neuro lower limb specific peripheral nerves Flashcards
what nerve is associated with transverse abdominal and internal oblique muscles?
iliohypogastric nerve
what are the symptoms of iliohypogastric nerve pain?
- burning, lancinating inguinal & suprapubic pain
- inguinal paresthesia (prickling and/or tingling)
- inguinal dysesthesia (itchiness, burning, electric shock) or pain
- pain in outer butt & hip - similar to trochanteric bursitis
- agg by hip ext
- walk flexed (reduce nerve tension)
- no motor deficit
what is the most common cause of Iliohypogastric nerve pain?
surgical procedure
scar tissue /neuroma formation
muscle tear in lower abdomen (trauma/sports)
pregnancy
what is trochanteric bursitis?
inflamation of bursa over greater trochanter
pain at point on hip: initially sharp then ache and spreading across larger area
pain worse at night, when lying on affected side, getting up from chair after sitting, prolonged walking or standing or squatting
m/c middle aged/elderly women
what conditions are associated with trochanteric bursitis?
- overuse- running, climbing stairs, cycling, standing
- hip injury - fall, bump, lying on side for extended time
- scoiliosis
- arthritis of lumbar
- leg length inequality
- rheumatoid arthritis
- surgery
- bone spurs/calcium deposits
what is the most common cause of pudendal nerve injury?
compression, stretching, translation
perineal tear via vaginal birth
pelvic surgery / tumour
viral infection herpes zoster; HIV, MS and DM
what is the motor/sensory presentation of pudendal nerve injury?
sensory > motor
pain, numbness, dysfunction inc genitals, rectum, terminal urinary tract
sexual dysfunction (persistent arousal/dyspareunia)
sphincter dysfunction: difficulty with bladder & bowel fctn
foreign body sensation in anus/vag/urethra /
what structures does the sensory branch of ilioinguinal nerve supply?
pubic symphysis; femoral triangle, root of penis /anterior scrotum or mons pubis/labia majora
skin along inguinal ligament
what is the most common cause of ilioinguinal nerve injury?
lower abdominal incision - preg, femoral catheter; inguinal hernia
hip OA
heavy weightlifting
renal /retroperitoneal pathology
What are the signs and symptoms of ilioinguinal nerve injury?
- inguinal and/or hip pain
- Pain ++ with inc abdominal wall tension (inc standing straight)
- inguinal pain (pressure anterior to ASIS)
- hyperesthesia / dysesthesia along inguinal lig
- abdominal muscle atrophy/weakness
- difficulty rising from supine
- protrusion of abdomen above inguinal lig during abd contraction
What are the physical symptoms of ilioinguinal nerve injury?
- hyperesthesia
/hypoesthesia of skin along inguinal lig - may radiate to lower abdomen - pain maybe localized to medial groin / labia majora/ scrotum / inner thigh
- tender to pressure where nerve exits inguinal canal
-++ pain with hip ext - walking forward flexed (to relieve nerve tension)
- pain repro palpating medial to ASIS
what are the symptoms of lateral femoral cutaneous nerve injury aka meralgia paresthetica?
- anterior & lateral thigh burning, tingling, and/or numbness
- ++ with standing, walking, hip ext, lying prone
- usually unilateral
- improves with sitting unless compressive forces (belts, garments) etc
What are the signs and symptoms of lateral femoral cutaneous nerve injury?
- hyperesthesia over lateral thigh
- prod with pressure medial to ASIS (over inguinal lig)
- positive Tinel’s over ASIS or inguinal ligament
- standing hip ext may repro symptoms
- no motor
Describe symptoms of meralgia paresthetica.
- anterolateral thigh pain
- paresthesia and tingling
- sensitive to clothing contact and leg extension
- +ve reverse SLR
-trophic skin changes over distribution - focal pressure on inguinal ligament may inc symptoms
- no motor signs
who is most likely to be affected by meralgia paresthetica?
midldle aged males
- inc with diabetes
