Sciatica and Femoral Hernia

Question 1

How many spinal nerve pairs are there, and are they sensory, motor or mixed?

Answer 1

• 31
• Mixed

Question 2

Boundaries of intervertebral foramen

Answer 2

• Anterior = IVD + back of vertebral bodies
• Superior = pedicle
• Inferior = pedicle
• Posterior = capsule of facet joint + ligamentum flavum

Question 3

What type of joint occurs between vertebral bodies and IVDs?

Answer 3

Secondary cartilaginous

Question 4

What are the superior and inferior surfaces of IVDs lined with?

Answer 4

Hyaline cartilage

Question 5

Function of nucleus pulposus

Answer 5

Shock absorber –> distribute forces in radial fashion

Question 6

What is the annulus fibrosus made of?

Answer 6

15-25 sheets of tightly packed alternating directing collagen lamellae

Question 7

Where do cervical spinal roots exit, and what is the exception and why?

Answer 7

• Normally above corresponding pedicle
• C8 passed above T1 –> no corresponding pedicle

Question 8

Where do thoracic spinal roots exit?

Answer 8

Below corresponding pedicle

Question 9

Where do lumbar spinal roots exit?

Answer 9

Below corresponding pedicle

Question 10

What are spinal nerve plexuses formed by?

Answer 10

Ventral rami of corresponding nerve roots

Question 11

Nerve root values of cervical plexus

Answer 11

C1-5

Question 12

Nerve root values of brachial plexus

Answer 12

C5-T1

Question 13

Nerve root values of lumbar plexus

Answer 13

T12-L4

Question 14

Nerve root values of lumbosacral trunk

Answer 14

L4-5

Question 15

Nerve root values of sacral plexus

Answer 15

L4-S4

Question 16

Divisions of sciatic nerve

Answer 16

• Common peroneal nerve
• Tibial nerve

Question 17

Where does the sciatic nerve pass in the posterior thigh?

Answer 17

Beneath long head of biceps femoris

Question 18

Types of IVD herniation

Answer 18

• Central
• Posterolateral
• Far lateral

Question 19

What is sciatica, and what causes it?

Answer 19

• Pain radiating down lower limb with(out) back pain
• Disc herniation (L4/5 or L5/S1)

Question 20

Which nerve roots are commonly compressed in sciatica?

Answer 20

L5 + S1

Question 21

What sensory loss occurs with S1 root compression?

Answer 21

Lateral foot + posterior lateral leg

Question 22

Treatment of sciatica

Answer 22

• Pain management
• Physiotherapy (extension, lower back + sciatic nerve exercises)
• Surgical decompression

Question 23

Where does an inguinal hernia occur?

Answer 23

Superomedial to pubic tubercle

Question 24

Where does a femoral hernia occur?

Answer 24

Inferolateral to pubic tubercle

Question 25

What is a reducible hernia?

Answer 25

Contents may return spontaneously or pushed back by gentle pressure

Question 26

What is an incarcerated hernia?

Answer 26

Irreducible, possibly presenting with bowel obstruction (don’t try to reduce forcefully)

Question 27

What is a strangulated hernia?

Answer 27

Blood supply is threatened (requires emergent surgical intervention to precent necrosis of contents)

Question 28

Boundaries of femoral triangle

Answer 28

• Sartorius (lateral)
• Inguinal ligament (superior)
• Adductor longus (medial)

Question 29

Boundaries of femoral ring

Answer 29

• Inguinal ligament (anterior)
• Iliopectineal ligament, pubic bone + fascia over pectineus (posterior)
• Edge of lacunar ligament (medial)
• Thin septum (lateral)