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Limbs > Neurology of the Lower Limb > Flashcards

Neurology of the Lower Limb Flashcards

1
Q

What can you test

A

Spinal roots

  • Dermatomes
  • Myotomes (harder to test, muscles innervated by more than 1 root)

Peripheral nerves

  • Cutaneous branches
  • Motor branches
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2
Q

Name the 6 main lower limb nerves

A

Superior, inferior gluteal (no cutaneous)

Femoral
Obturator
Sciatic
-Common fibular (superficial and deep)
-Tibial (plantar)
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3
Q

Describe the regions covered by the lower limb dermatomes and where you can test each root

How would you test each dermatome

A 
L1, inguinal region
L2, upper ant thigh
L3, lower ant thigh and knee
L4, medial leg, big toe
L5, lateral leg, 3rd toe
S1, little toe
S2, post thigh, popliteal fossa
S3, gluteal region
S4, anal canal

Pin prick

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4
Q

Where is the cutaneous innervation of the subcostal (T12), ilioinguinal (L1), genitofemoral (L1-2)

A

Subcostal, lateral of inguinal region
Genitofemoral, medial of inguinal region, ant scrotum, labia major
Ilioinguinal, groin area

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5
Q

Where is the cutaneous innervation of the lateral femoral (L2-3)

A

Lateral thigh

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6
Q

Where is the cutaneous innervation of the anterior and intermediate cutaneous nerve from the femoral (L2-3)

A

Anterior, medial thigh

Anterior medial leg

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7
Q

Where is the cutaneous innervation of the lateral sural from the common fibular (L4-5)

A

Lateral upper leg

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8
Q

Where is the cutaneous innervation of the superficial fibular (L5-S1)

A

Dorsal side of foot minus 1st webbing

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9
Q

Where is the cutaneous innervation of the clonal nerves

A

Gluteal region

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10
Q

Where is the cutaneous innervation of the posterior femoral cutaneous (S2-3)

A

Posterior medial thigh and popliteal region

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11
Q

Where is the cutaneous innervation of the obturator (L2-3)

A

Medial posterior lower and upper thigh

V small space, generally not tested

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12
Q

Where is the cutaneous innervation of the saphenous (L4), branch of the femoral

A

Medial strip of posterior thigh and medial side of foot

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13
Q

Where is the cutaneous innervation of the calcaneal branch of the tibial (S2-3)

A

Back and plantar surface of heel

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14
Q

Where is the cutaneous innervation of the sural nerve (S1)

A

Lateral side of foot and lateral posterior of leg

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15
Q

What are the lower limb myotomes for
hip flexion
hip extension

A

Flexion
L2-3

Extension
L5-S1

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16
Q

What are the lower limb myotomes for
Knee extension
Knee flexion

A

Extension
L3-4

Flexion
L5-S1

17
Q

What are the lower limb myotomes for
Ankle extension
Ankle flexion

A

Extension
L4-5

Flexion
S1-2

18
Q

What are the lower limb myotomes for
Foot inversion
Foot eversion
Foor intrinsics

A

Inversion
L4-5

Eversion
L5-S1

Intrinsics
S2-3

19
Q

What are the roots of the nerves of the lumbar plexus

  • subcostal
  • iliohypogastric
  • ilioinguinal
  • genitofemoral
  • lateral thigh cutaneous
  • femoral
  • obturator
  • lumbosacral
A 
Subcostal T12
Iliohypogastric L1
Ilioinguinal L1
Genitofemoral L1-2 (pierces psoas major)
Lateral thigh cutaneous L2-3
Femoral L2-4
Obturator L2-4
Lumbosacral L4-5 (joints with upper sacral => sciatic)
20
Q

Describe the

  • Location
  • how damage to the nerve can occur
  • cutaneous innervation of the femoral nerve (L2-4)
A

Passes between groove between psoas and illiacus

Damage here v rare
-surgical traum to branches

Cutaneous

  • L2-3, anterior, medial cutaneous of upper thigh
  • L4, medial leg and foot (saphenous)
21
Q

Describe the

  • Location
  • how damage to the nerve can occur
  • cutaneous innervation of the obturator nerve (L2-4)
A

Passes medial to psoas major => obturator foramen

Damage here v rare
-Can’t adduct hip

Cutaneous
-L2-4, medial thigh, v small areas, hard to test

22
Q

Describe referred pain that can be found in the knee and hip region and why

A

Hip and knee share femoral and obturator innervation

Pain referred from hips <=> knees as a result

23
Q

Describe the

  • location
  • how damage to the nerve can occur
  • cutaneous innervation of the lateral femoral cutaneous nerve (L2-3)
A

Passes near ASIS under inguinal canal, lateral to hip

Sigmoid colon tumors can compress nerve/tight jeans => myalgia paresthesia

Cutaneous
-L2-3, lateral thigh

24
Q

Describe the nerve found in the anterior division of the sacral plexus

A

Tibial, L4-S3 (joints sciatic)

25
Q

Describe the 3 nerves found in the posterior division of the sacral plexus

A

Common fibular L4-S2 (not S3, not plantar)
Sup gluteal L4-S1
Inf gluteal L5-S2

26
Q

Describe the 5 nerves found in the direction divisions of the sacral plexus

A 
Pudendal S2-4 (perineum)
Perforating cutaneous S2-3
Post cutaneous of thigh S1-3
Perineal S3-4 (levator ani)
Piriformis S1-2
27
Q

What muscles are innervated by the superior gluteal nerve (L4-S1)

A

Gluteus medius
Gluteis minimus
Tensor fascia lata
Hip joint

28
Q

What muscles are innervated by the inferior gluteal nerve (L5-S2)

A

Gluteus maximus

29
Q

What cutaneous nerves come off the posterior cutaneous nerves of the thigh

A

Superior cluneal
Middle cluneal
Inferior cluneal
Posterior femoral cutaneous (often damaged by compression)

30
Q

Describe the route of the sciatic nerve (L4-S3)

A

Emerges from infrapiriformis space
Splits behind biceps femoris => tibial and common fibular

But emergence highly variable

31
Q

What is sciatica

How can you test for it

A

Bending over stretches roots => shooting pains

Test by stretching, if affected => pain

32
Q

What cutaneous nerves come off the tibial nerve (L4-S3)

How is it damaged

A

Cutaneous

  • Medial plantar
  • Lateral plantar
  • Calcaneal

Hard to damage in isolation
Compressed by med retinaculum

33
Q

What cutaneous nerves come off the common fibular (L4-S2)

A

Cutaneous (superficial)

  • Lateral leg
  • Dorsal foot minus 1st webbing

Cutaneous (deep)
-1st webbing

Most commonly damaged

Limbs (15 decks)

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