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MSK 2023 > Nerve injuries to lower limb > Flashcards

Nerve injuries to lower limb Flashcards

1
Q

What is spinal cord injury known as?

A

Myelopathy (affects spinal levels resulting in neural level)

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2
Q

What is spinal nerve root injury known as?

A

Radiculopathy (affects dermatomes and myotomes specific to root)

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3
Q

What is peripheral nerve injury known as?

A

Peripheral Neuropathy (loss of specific peripheral nerve function)

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4
Q

Types of injury (4S’s)

A

Stretched (traction)
Squashed (compression)
Severed (laceration)
Stressed (by medical conditions eg diabetes)

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5
Q

How do we class nerve injuries in terms of their severity?

A

Seddon Classification

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6
Q

Class 1 seddon

A

Neuropraxia

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7
Q

What occurs in Neuropraxia?

A

Temporary block of conduction
No disruption/degeneration of nerve structure
Full recovery in days/weeks

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8
Q

Class 2 seddon

A

Axonotmesis (axons divided)

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9
Q

What occurs in axonotmesis?

A

Disruption to axon and myelin sheath
Epineurium, perineurium and endoneurium still INTACT

Degeneration distal to injury

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10
Q

Outcomes axonotmesis?

A 
Axonal regeneration (1-3mm per day)
No surgical intervention 
Variable recovery (depending on length apart of axons)
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11
Q

Class 3 seddon

A

Neurotmesis (nerve divided)

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12
Q

What occurs in neurotmesis?

A

Partial/full disruption of nerve structure
Epi/peri/endoneurium not intact

Degeneration distal to site

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13
Q

Outcomes neurotmesis?

A

Scar tissue forms
Surgery needed ALWAYS
Variable prognosis (full loss/recovery)

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14
Q

Femoral nerve damage causes

A

Uncommon
Direct trauma from hip fracture?
Iatrogenic (hip replacement)
Nerve blocks (treatment)

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15
Q

Sensory function femoral nerve

A 
Anteriomedial thigh (anterior femoral cutaneous nerve)
Medial leg (saphenous nerve)
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16
Q

Motor function femoral nerve

A

Supplies anterior muscles of thigh
Hip flexion weakened (psoas major still can work)
Knee extension absent (quadriceps gone)

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17
Q

How can damage to sciatic nerve occur?

A

Compression in gluteal region (piriformis syndrome)
Iatrogenic (IM injections)
Direct trauma (posterior hip dislocation)

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18
Q

Sensory function sciatic nerve

A

Branches into common fibular (then superficial and deep) and tibial nerve

19
Q

Motor function sciatic nerve

A

Posterior thigh

Knee flexion absent (sartorius and gracilis not strong enough alone)

Loss of ankle dorsiflexion/plantarflexion, eversion and inversion of foot, flexion and extension of toes

Hip extension intact (gluteus maximus intact)

20
Q

Superior gluteal nerve injury sign

A

Trendelenburg sign
SOUND SIDE SAGS

(loss of innervation to gluteus medius and minimus)

21
Q

How can tibial nerve be damaged?

A 
Popliteal fossa location:
Aneurysm of popliteal artery
Popliteal (baker's) cyst
Iatrogenic (knee surgery)
Direct trauma behind knee

Medial malleolar fracture
Compression of tarsal tunnel

22
Q

Sensory function tibial nerve

A

Sole of foot (medial and lateral plantar nerve)

Heel (medial calcaneal)

23
Q

Motor function of tibial nerve

A

Posterior compartment of leg
No plantarflexion/toe flexion
Inversion weakened (but still works as tibialis anterior)

24
Q

Proximal vs distal tibial injury

A

If proximal posterior leg affected

If distal eg medial malleolus only toe flexion really weakened (muscle already have supply)

25
Q

Common fibular nerve how can it be damaged?

A

Close proximity to fibula neck (fibula fracture)

Compression from plaster cast

26
Q

Sensory function common fibular

A

Proximal lateral

Then divides to deep and superficial

27
Q

Motor function of common fibular (and if damaged)

A

Superficial and deep fibular nerve affected
No dorsiflexion (from anterior compartment)
= foot drop

28
Q

How can superficial fibular nerve be damaged?

A

Direct trauma (fracture/penetration injury)
Iatrogenic (ankle surgery laterally)
Deficit from common fibular

29
Q

Sensory function superficial fibular nerve

A

Anterolateral leg

Dorsum of foot (not first webbed space or medial and lateral borders)

30
Q

Motor function superficial fibular (and if damaged)

A

Lateral leg compartment

= No eversion

31
Q

How can deep fibular nerve be damaged?

A

Mononeuropathy from medical conditions
eg diabetes, motor neurone disease, vasculitis

Deficit from common fibular

32
Q

Sensory function deep fibular nerve

A

1st webbed space on dorsum of foot

33
Q

Motor function deep fibular nerve (and if damaged)

A

Anterior leg
No dorsiflexion (foot drop)
No toe extension

34
Q

Sensory nerves (JUST sensory)

A

Lateral femoral cutaneous
Sural
Saphenous

35
Q

Lateral femoral cutaneous supplies (sensory)

A

Anterolateral thigh (worse when walking if injured)

36
Q

How can lateral femoral cutaneous be injured?

A

Compression (meralgia paraesthetica)

tight clothing, belts, pregnancy, obesity

37
Q

Sural nerve supplies (sensory only)

A

From tibial and common fibular branches
Lateral ankle/foot
Posterior leg

38
Q

Key features sural nerve

A

Close proximity to small saphenous vein

Can be used for nerve grafts

39
Q

Saphenous nerve supplies (sensory only)

A

Branch of femoral nerve
Medial leg
Medial border of foot

40
Q

How can saphenous nerve be damaged?

A

Iatrogenic:
Close proximity to great saphenous vein (bypass)
Surgery (distal tibia/medial malleolus)

41
Q

Wallerian degeneration

A

axons distal to injury degenerate

macrophages and schwann cells phagocytose debris

42
Q

What do schwann cells do during wallerian degenration

A

Proliferate
Form lines of cells: Bands of Bunger
(muscle is denervated currently and undergos atrophy)

43
Q

What happens if severed ends are not surgically apposed?

A

Sprouting of axons from severed end
Form traumatic neuroma
= Painful

MSK 2023 (55 decks)

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