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Nerve Injuries in the Lower Limb

Nerve Injuries in the Lower Limb. Joseph Frantzias, Haroon Rehman and Shami Acharya for NANSIG. Content. Femoral nerve injury Obturator nerve injury Peroneal nerve injuy Tibial nerve injury Examination of lower limb . Femoral Nerve Anatomy. Ventral Rami L2,L3, L4

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Nerve Injuries in the Lower Limb

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  1. Nerve Injuries in the Lower Limb Joseph Frantzias, HaroonRehman and ShamiAcharya for NANSIG

  2. Content • Femoral nerve injury • Obturator nerve injury • Peroneal nerve injuy • Tibial nerve injury • Examination of lower limb

  3. Femoral Nerve Anatomy • Ventral Rami L2,L3, L4 • Passes between iliopsos and under inguinal ligament • Innervates : • Sensation over anterior thigh • Muscles in anterior compartment of thigh • Sensation over medial side of foot

  4. Femoral Nerve Injury • Diabetes • Trauma – knifewound, glass, gunshot etc • Intrapelvic • Inguinal region • Anterior thigh • Iatrogenic – cement THR

  5. Femoral Nerve Injury – Presentation • Pain in inguinal region • Difficulty extending knee • Knee buckling – if sever • Anterior thigh numbness

  6. Obturator Nerve Anatomy • Lumbar plexus • Travels through obturator canal • Innervates • Adductor muscles • Skin on medial thigh

  7. Obturator Nerve Injury • Rarely isolated • Pelvic trauma • Compression

  8. Obturator Nerve Injury – Presentation • Unstable leg • Ache • Loss of internal rotation

  9. Peroneal Nerve • Sciatic nerve branch • Distal third thigh • Innervates • Short head biceps femoris • Anterior and lateral compartments • Ext digitorumbrevis • 1st two dorsal interossei • Sensation over lateral leg and ankle

  10. Peroneal Nerve Injuries • Fibular head • Polytrauma • Lacerations, fractures, direct injury • Iatrogenic • Compression • Rarely: paraneoplastic, DM, hyperthyroidism, leprosy and anorexia

  11. Peroneal Nerve Injuries - presentation • Foot drop • Numbness over shin or top of foot • High-stepping walk  • Pain, tingling

  12. Tibial Nerve anatomy • Sciatic nerve branch • Passes under tendinous arch • Behind medial malleolus • Through tarsal tunnel

  13. Tibial Nerve Injury • Compression at arch of soleus • Mass lesions, cysts, tumours • Direct injury • Tarsal Tunnel Syndrome

  14. Tarsal Tunnel Syndrome • Diffuse, intractable heal pain • Worse with weight bearing • Worse throughout day • Treated with analgesia or surgical release

  15. Examined peripheral nerve • Neurovascular examination • Observation • Tone • Power • Sensation • Reflexes • Co-ordination • Reflexes • Gait

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