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Anatomy MSK > Nerves Of Lower Limb > Flashcards

Nerves Of Lower Limb Flashcards

1
Q

Main nerves of lumbar plexus are?

A
  • i(twice) get laid on Friday*
    1) Iliohypogastric
    2) Ilioinguinal
    3) Genetofemoral
    4) Femoral nerve *
    5) Obturator nerve *
    6) Lateral femoral cutaneous
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2
Q

Main nerves of sacral plexus are ?

A

1) Superior gluteal nerve.
2) Inferior gluteal nerve
3) Pudendal nerve.
4) Sciatic nerve

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3
Q

Sciatic nerve which terminates in —————— into:

A

(popliteal fossa )

a. Tibial nerve.
b. Common peroneal nerve.

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4
Q

LUMBAR Plexus include L?

A

(L1, L2, L3 & L4)

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5
Q

LUMBAR Plexus Is a network of nerve fibers that supplies————

A

skin

and musculature of lower limb.

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6
Q

LUMBAR Plexus Is located in——— region, within
the substance of ——— muscle and
anterior to————-

A

-lumbar
-psoas major
-transverse processes of
the lumbar vertebrae.

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7
Q

LUMBAR Plexus Is formed by——— (divisions) of

lumbar spinal nerves L1, L2, L3 and L4.

A

anterior rami

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8
Q

LUMBAR Plexus Receives contributions from?

A

thoracic spinal

nerve T12.

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9
Q

L2, L3

A

Lateral Cutaneous Nerve of the Thigh

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10
Q

Lateral Cutaneous Nerve of the Thigh function ——— innervate——

A

purely sensory
1) Anterior and lateral thigh down to level
of the knee.
2)Lower lateral quadrant of gluteal region

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11
Q

Lateral Cutaneous Nerve of the Thigh Enters the thigh at——————— Divides into——-

A

-at lateral aspect of
inguinal ligament
-Divides into anterior and posterior
branches.

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12
Q

INJURY OF LATERAL CUTANEOUS NERVE OF THIGH L2,3

A

Compression or inflammation

Sharp pain in the course of distribution.

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13
Q

OBTURATOR NERVE:
L?
Nerve of ?

A

L2, L3, L4

medial compartment of the thigh

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14
Q

Obturator nerve after it’s formation descends through ——- and emerge from its——-then ——-

A 
Psoas major
Medial border
(Travel post. To common iliac arteries and
Laterally along pelvic wall 
Toward obturator foramen)
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15
Q

Obturator nerve have two devision

A

Anterior and poterior

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16
Q

Anterior devision of obturator nerve Descends between

A

Adductor
longus and
adductor brevis (towards
femoral artery).

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17
Q

Obturator nerve between adductor

longus and adductor brevis supplies

A

motor fibres to
adductor longus,
adductor brevis
gracilis.

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18
Q

In rare cases, anterior obturator nerve can supply

A

pectineus muscle.

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19
Q

Anterior division of Obturator nerve can pierces———— to become
cutaneous branch of the obturator
nerve.
And function as ——

A

deep fascia

Sensory

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20
Q

Posterior division of obturator nerve passes through————— and
then travels anteriorly
to reach

A

-obturator
externus muscle
-adductor
magnus.

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21
Q

Posterior division of obturator nerve innervates

A

obturator externus
adductor magnus
muscles.

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22
Q

What is the causes of OBTURATOR NERVE INJURY

A

1) Penetrating wounds
2) Anterior dislocation of hip joint
3) during surgery involving pelvis/abdomen

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23
Q

What will result from obturator nerve injury?

A

1) muscle paralyzed
2) motor loss
3) sensory loss

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24
Q

Which muscles are paralyzed in obturator nerve injury ?

A 
All adductor
muscles except
for hamstring
part of
adductor
magnus.
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25
Q

obturator nerve injury *motor loss

A

-loss of addiction of thigh

Result in posture and gait problem

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26
Q

obturator nerve injury *sensory loss

A

-medial side of thigh
-hip and knee joints
Result in numbness and parasthesia on medial aspect of thigh

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27
Q

Obturator nerve block is used in

A

management of
pain after lower limb surgery
or for chronic hip pain.

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28
Q

Obturator nerve block procedure can be carried out under

A

Ultrasound

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29
Q

Obturator nerve block procedure

A

Anaesthetic is injected inferior
to the pubic tubercle and
lateral to the tendon of
adductor longus muscle.

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30
Q

Largest branch of lumbar plexus

A

Femoral nerve

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31
Q

FEMORAL NERVE
L?
Nerve of which compartment of the thigh?

A

(L2, L3 & L4)

Anterior

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32
Q

FEMORAL NERVE arise in ——-

A

-abdomen

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33
Q

FEMORAL NERVE Travels inferiorly through ——- muscle of the——- abdominal wall.

A

psoas major

posterior

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34
Q

FEMORAL NERVE Supplies branches to ————— prior to entering the thigh

A

iliacus and pectineus muscles

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35
Q

Femoral nerve Enters thigh behind inguinal ligament into

A

Femoral Triangle

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36
Q

FEMORAL NERVE anterior division

*muscular

A

Branches to sartouris

Branches to pectineus

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37
Q

FEMORAL NERVE anterior division

*cutaneous

A

Medial and intermediate cutaneous nerve of thigh

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38
Q

FEMORAL NERVE posterior division

*muscular (motor)

A

quadriceps femoris

And articular hip and knee joint

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39
Q

FEMORAL NERVE posterior division

*cutanous (sensory)

A

Saphenous nerve

-skin of Anteromedial surface of leg, medial border of foot.

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40
Q

FEMORAL NERVE travels through ————l (accompanied by the femoral artery and vein) and exits
prior to the———-

A

adductor canal

adductor hiatus.

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41
Q

Terminal cutaneous branch of femoral nerve is the

A

saphenous nerve.

42
Q

Clinical Relevance of femoral nerve

A

Stripping of the Saphenous Vein

FEMORAL NERVE BLOCK

43
Q

Saphenous vein is often stripped in

individuals with

A

problematic varicose veins

or for coronary bypass.

44
Q

Long (Great) saphenous vein is accompanied

in its course by

A

saphenous nerve.

45
Q

Damage to saphenous nerve during Stripping of the Saphenous Vein
can lead to

A

pain,
paraesthesia or
complete loss of sensation the medial side of
the lower leg.

46
Q

Femoral nerve block (in combination
with a sciatic nerve block) may be
indicated in patients requiring

A 
1) lower
limb surgery who cannot tolerate
a general anaesthetic. 
2) peri- and post-operative analgesia for
patients with a fractured neck of femur
who cannot tolerate particular
analgesics.
47
Q

FEMORAL NERVE INJURY

Causes

A

1) Complete division is
rare.
2)Injured by stab or gunshot
wound.

48
Q

FEMORAL NERVE INJURY

  • muscles paralyzed
  • motor loss
A
  • Quadriceps femoris.

* loss of knee extension

49
Q

*sensory loss of femoral nerve injury

A 
1)On anterior and medial aspect of
thigh.
2)Medial side of lower leg.
3)Medial border
of foot
4)Patellar plexus 
5)Hip & knee joints
50
Q

lumbosacral plexopathy is a disorder affecting —— caused by

A

lumbar or sacral plexus of nerves.

damage to the nerve bundles.

51
Q

plexopathy is suspected if the

A

symptoms cannot be localized to a single nerve.

52
Q

Patients with plexopathy may complain of

A

neuropathic pains, numbness or weakness and wasting of muscles.

53
Q

The Sacral Plexus Is a network of nerve fibers that supplies

A

skin

and muscles of the pelvis and lower limb.

54
Q

The Sacral Plexus

Located

A

posterior pelvic wall

anterior to piriformis muscle.

55
Q 
The Sacral Plexus
Is formed by the——— rami (divisions) of
• Lumbar spinal nerves———— 
 AND
 • Sacral spinal nerves—|—-
A
  • anterior
  • L4 and L5
  • S1, S2, S3 and S4
56
Q

five major peripheral nerves of the sacral plexus,
Leave the pelvis via;
And enter——-

A

via greater sciatic foramen

• these nerves enter gluteal region of the lower limb

57
Q

five major peripheral nerves of the sacral plexus,

Remain in the pelvis innervate

A

pelvic muscles, organs and perineum.

58
Q

Superior Gluteal Nerve

L?

A

L4, L5, S1

59
Q

T/F

Superior gluteal nerve have no sensory function

A

T

60
Q

Superior Gluteal Nerve Leaves pelvis via——————, entering————-
superiorly to————-

A

greater sciatic foramen

gluteal region

piriformis muscle.

61
Q

Superior Gluteal Nerve Runs between

A

gluteus medius and minimus.

62
Q

Superior Gluteal Nerve Is accompanied by

A

superior gluteal artery and vein

63
Q

Superior Gluteal Nerve

  • motor function
    1) Gluteus minimus
A

in concert with gluteus medius
• Abduction of the hip; preventing adduction of the hip.
.Medial rotation of thigh

64
Q

Superior Gluteal Nerve

  • motor function
    2) Gluteus medius
A
  • primer abductor
  • Anterior part (abducts, assists flexion and medial rotation of hip)
  • Posterior part (abducts, assists in ext and lateral rotation of hip)
65
Q

Superior Gluteal Nerve

  • motor function
    3) tensor fascia lata
A

Hip - flexion, medial rotation, abduction,

Knee - lateral rotation, Torso - stabilization

66
Q

INJURY TO SUPERIOR GLUTEAL NERVE

  • muscle paralyzed
  • motor loss
A

Gluteus medius • Gluteus minimus
Loss of abduction
of hip

67
Q

INJURY TO SUPERIOR GLUTEAL NERVE

1) unilateral
2) bilateral

A

1) unilateral shows lipping gait and gait and positive Trendelenburg’s sign i.e. Drooping of pelvis on one side when ipsilateral foot is lifted off the ground.
2) Bilateral injury shows waddling gait

68
Q

Positive Trendelenburg’s sign

A 
Paralysis of the left superior
gluteal nerve leads to paralysis of
left gluteus medius and minimus
muscle.
-right unsupported side of the pelvis drops, causing the inability
to the wall with the right foot.
69
Q

INFERIOR GLUTEAL NERVE
L?
Enter gluteal region from pelvis through———- inferiorly to ———-

A

L5-S2
greater sciatic foramen
piriformis muscle.

70
Q

INFERIOR GLUTEAL NERVE run between

A

gluteus maximus and medius.

71
Q

T/F

INFERIOR GLUTEAL NERVE have no sensory function

A

T

72
Q

INFERIOR GLUTEAL NERVE
Muscle innervate?
Function

A

Gluteus maximus (
extend and laterally rotate the hip joint;
the upper fibers can abduct the hip whereas
the lower fibers can adduct)

73
Q

when there is radiating pain in the back of the lower limb called———-, It may be due to a ———-

A

Sciatica

slipped disc.

74
Q

90% cases involve common peroneal injury due to

A

superficial positions

75
Q

INJURY TO SCIATIC NERVe causes;

A 
Dislocation of hip joint..
Piriformis syndrome(deep gluteal syndrome)
I.V disc prolapse 
IM injection
Penetrating wound and fracture of pelvis
76
Q

INJURY TO SCIATIC NERVE

Sensory deficit

A

sural nerve cutaneous brs of medial & lateral plantar nerves proprioception to knee, ankle & toe joints

77
Q

INJURY TO SCIATIC NERVE
Motor dysfunction?
Test by?

A

Posterior (flexor) compartments of leg and foot test by asking patient to ‘walk on their toes’

78
Q

Sciatic Nerve – Clinical Relevance: Intramuscular Injections

Sciatic nerve passes through the——-

A

lower medial

quadrant.

79
Q

• To avoid damaging the sciatic nerve and other nerves
and vessels therefore, intramuscular injections are given
only in the

A

upper lateral quadrant of the gluteal region.

80
Q

Piriformis Syndrome

. • It is also known as deep gluteal syndrome.

A

compression of sciatic nerve by

piriformis muscle.

81
Q

Clinical features of piriformis syndrome include?

And pain can occasionally be exacerbated by?

A

radicular pain, numbness, muscle
weakness and buttock tenderness
. • internal rotation
of the lower limb at the hip.

82
Q

Sciatic nerve lies on ———and

—-.

A

quadratus femoris

adductor Magnus

83
Q

Sleeping foot

A

nerve gets pressed between the femur

and the hard edge of the table, chair, or bed.

84
Q

Posterior Femoral Cutaneous:

A

S1, S2, S3

85
Q

Posterior Femoral Cutaneous

Leaves the pelvis via ———
entering the gluteal region——— to the
piriformis muscle. 
• Descends deep to the ———- and runs
down the back of the thigh to knee.
A

greater sciatic foramen,

inferiorly

gluteus maximus

86
Q

Posterior Femoral Cutaneous:

Motor Functions:
• Sensory Functions:

A

None

• Innervates skin on posterior surface of the
thigh and leg.
• Also innervates skin of the perineum.

87
Q

Tibial Nerve

Arises at the——-,giving off branches to
muscles in the——
During its descent, it supplies?

A

L4-S3

apex of the popliteal fossa.

superficial posterior compartment of
the leg.

all deep muscles of the
posterior leg.

88
Q

tibial nerve also gives rise to branches that

contribute towards?

A

sural nerve, which innervates

posterolateral aspect of the leg.

89
Q

At the foot, the tibial nerve passes
posteriorly and inferiorly to the———-, through a structure known
as————-

A

medial malleolus

tarsal tunnel.

90
Q

This tunnel is covered superiorly by
—————-•
Within this tunnel, branches arise from tibial nerve to supply?

A

flexor retinaculum.

cutaneous innervation to the heel

91
Q

distal to tarsal tunnel,

tibial nerve terminates by dividing into

A

sensory branches, which innervate

sole of the foot.

92
Q

tibial nerve gives off cutaneous

branches in?

A

the popliteal fossa

93
Q

In the popliteal fossa, tibial nerve gives off cutaneous

branches. • These combine with branches from ————-to form the———-

A

common fibular nerve

Sural nerve

94
Q

Tibial nerve also supplies all the sole of the foot via three
branches:

A

Medial calcaneal branches:

Medial plantar nerve

Lateral plantar nerve

95
Q

Medial calcaneal branches: Arise within the?

innervate?

A

tarsal tunnel,

skin over the heel.

96
Q

Medial plantar nerve: Innervates

A

plantar surface of
medial three and a half digits, and the associated sole
area.

97
Q

Lateral plantar nerve

A

Innervates plantar surface of
lateral one and a half digits, and the associated sole
area.

98
Q

Tibial Nerve – Clinical Relevance: Tarsal Tunnel Syndrome

A 
tibial nerve is compressed within
tarsal tunnel (posterior to the medial malleolus).
99
Q

Tarsal Tunnel Syndrome

causes, of which the main three are

A
  • Osteoarthritis
  • Rheumatoid arthritis
  • Post-trauma ankle deformities
100
Q

Damage to tibial nerve result in sensory loss of

A
  • sural nerve
  • cutaneous brs of medial & lateral plantar nerves
  • knee, ankle & toe joints
101
Q

The Common Fibular Nerve -

A

L4 – S2

102
Q

Superficial fibular
• Innervates ——— of the leg
• Deep fibular nerves.Innervates muscles of——

A 
muscles of lateral compartment 
dorsum of
the foot (except the skin between the first and second toes)

anterior compartment of the
leg(skin between the first and second toes.)

Anatomy MSK (10 decks)

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