  • Location of pain
  • Sensory distribution
  • Motor loss
  • Reflexes
  • Bowel/bladder
  • Sexual function
A

Pain severity

  • Radiates
  • More severe than conus medullaris

Location of pain

  • Unilateral
  • Asymmetric
  • Perineum, thighs, legs

Sensory distribution

  • Saddle
  • Unilateral/ asymmetric

Motor loss

  • Asymmetric
  • Atrophy

Reflexes
- Ankle and knee reduced

Bowel/ bladder
- Symptoms present later

Sexual function
- Impairment is less severe than conus medullar is

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2
Q

Cauda equina

  • Description
  • Causes
A

Lesion below L1/2
- LMN lesion

Causes

  • Disc herniation
  • Spinal fracture
  • Tumours
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3
Q

Conus medullaris

  • Description
  • Causes
A

Lesion at L1/2 cord

Causes

  • Disc herniation
  • Tumour
  • Inflammatory: sarcoidosis, chronic inflammatory demyelinating, polyradiculopathy.
  • Infection: CMV, HSV, EBV, Lyme, TB
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4
Q

Conus medullaris symptoms

  • Pain severity
  • Location of pain
  • Sensory distribution
  • Motor loss
  • Reflexes
  • Bowel/bladder
  • Sexual function
A

Pain
- Less severe than caudal equina

Location

  • Bilateral
  • Perineum, thighs

Sensory

  • Bilateral
  • Saddle

Motor loss
- Symmetric

Reflexes
- Ankle reduced only

Bowel/bladder

  • Presents earlier
    Sexual
  • Severe dysfunction
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5
Q

Sciatic (nerve root compression)

  • Nerve roots compressed
  • Causes of compression
  • Pain
A

Impingement of level root at L5/S1

Compression can be caused by

  • Disc herniation
  • Osteophyte
  • Ligaments
  • Stenosis of spinal canal

Pain

  • Sharp in dermatome
  • Dull ache in myotome
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6
Q

Dermatomes

  • L1-5
  • S1-3
A

L1
- Inguinal area

L2
- Front of thigh

L3
- Front of knee

L4
- Inner leg

L5
- Outer leg, dorsum of door, inner sole

S1
- Little toe, back of leg

S2
- Thigh on top of buttock

S3-5
- Around anus/genitalia

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7
Q

Knee jerk nerve root

A

L4

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8
Q

Ankle jerk nerve root

A

S1

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9
Q

Causes of lumbosacral plexus lesions

A

Childbirth

Structural

  • Haematoma/ warfarin
  • Abscess
  • Infiltration from malignancy
  • Trauma

Non-structural

  • Inflammatory
  • Diabetes
  • Vasculitis–> prevents blood supply to nerves
  • Radiotherapy
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10
Q

Femoral nerve lesion organisation

A

If proximal
- Iliopsoas affected= weak hip flexors

Below inguinal ligament

  • Only knee extension affected
  • Loss of knee jerk

Distal
- Pure motor or sensory syndrome

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11
Q

Causes of femoral nerve damage

A

Pelvic fracture

Prolonged dorsal lithotomy position
- In surgery

Gynae procedures
- Hysterectomy

Femoral artery bypass/ puncture

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12
Q

Sciatica

  • Description
  • Causes
  • Differentials
  • Movements affected
A

Nerve root entrapment of L5/S1
- Sciatic nerve distribution pain

Causes

  • Trauma
  • Haematoma
  • Piriformis syndrome
  • Misplaced IM injection

Differentials

  • Osteoarthritis [sacroiliac joints
  • Hip problem [if pain more below knee]

Movements affected, everythng but:

  • Hip flexion
  • Knee extension [Femoral]
  • Hip adduction [medial muscles, obturator]
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13
Q

Sciatic nerve

A

2 compartments

  • Common peroneal
  • Tibial

Presents differently if nerve is partially damaged

Divisions:

  • Sural
  • Common peroneal
  • Tibial
  • Superficial/deep peroneal
  • Medial lateral plantar
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14
Q

Tibial nerve damage

A

Responsible for plantar flexion, inversion
- Damage= cannot tip toe, weak foot inversion, painful numb sole

Causes:

  • Trauma
  • Baker’s cats
  • Nerve cyst
  • Tumour
  • Entrapment by tendinous arch of soles muscle
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15
Q

Tarsal tunnel syndrome

A

Compression of tibial nerve in tarsal tunnel

Presents

  • Pain in sole, worse on standing/ waling
  • No heel pain
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16
Q

Sural nerve

A

Sensory nerve from tibial and common peroneal nerve
- Posterior to lateral malleolus

Commonly used for nerve biopsy, i.e to diagnose vasculitis.

  • Purely sensory
  • Supplies little area
17
Q

Common peroneal nerve damage

A

From sciatic nerve

Causes
- Leg crossing
- Tight plaster cast
- Weight loss
- Fibula fracture
Sensory loss
- Lower lower leg
- Dorsum of foot

Motor loss

  • Dorsiflexion
  • Eversion of foot
18
Q

Causes of neurogenic foot drop

A

UMN lesion

  • Tumour
  • Stroke
  • Polio

Common peroneal lesion
- Most common

L4/5 entrapment

Cauda equina
Conus medullar is

Sciatic nerve lesion

19
Q

Length dependent polyneuropathy

A

Lesions in the longest nerves
- usually in the lower limb

Presents
- Numbness, paraesthesia, weakness, pain of affected regions
Causes
- Diabetes
- Alcohol
- B12 deficiency
- Chemotherapy
20
Q

Guillain Barre syndrome

A

Acute inflammatory demyleinating polyneuropathy

Antibodies are produced proceeding infection
- Injuries myelin or axon

Presents

  • Rapid progression
  • Weakness in limbs, face, respiratory and bulbar muscles
  • absent reflexes
21
Q

Neuronopathy

A

Polyneuropathy that affects specific population of neurones
- motor: anterior horn cell lesion [polio, ALS]

  • Sensory: Dorsal root ganglion [Sjogren’s syndrome, paraneoplastic]
22
Q

Polyradiculopathy

A

Lesion affecting many nerve roots

Causes

  • Spinal stenosis of spinal canal
  • Cancer: leptomeningeal metastatsis
  • Infection: lyme, HIV
23
Q

Shin splints

A

Transient increase in intracompartmeyt pressure in the anterior/ lateral leg= pain on/post exercise
- Due to compression of nerve

Treat with RICE

24
Q

Compartment syndrome

A

Increase in pressure within myofascial compartment
= Limits ability for muscle to expand
- Muscle and nerve ischaemia

When acute= surgical emergency

Most common in

  • Lower leg
  • Forearm

Signs

  • Pain very in proportional to injury, increased in passive stretching
  • Tense limb
  • Decreased function
  • Neurologic comprimise distally
  • Reduced distal pulses

Causes

  • Fractures [esp. tibial]
  • Crush injuries
  • Burns
  • electric shock
  • Fluid injection into muscle
  • drugs: warfare, anabolic steroids, IV
  • Haemophilia
25
Q

Acute anterior compartment syndrome in leg

- Structures affected (how) and consequences

A

anterior tibial artery
- Lateral tibial plateau fractures

Deep peroneal nerve
- Loss of sensation in first dorsal web space

Muscles that dorsiflex ankle and foot affected

26
Q

Acute posterior compartment syndrome in leg

A

Plantar flexors in foot affected

  • Gastroc
  • Plantaris
  • Soleus

Sural nerbe
- Lateral foot and distal calf sensation affected

Module 204: Musculoskeletal system (22 decks)

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