Lumbosacral Plexus Injuries Flashcards
Nerves (6) and trunk of the LUMBAR PLEXUS.
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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
Nerves (6) of the SACRAL PLEXUS.
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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
The 2 nerves that make up the sciatic nerve in the sacral plexus.
Sciatic nerve divides into:
1) tibial nerve
2) common peroneal nerve
Background of the plexus nerves.
NETWORK of NERVE FIBERS that BRANCH OUT to INNERVATE the LOWER LIMBS.
Derived from ROOTS of LUMBAR + SACRAL spinal nerves.
Clinical significance of the spinal nerves.
- Spinal disc herniation is the most common cause of damage.
- Compression of local spinal nerves.
Symptoms of compression of local spinal nerves.
1) Shooting pain down the leg
2) Numbness and muscle weakness in areas of affected nerves.
Cauda Equina Syndrome (CES) definition
Due to compression of cauda equina.
-Neurosurgical emergency
-Rare condition
What is the cauda equina?
the collection of nerves distal to the terminal part of the spinal cord.
Common causes of CES
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
Spina bifida
birth defect, spine and spinal cord dont form properly, part of the neural tube fails to develop or close properly.
Signs and Symptoms of CES
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
Diagnosis of CES
MRI of spine
Complication of CES
Permanent paralysis
Treatment of CES
Decompression surgery
Femoral Neuropathy (FN) definition.
damage to femoral nerve.
what is the femoral nerve responsible for?
1) controls thigh muscles
2) hip bending
3) knee extension
4) sensation in deramtomes of legs
Causes of FN
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
Symptoms of FN
1) numbness or tingling of the leg
2) muscle weakness
3) difficulty walking or using leg
4) loss of sensation
5) loss of coordination
Diagnosing FN
Electromyography (EMG)
Peroneal Nerve Palsy (PNP) definition
damage or compression to the peroneal nerve which is a branch of the sciatic nerve.
What is the peroneal nerve responsible for?
movement and sensation to the
1) lower leg
2) foot
3) toes
Causes of PNP
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
Symptoms of PNP
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.
Obturator Nerve Palsy (ONP) definition
damage or dysfunction of the obturator nerve which arises from the lumbar plexus.
What is the obturator nerve responsible for?
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
Causes of ONP
1) direct trauma to groin
2) entrapment of the obturator nerve - exercise-induced medial thigh pain, common in athletes.
3) compression during surgery
Signs and symptoms of ONP
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.
Meralgia Paresthetica (MP) definition
localised sensory symptoms of the outer thigh caused by compression of the lateral femoral cutaneous nerve. MONONEUROPATHY. KA nerve entrapment syndrome.
Mechanical causes of MP
1) pregnancy/any condition that increases abdominal pressure
2) obesity
3) different leg lengths
4) pubic symphysis dysfunction
Metabolic causes of MP
1) neuropathy (diabetes)
2) hypothyroidism
Iatrogenic causes of MP
1) prolonged traction during spine surgery
2) injury to the nerve during retroperitoneal dissection
Signs and symptoms of MP
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.
Sciatic Neuropathy (SN) definition
pain in the lower extremity resulting from irritation of the sciatic nerve.
Where is the pain typically felt in SN?
from low back lumbar area to behind the thigh + radiating down below the knee and may reach the foot.
Causes of SN
1) Disc herniation
2) spinal stenosis
3) spondylolisthesis
4) direct trauma
5) irritation during pregnancy
Symptoms of SN
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
RFs of SN
1) age
2) obesity
3) prolonged sitting
4) diabetes
5) inactive lifestyle
Diagnosis of SN
1) X-Ray
2) CT Scan
3) MRI
Treatment of SN
1) physical therapy
2) medications
3) surgery
4) steroid injections
Morton’s Neuroma (MN) definition
compressive neuropathy of the interdigital nerve, usually between third and fourth metatarsals. FEMALES are more affected.
Causes of MN; compression of interdigital nerve due to
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
Symptoms of MN
1) burning pain
2) tingling toes
3) pain worsens with shoes
Steps of EMG test
1) needle electrode inserted into muscle
2) contract and rest muscle as instructed
3) needle records muscle activity during rest and movement.
what does Electromyography (EMG) measure
how well your muscles respond to the movement nerve signals sent from the brain.
How long does an EMG test take
30-60 minutes (W/O time for residual pain treatment)
what does Nerve Conduction Study (NCS) measure
how well the nerves in your body carry the movement electrical signals from your brain to your muscles.
steps of an NCS test
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.
how long does an NCS test take
15-60 minutes, depending o extent of testing.
