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1、NERVEINJURIESOFTHELOWEREXTREMITYSTACYRUDNICKI,MDASSOCIATEPROFESSOROFNEUROLOGYDermatomesoftheLegRootInnervationoftheLegHipFlexionL1,2,3KneeExtensionL2,3,4FootDorsiflexionL4,5FootPlantarFlexionS1,2KneeFlexionL5,S1,S2HipExtensionL5,S1,S2ClinicalPrinciplesDetectingsu
2、btleweaknessGetupfromsquatQuadriceps/GluteusmaximusStandontiptoesGastrocnemius/SoleusStandonheelsTibialisAnteriorReflexesKneeJerks-evaluatesQuadricepsmuscleFemoralNervePrimarilyL4nerveroot(alsoL2,L3)AnkleJerk-evaluatesGastrocnemiusmuscleTibialNervePrimarilytheS1n
3、erveroot(alsoS2)CASE1History20yocollegestudentinvolvedinanMVAShesuffersmultiplepelvicfracturesShecomplainsofweaknessandnumbnessoftherightlegSheisawarethatherrightfootis“dropped”relativetotheleft,andthatshemustliftherfootuphighertoclearhertoesExamShehasweaknessof:
4、FootdorsiflexionFooteversionToeextensionStrengthisnormalin:FootplantarflexionFootinversionToeflexionThereisjustahintofweaknessinkneeflexionSENSORYLOSSLocalizationFindingMuscleNerveRootInvolvedFtDorsiflexTIBANTFIBL4,5GrttoeextEHLFIBL5ToeextEDL,EDBFIBL4,5Footeversi
5、onFIBL,BFIBL4,5KneeflexMultTIB/FibL5S1S2SparedFootplantflexGASTROC,TIBS1,2SOLEUSToeflexFDL/FDBTIBL5,S1FootinvPOSTTIBTIBL4,5LocalizationFindingMuscleNerveRootInvolvedFtDorsiflexTIBANTFIBL4,5GrttoeextEHLFIBL5ToeextEDL,EDBFIBL4,5FooteversionFIBL,BFIBL4,5KneeflexMult
6、TIB/FibL5S1S2SparedFootplantflexGASTROC,TIBS1,2SOLEUSToeflexFDL/FDBTIBL5,S1FootinvPOSTTIBTIBL4,5CommonFibular(Peroneal)NerveCommonFibShortheadBFDeepFibSuperficialFibFibLongusTibAntFibBrevisEHLFibTertiusEDBDifferentiatingb/wL5radiculopathyandFibularNeuropathyMotor
7、examFootinversion-PosteriortibialmuscleSpared-FibularneuropathyInvolved-L5SensoryexamSensorylossindeepfibular,commonfibular,andL5diseaseFinalDiagnosisSciaticneuropathywithselectiveinvolvementofthefibular(peroneal)nervefibersatthelevelofthepelvisPearl:Thefibularco
8、mponentofthesciaticnerveismoresusceptibletotraumaticinjurythanthetibialcomponent-“falselocalization”CASE2HistoryThepatientisa45yomanwhocomplainsofburningpainin
