Lumbosacral Plexus Injuries

Question 1

Nerves (6) and trunk of the LUMBAR PLEXUS.

Answer 1

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1) Iliohypogastric nerve
2) Ilioinguinal nerve
3) Genitofemoral nerve
4) Lateral Femoral Cutaneous Nerve
5) Femoral Nerve
6) Obturator Nerve
7) Lumbosacral TRUNK

Question 2

Nerves (6) of the SACRAL PLEXUS.

Answer 2

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1) Superior Gluteal nerve
2) Inferior Gluteal nerve
3) Sciatic nerve (common peroneal nerve + tibial nerve)
4) Posterior Cutaneous nerve
5) Perforating Cutaneous nerve
6) Pudendal nerve

Question 3

The 2 nerves that make up the sciatic nerve in the sacral plexus.

Answer 3

Sciatic nerve divides into:
1) tibial nerve
2) common peroneal nerve

Question 4

Background of the plexus nerves.

Answer 4

NETWORK of NERVE FIBERS that BRANCH OUT to INNERVATE the LOWER LIMBS.

Derived from ROOTS of LUMBAR + SACRAL spinal nerves.

Question 5

Clinical significance of the spinal nerves.

Answer 5

• Spinal disc herniation is the most common cause of damage.
• Compression of local spinal nerves.

Question 6

Symptoms of compression of local spinal nerves.

Answer 6

1) Shooting pain down the leg
2) Numbness and muscle weakness in areas of affected nerves.

Question 7

Cauda Equina Syndrome (CES) definition

Answer 7

Due to compression of cauda equina.
-Neurosurgical emergency
-Rare condition

Question 8

What is the cauda equina?

Answer 8

the collection of nerves distal to the terminal part of the spinal cord.

Question 9

Common causes of CES

Answer 9

1) lumbar stenosis - narrowing of the spinal canal in the lumbar region.
2) spinal trauma
3) herniation of the disc
4) malignancy - presence of cancer cells
5) spinal infections - abscess, tuberculosis
6) neural tube defects - spina bifida

Question 10

Spina bifida

Answer 10

birth defect, spine and spinal cord dont form properly, part of the neural tube fails to develop or close properly.

Question 11

Signs and Symptoms of CES

Answer 11

1) Saddle anesthesia - numbness around saddle region; butt, anus, genitals.
2) Pain in lower back radiating down one or both legs.
3) Urinary Incontinence and sexual dysfunction.
4) Lack of sensations and weakness in legs.
5) Hypotonia - low muscle tone.
6) Hyporeflexia

Question 12

Diagnosis of CES

Answer 12

MRI of spine

Question 13

Complication of CES

Answer 13

Permanent paralysis

Question 14

Treatment of CES

Answer 14

Decompression surgery

Question 15

Femoral Neuropathy (FN) definition.

Answer 15

damage to femoral nerve.

Question 16

what is the femoral nerve responsible for?

Answer 16

1) controls thigh muscles
2) hip bending
3) knee extension
4) sensation in deramtomes of legs

Question 17

Causes of FN

Answer 17

1) Direct trauma
2) Trauma during spinal surgery
3) Pressure of femoral nerve due to hematoma or tumor
4) Fracture
5) Lithotomy position during childbirth

Question 18

Symptoms of FN

Answer 18

1) numbness or tingling of the leg
2) muscle weakness
3) difficulty walking or using leg
4) loss of sensation
5) loss of coordination

Question 19

Diagnosing FN

Answer 19

Electromyography (EMG)

Question 20

Peroneal Nerve Palsy (PNP) definition

Answer 20

damage or compression to the peroneal nerve which is a branch of the sciatic nerve.

Question 21

What is the peroneal nerve responsible for?

Answer 21

movement and sensation to the
1) lower leg
2) foot
3) toes

Question 22

Causes of PNP

Answer 22

1) trauma or injury to the knee
2) fracture of the fibula
3) use of a tight plaster of the lower leg (long-term constriction)
4) regularly wearing high boots
5) pressure to the knee from positions during deep sleep or coma
6) injury during knee surgery

Question 23

Symptoms of PNP

Answer 23

1) decreased sensation, numbness, tingling in top of foot OR outer part of upper or lower leg.
2) Slapping gait - foot that drops
3) toes drag while walking
4) walking problems
5) weakness of ankles or feet
6) loss of muscle mass - nerves aren’t stimulating the muscles.

Question 24

Obturator Nerve Palsy (ONP) definition

Answer 24

damage or dysfunction of the obturator nerve which arises from the lumbar plexus.

Question 25

What is the obturator nerve responsible for?

Answer 25

sensory and motor innervation to the medial compartment of the thigh for:
1) balancing, rotating, extending legs
2) flexing hips.
3) sensation to inner thigh

Question 26

Causes of ONP

Answer 26

1) direct trauma to groin
2) entrapment of the obturator nerve - exercise-induced medial thigh pain, common in athletes.
3) compression during surgery

Question 27

Signs and symptoms of ONP

Answer 27

1) pain and paresthesias
2) leg weakness = trouble walking
3) weak hip adductors on aff. side
4) wasting of medial thigh (atrophy)
5) abnormal abduction of hip during ambulation = circumduction + wide-based gait.
6) area of sensory loss of medial thigh; may extend below knee.

Question 28

Meralgia Paresthetica (MP) definition

Answer 28

localised sensory symptoms of the outer thigh caused by compression of the lateral femoral cutaneous nerve. MONONEUROPATHY. KA nerve entrapment syndrome.

Question 29

Mechanical causes of MP

Answer 29

1) pregnancy/any condition that increases abdominal pressure
2) obesity
3) different leg lengths
4) pubic symphysis dysfunction

Question 30

Metabolic causes of MP

Answer 30

1) neuropathy (diabetes)
2) hypothyroidism

Question 31

Iatrogenic causes of MP

Answer 31

1) prolonged traction during spine surgery
2) injury to the nerve during retroperitoneal dissection

Question 32

Signs and symptoms of MP

Answer 32

1) pain on the outer side of thigh, occ. ext. to outer side of knee.
2) burning sensation, tingling, numbness in the same area.
3) occ. aching in groin area/pain spreading across buttokcks.
4) usually more sensitive to light touch than firm pressure
5) hypersensitivity to heat
6) occ. pt c/o itching sensation rather than pain.

Question 33

Sciatic Neuropathy (SN) definition

Answer 33

pain in the lower extremity resulting from irritation of the sciatic nerve.

Question 34

Where is the pain typically felt in SN?

Answer 34

from low back lumbar area to behind the thigh + radiating down below the knee and may reach the foot.

Question 35

Causes of SN

Answer 35

1) Disc herniation
2) spinal stenosis
3) spondylolisthesis
4) direct trauma
5) irritation during pregnancy

Question 36

Symptoms of SN

Answer 36

1) lower back pain
2) hip pain
3) burning or tingling in the leg
4) difficulty moving leg or foot
5) difficulty to stand up
6) pain in the rear or leg while sitting

Question 37

RFs of SN

Answer 37

1) age
2) obesity
3) prolonged sitting
4) diabetes
5) inactive lifestyle

Question 38

Diagnosis of SN

Answer 38

1) X-Ray
2) CT Scan
3) MRI

Question 39

Treatment of SN

Answer 39

1) physical therapy
2) medications
3) surgery
4) steroid injections

Question 40

Morton’s Neuroma (MN) definition

Answer 40

compressive neuropathy of the interdigital nerve, usually between third and fourth metatarsals. FEMALES are more affected.

Question 41

Causes of MN; compression of interdigital nerve due to

Answer 41

1) narrow toe-box footwear
2) hyperextension of toes in heels
3) deviation of the toes
4) inflammation in the intermetatarsal bursa
5) thickening of the transverse metatarsal ligament
6) forefoot trauma
7) high-impact activities
8) metatarsophalangeal joint pathology
9) lipoma

Question 42

Symptoms of MN

Answer 42

1) burning pain
2) tingling toes
3) pain worsens with shoes

Question 43

Steps of EMG test

Answer 43

1) needle electrode inserted into muscle
2) contract and rest muscle as instructed
3) needle records muscle activity during rest and movement.

Question 44

what does Electromyography (EMG) measure

Answer 44

how well your muscles respond to the movement nerve signals sent from the brain.

Question 45

How long does an EMG test take

Answer 45

30-60 minutes (W/O time for residual pain treatment)

Question 46

what does Nerve Conduction Study (NCS) measure

Answer 46

how well the nerves in your body carry the movement electrical signals from your brain to your muscles.

Question 47

steps of an NCS test

Answer 47

1) several flat metal disc electrodes placed on skin
2) several quick electrical pulses applied through your nerves
3) record the time it takes for your nerves to transmit the signals.

Question 48

how long does an NCS test take

Answer 48

15-60 minutes, depending o extent of testing.