Nerves of the Lower Limbs Flashcards
Which nerve roots are responsible for the following movements at the hip joint:
- Medial internal rotation
- Lateral external rotation
- Abduction
- Adduction
- Extension
- Flexion
- 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
Which nerve roots are responsible for the following movements at the subtalar joint:
- Eversion
- Inversion
- Eversion: L5 and S1
- Inversion: L4 and L5
Which nerve roots are responsible for the following movements at the metatarsophalangeal joint:
- Dorsiflexion
- Plantar flexion
- Dorsiflexion: L5 and S1
- Plantar flexion: S1 and S2
Which nerve roots are responsible for the following movements at the knee joint:
- Extension
- Flexion
- Extension: L3 and L4
- Flexion: L5 and S1
Which nerve roots are responsible for the following movements at the ankle joint:
- Dorsiflexion
- Plantar flexion
- Dorsiflexion: L4 and L5
- Plantar flexion: S1 and S2
How many gluteal nerves are there ? What is their names ?
Two
Superficial gluteal nerve and Inferior gluteal nerve
Describe the location and path of the superficial gluteal nerve relative to surrounding structures (including any possible change of name/divisions).
- 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).
What nerve root does the superficial gluteal nerve originate from ? the inferior gluteal nerve ?
Superficial gluteal nerve: L4-S1
Inferior gluteal nerve: L5-S2
Describe the location and path of the inferior gluteal nerve relative to surrounding structures (including any possible change of name/divisions).
- Exits pelvis through infrapiriform space
- Runs deep to gluteus maximus
What structure(s) does the gluteal nerve innervate ?
Inferior gluteal nerve innervates gluteus maximus
When standing on one leg, which muscles are involve in keeping the pelvis level ?
Ipsilateral gluteus medius and minimus
What are possible clinical findings following gluteal nerve injury ?
- 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
What are the nerve roots of the sciatic nerve ?
L4-S3
Describe the location and path of the sciatic nerve relative to surrounding structures (including any possible change of name/divisions).
- 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
Where should intragluteal injections be performed ?
In the superolateral quadrant of the buttock
Which structures does the sciatic nerve provide sensory innervation to ? motor innervation ?
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
What are possible causes of sciatic nerve injury ?
- Compression of the nerve by the muscle (including from muscle spasms) (More common in athletes and women)
- Direct injury/trauma to the nerve itself
What are possible clinical findings following sciatic nerve injury ?
- Loss of extension of the hip
- Weakness in flexion of the leg
What are the nerve roots of the common fibular nerve ?
L4-S2
Describe the location and path of the common fibular nerve relative to surrounding structures (including any possible change of name/divisions).
- 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
What are some possible causes of common fibular nerve injury ?
- Fibular (esp. neck) fracture
- Direct trauma
- Dislocation of the knee join
What are possible clinical findings following common fibular nerve injury ?
- 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)