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MD2002 Arvin > Nerves of the Lower Limbs > Flashcards

Nerves of the Lower Limbs Flashcards

1
Q

Which nerve roots are responsible for the following movements at the hip joint:

  • Medial internal rotation
  • Lateral external rotation
  • Abduction
  • Adduction
  • Extension
  • Flexion
A
  • Medial internal rotation: L1, L2, L3
  • Lateral external rotation: L1 and L5
  • Abduction: S1 and L5
  • Adduction: L1, L2, L3, L4
  • Extension: L4 and L5
  • Flexion: L2 and L3
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2
Q

Which nerve roots are responsible for the following movements at the subtalar joint:

  • Eversion
  • Inversion
A
  • Eversion: L5 and S1

- Inversion: L4 and L5

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3
Q

Which nerve roots are responsible for the following movements at the metatarsophalangeal joint:

  • Dorsiflexion
  • Plantar flexion
A
  • Dorsiflexion: L5 and S1

- Plantar flexion: S1 and S2

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4
Q

Which nerve roots are responsible for the following movements at the knee joint:

  • Extension
  • Flexion
A
  • Extension: L3 and L4

- Flexion: L5 and S1

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5
Q

Which nerve roots are responsible for the following movements at the ankle joint:

  • Dorsiflexion
  • Plantar flexion
A
  • Dorsiflexion: L4 and L5

- Plantar flexion: S1 and S2

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6
Q

How many gluteal nerves are there ? What is their names ?

A

Two

Superficial gluteal nerve and Inferior gluteal nerve

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7
Q

Describe the location and path of the superficial gluteal nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Exits pelvis through suprapiriform space
  • Runs laterally between the gluteus medius and minimus
  • Splits into a superior branch (gluteus medius) and an inferior branch (gluteus minimus and tensor fasciae latae).
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8
Q

What nerve root does the superficial gluteal nerve originate from ? the inferior gluteal nerve ?

A

Superficial gluteal nerve: L4-S1

Inferior gluteal nerve: L5-S2

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9
Q

Describe the location and path of the inferior gluteal nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Exits pelvis through infrapiriform space

- Runs deep to gluteus maximus

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10
Q

What structure(s) does the gluteal nerve innervate ?

A

Inferior gluteal nerve innervates gluteus maximus

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11
Q

When standing on one leg, which muscles are involve in keeping the pelvis level ?

A

Ipsilateral gluteus medius and minimus

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12
Q

What are possible clinical findings following gluteal nerve injury ?

A
  • Abduction of the thigh is affected
  • Pelvis drops at the unaffected side
    - Positive Trendelenburg test: Patients compensate for this by producing a waddling gait by raising the pelvis to allow clearance of the foot moving forward.
  • Medial rotation of the thigh is affected
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13
Q

What are the nerve roots of the sciatic nerve ?

A

L4-S3

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14
Q

Describe the location and path of the sciatic nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Exits pelvis through infrapiriform space
  • Runs deep to gluteus maximus, midway between the ischial tuberosity and the greater trochanter
  • In 12% of the population, branches into the tibial and common fibular nerves upon exit from the pelvis
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15
Q

Where should intragluteal injections be performed ?

A

In the superolateral quadrant of the buttock

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16
Q

Which structures does the sciatic nerve provide sensory innervation to ? motor innervation ?

A

SENSORY
- Hip joint

MOTOR (Muscles in the posterior compartment of the thigh)

  • Short head of biceps from common fibular division
  • Rest of the hamstrings from tibial division
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17
Q

What are possible causes of sciatic nerve injury ?

A
  • Compression of the nerve by the muscle (including from muscle spasms) (More common in athletes and women)
  • Direct injury/trauma to the nerve itself
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18
Q

What are possible clinical findings following sciatic nerve injury ?

A
  • Loss of extension of the hip

- Weakness in flexion of the leg

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19
Q

What are the nerve roots of the common fibular nerve ?

A

L4-S2

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20
Q

Describe the location and path of the common fibular nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Originates at apex of popliteal fossa (as a continuation of sciatic nerve)
  • Runs inferiorly and laterally following the medial border of the biceps
  • Passes over the lateral head of the gastrocnemius
  • Gives off lateral sural cutaneous branch (sensory)
  • Winds around the neck of the fibula
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21
Q

What are some possible causes of common fibular nerve injury ?

A
  • Fibular (esp. neck) fracture
  • Direct trauma
  • Dislocation of the knee join
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22
Q

What are possible clinical findings following common fibular nerve injury ?

A
  • Signs and symptoms of deep fibular nerve injury
  • Signs and symptoms of superficial fibular nerve injury
  • Possible paresthesia in lateral aspect of knee, anterolateral aspect of leg (depending on level)
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23
Q

Which structures does the common fibular nerve provide sensory innervation to ? motor innervation ?

A

SENSORY

  • Skin over upper lateral and lower posterolateral leg directly.
  • (via branches) Skin of the anterolateral leg,
  • (via branches) Dorsum of the foot

MOTOR

  • Short head of the biceps femoris directly.
  • (via branches) muscles in lateral and anterior compartments of leg
24
Q

What are the nerve roots of the deep fibular nerve ?

25
Q

Describe the location and path of the deep fibular nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Arises between fibularis longus and neck of fibula
  • Passes between tibialis anterior and extensor digitorum longus, descending down the interosseous membrane, accompanied by anterior tibial artery
  • Enters the dorsum of the foot passing under the extensor retinaculum
  • Gives rise to DORSAL DIGITAL NERVE to toes 1-2
26
Q

Which structures does the deep fibular nerve provide sensory innervation to ? motor innervation ?

A

SENSORY

  • Ankle joint
  • Web space between the 1st and 2nd toes

MOTOR (muscles in the anterior compartment of the leg)

  • Tibialis anterior
  • Extensor hallucis longus
  • Extensor digitorum longus
  • Fibularis tertius
  • Extensor digitorum brevis - Extensor hallucis brevis
27
Q

What are some possible causes of deep fibular nerve injury ?

A
  • Tight fitting shoes (e.g. ski-boot syndrome)

- Compartment syndrome (nerve entrapment, because “pressure within the muscles builds”)

28
Q

What are possible clinical findings following deep fibular nerve injury ?

A
  1. Paresthesia/anesthesia between the 1st and 2nd toes
  2. Weakness in/Loss of function of muscles in anterior
    compartment of the leg
    If loss of extension of ankle –> Foot-drop+inverted –> Slap gait/Steppage gait
  3. Pain in the anterior compartment of the leg
29
Q

What are the nerve roots of the superficial fibular nerve ?

30
Q

Which of anterior, posterior lateral compartment of the leg is deep fibular nerve territory ? superficial nerve territory ? tibial nerve territory ?

A

Anterior compartment is deep fibular nerve territory

Lateral compartment is superficial fibular nerve territory

Posterior compartment is tibial nerve territory

31
Q

Describe the location and path of the superficial fibular nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Arises between fibularis longus and neck of fibula
  • Descends in lateral compartment of the leg
  • At distal 1/3 of leg, emerges from the deep fascia
    - Gives rise to CUTANEOUS BRANCHES and DORSAL DIGITAL NERVES to 2nd-5th toes along its course.
32
Q

Which structures does the superficial fibular nerve provide sensory innervation to ? motor innervation ?

A

SENSORY

  • Ankle joint
  • Skin on anterior distal leg
  • Skin on dorsum of foot

MOTOR (muscles in the lateral compartment of the thigh)

  • Fibularis longus
  • Fibularis brevis
33
Q

What are some possible causes of superficial fibular nerve injury ?

A
  • Chronic ankle sprains –> Stretching of the nerve

- Direct injury

34
Q

What are possible clinical findings following superficial fibular nerve injury ?

A
  1. Paresthesia/anaesthesia along antero-lateral side of leg and dorsum of ankle and foot.
  2. Loss of function of muscles in lateral compartment of the leg –> Loss of eversion
35
Q

What are the nerve roots of the tibial nerve ?

36
Q

Describe the location and path of the tibial nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Arises from the SCIATIC NERVE at the apex of the popliteal fossa
  • Postero-lateral to the popliteal vessels
  • Gives off MEDIAL SURAL CUTANEOUS branch (sensory)
  • Leave poplitea on popliteus muscle
  • Passes under the tendinous arch of soleus and descends between superficial and deep flexors towards medial malleolus
  • Passes into the sole behind medial malleolus, deep to the flexor retinaculum
  • Divides into the MEDIAL AND LATERAL PLANTAR NERVES
37
Q

Which structures does the tibial nerve provide sensory innervation to ? motor innervation ?

A

SENSORY

  • Ankle joint
  • Skin of the heel

MOTOR (muscles in the superficial and deep posterior compartments of the leg)

  • Plantaris
  • Popliteus
  • Gastrocnemius
  • Soleus
  • Tibialis posterior
  • Flexor hallucis longus
  • Flexor digitorum longus
38
Q

Which structures does the medial plantar nerve provide sensory innervation to ? motor innervation ?

A

SENSORY

  • Anterior two-thirds of the sole
  • Adjacent surfaces of the medial 3.5 toes

MOTOR

  • Abductor hallucis
  • Flexor digitorum brevis
  • Flexor hallucis brevis
  • Lumbrical 1
39
Q

Which structures does the lateral plantar nerve provide sensory innervation to ? motor innervation ?

A

SENSORY

  • Skin on the lateral side of the anterior two-thirds of the sole
  • Adjacent plantar surfaces of the lateral 1.5 digits

MOTOR
-All plantar muscles other than those supplied by medial plantar nerve

40
Q

What nerves do the lateral and medial plantar nerves give rise to ?

A

Plantar digital nerves

41
Q

Why is injury to the tibial nerve rare ?

A

Because of its deep position

42
Q

What are possible clinical findings following tibial nerve injury ?

A
  1. Loss of ankle and digit plantarflexion

2. Loss of sensation to the sole

43
Q

Describe the location and path of the sural nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Formed by lateral cutaneous sural branch from the common fibular nerve and medial cutaneous sural branch from the tibial nerve
44
Q

What is the clinical significance of the sural nerve ?

A

May be used as nerve graft

45
Q

Which structures does the sural nerve provide sensory innervation to ? motor innervation to ?

A

PURELY SENSORY!

  • Skin on the lower posterolateral surface of the leg
  • Skin on lateral side of the foot and little toe
46
Q

What are the nerve roots of the femoral nerve ?

47
Q

Describe the location and path of the femoral nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Travels anteriorly- inferiorly between iliacus and psoas major towards retro-inguinal space
  • Passes through muscular compartment with iliopsoas and enters the thigh
  • Gives off MUSCULAR, ANTERIOR CUTANEOUS FEMORAL and SAPHENOUS branches
48
Q

Which structures does the femoral nerve provide sensory innervation to ? motor innervation ?

A 
SENSORY
- Hip joint
- Knee joint
- Skin on the anterior surface of the
thigh by anterior cutaneous femoral branch

MOTOR (muscles in the anterior compartment of the thigh)

  • Quadriceps femoris
  • Sartorius
  • Pectineus
  • Iliacus
49
Q

What are the nerve roots of the saphenous nerve ?

50
Q

Describe the location and path of the saphenous nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Enters the adductor canal with femoral artery
  • Pierces lamina vastoadductoria and becomes superficial between the sartorius and gracilis
    - Accompanies the greater saphenous vein in the leg
51
Q

Which structures does the saphenous nerve provide sensory innervation to ? motor innervation ?

A

SENSORY

  • Skin on the medial surface of the knee
  • Anteromedial surface of leg
  • Medial malleolus
52
Q

What nerve may be at risk in venous access or varicose vein surgery ?

A

Saphenous nerve

53
Q

What are the nerve roots of the obturator nerve ?

54
Q

Describe the location and path of the obturator nerve relative to surrounding structures (including any possible change of name/divisions).

A
  • Travels anteriorly on lateral pelvic wall towards obturator canal
  • Passes through obturator canal and enters the medial aspect of the thigh
55
Q

Which structures does the obturator nerve provide sensory innervation to ? motor innervation ?

A

SENSORY

  • Hip joint
  • Knee joint
  • Upper half of medial thigh

MOTOR (muscles in the medial compartment of the thigh)

  • Adductor magnus
  • Adductor longus
  • Adductor brevis
  • Gracilis
  • Obturator externus
56
Q

What are some possible causes of obturator nerve injury ?

A
  • Patient positioning during total hip replacement
  • Pelvic trauma
  • Very strenuous exercise (excessively tight muscles)
57
Q

What are possible clinical findings following obturator nerve injury ?

A
  • Paraesthesia or pain in the medial thigh, groin or pubic bone
  • Weakness in/loss of adduction of the thigh

MD2002 Arvin (110 decks)

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