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Nerve Injury - Lower Limb

This document discusses the dermatomes, myotomes, and common nerve injuries of the lower limb. It outlines the sensory and motor effects of injuries to the femoral, obturator, sciatic, common peroneal, and tibial nerves. Surface landmarks are provided for palpating the femoral, popliteal, anterior tibial, dorsalis pedis, and posterior tibial arteries in the lower limb. Important facts about the anatomy and injuries of the knee and lower limb are highlighted.

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95 views4 pages

Nerve Injury - Lower Limb

This document discusses the dermatomes, myotomes, and common nerve injuries of the lower limb. It outlines the sensory and motor effects of injuries to the femoral, obturator, sciatic, common peroneal, and tibial nerves. Surface landmarks are provided for palpating the femoral, popliteal, anterior tibial, dorsalis pedis, and posterior tibial arteries in the lower limb. Important facts about the anatomy and injuries of the knee and lower limb are highlighted.

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ANATOMY OF THE LOWER LIMB NEURAL INJURY DR.

AHMED ALMUSAWI 1

DERMATOMES OF THE LOWER LIMB


Dermatomes of the lower limb that can be tested for sensation and have minimal overlap are:
L1 dermatome; over the inguinal
ligament.

the thigh.

side of the thigh.

the big toe.

the second toe.

thigh.

perineum, around the anus.

MYOTOMES OF THE LOWER LIMB


On the basis of movements of joints, the myotomes of the LOWER limb may be expressed as follows;

myotomes.

NERVE INJURIES IN THE LOWER LIMB


ANATOMY OF THE LOWER LIMB NEURAL INJURY DR. AHMED ALMUSAWI 2

Femoral nerve injury


The femoral nerve can be injured in stab or gunshot wounds, but a complete division of the nerve is rare. The
following effects occur when the nerve is completely divided;
Motor

for this during walking by the adductors to bring the leg forward and medially.

ralysis of iliacus and pectineus.

Sensory
There is loss of skin sensation over the front and medial side of the thigh (intermediate and medial cutaneous
nerves) and over the medial side of the leg and medial border of the foot (saphenous nerve).
Obturator nerve injury
This nerve is rarely injured by wounds or hip dislocations. It is more commonly compressed by the fetal head
during parturition or by growing pelvic tumors. The following features occur;
Motor
All the adductors are paralyzed (except the hamstring part of adductor magnus) causing severe weakness in
adduction.
Sensory
If the nerve is compressed, paresthesia is felt on the medial side of the thigh. Pain may be referred to the knee
and / or hip joints.
Sciatic nerve injury
This nerve is most commonly injured by badly placed intramuscular injections in the gluteal region. It is
sometimes injured by penetrating wounds, pelvic fractures or hip dislocations. Most lesions are incomplete
and in 90% of cases, the common peroneal part (more superficial fibers) is affected. Sciatic nerve damage
results in the following features;
Motor

since it is supplied by the inferior gluteal nerve.

and the weight of the foot causes it to fall down in the plantar-flexed position, a condition known as foot drop.
During walking, the falling foot makes a characteristic slam as it drops on the ground.
ANATOMY OF THE LOWER LIMB NEURAL INJURY DR. AHMED ALMUSAWI 3

Sensory
Sensation is lost below the knee except for the saphenous area i.e. medial side of the leg and medial border of
the foot.
Common peroneal nerve injury
This nerve is commonly injured in fractures of the neck
of the fibula and by pressure from ill-fitted casts or
splints resulting in the following features;
Motor
All the muscles of the anterior and lateral compartments
of the leg (dorsiflexors and everters) are paralyzed and
the opposing muscles (plantar-flexors and inverters)
keep the foot plantar-flexed and inverted, a position
called equinovarus.

Sensory
There is sensory loss over the anterior and lateral sides of the leg and dorsum of the foot including the medial
side of the big toe (superficial peroneal branch and cutaneous branch of the deep peroneal nerve). Sensation
is preserved on the lateral side of the foot and little toe (sural branch of tibial nerve) and on the medial border
of the foot as far as the ball of the big toe (saphenous branch of femoral nerve). However, since the injury
usually occurs at the neck of the fibula (distal to the origin of the lateral cutaneous nerve of the calf) the loss
of sensation is confined to the foot and distal leg.
Tibial nerve injury
The tibial nerve is rarely injured because of its deep and protected position.
Complete division (rare) results in the following features;

Motor
All the muscles of the calf and sole of the foot become paralyzed and the
opposing muscles (dorsiflexors and peronei) keep the foot dorsiflexed and
everted, a position known as calcaneovalgus.
Sensory
Sensation is lost on the sole leading to development of trophic ulcers.

SURFACE LANDMARKS FOR PALPATION OF LOWER LIMB ARTERIES


femoral artery is palpated behind the inguinal ligament midway between the anterior superior iliac
spine and the pubic tubercle as it is pressed against pectineus and the superior pubic ramus.

popliteal artery is palpated while the knee is passively flexed by deep palpation of the popliteal fossa
(using the 8 fingers of both hands while stabilizing the knee with the thumbs).
ANATOMY OF THE LOWER LIMB NEURAL INJURY DR. AHMED ALMUSAWI 4

anterior tibial artery is palpated midway between the 2 malleoli.

dorsalis pedis artery is palpated on the dorsum of the foot (in front of the ankle) just proximal to the first
intermetatarsal space.

posterior tibial artery is palpated a fingerbreadth behind the medial malleolus.

GOLDEN FACT TO REMEMBER

■ Most stable position of the knee joint Erect extended position


■ Most important muscle to stabilize the knee joint Quadriceps femoris
■ Most frequently injured joint in the lower limb Ankle joint
■ Key muscle of the knee joint Popliteus
■ Unhappy triad of knee joint Injury of (a) tibial collateral ligament, (b) medial
meniscus, and (c) anterior cruciate
ligament
■ Most commonly injured meniscus of the knee joint Medial meniscus
■ Strongest tibiofibular joint Inferior tibiofibular joint
■ Most important ligament for maintaining the arches of the foot Spring ligament

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