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1、NERVEINJURIESOFTHELOWEREXTREMITYSTACYRUDNICKI,MDASSOCIATEPROFESSOROFNEUROLOGYDermatomesoftheLegRootInnervationoftheLegHipFlexionL1,2,3KneeExtensionL2,3,4FootDorsiflexionL4,5FootPlantarFlexionS1,2KneeFlexionL5,S1,S2HipExtensionL5,S1,S2ClinicalPrinciplesDe
2、tectingsubtleweaknessGetupfromsquatQuadricepsStandontiptoesGastrocnemius/SoleusStandonheelsTibialisAnteriorReflexesKneeJerks-evaluatesQuadricepsmuscleFemoralNervePrimarilyL4nerveroot(alsoL2,L3)AnkleJerk-evaluatesGastrocnemiusmuscleTibialNervePrimarilythe
3、S1nerveroot(alsoS2)CASE1History20yocollegestudentinvolvedinanMVAShesuffersmultiplepelvicfracturesShecomplainsofweaknessandnumbnessoftherightlegExamShehasweaknessof:FootdorsiflexionFooteversionToeextensionStrengthisnormalin:FootplantarflexionFootinversion
4、ToeflexionThereisjustahintofweaknessinkneeflexionSENSORYLOSSLocalizationFindingMuscleNerveRootFtDorsiflexTIBANTPER(FIB)L4,5GrttoeextEHLPER(FIB)L5ToeextEDL,EDBPER(FIB)L4,5FooteversionPERL,BPER(FIB)L4,5FootplantflexGASTROC,TIBS1,2SOLEUSToeflexFDL/FDBTIBL5,
5、S1FootinvPOSTTIBTIBL4,5KneeflexMULTTIB/PERL5S1S2CommonFibular(Peroneal)NerveCommonFibDeepFibSuperficialFibPerLongusTibAntPerBrevisEHLPerTertiusEDBSENSORYLOSSINADEEPPERONEAL(FIBULAR)NEUROPATHYFinalDiagnosisSciaticneuropathywithselectiveinvolvementofthefib
6、ular(peroneal)nervefibersatthelevelofthepelvisCASE2HistoryThepatientisa45yomanwhocomplainsofburningpaininhisrightlateralthighHeisotherwisehealthy,thoughoverthelast2years,hehasgained30poundsbecausehecan’tfindtimetoexerciseExamHehasnormalstrengthinallmuscl
7、esofhislegReflexesarenormalSENSORYLOSSLocalizationFindingMuscleNerveRootSensloss--Latfem<8、fburningpaininthefootandweaknessofthefootExamHehasweaknessof:FootplantarflexionFootinversionToeflexionStrengthisnormalin:KneeflexionFootdorsiflexionFooteversionSENSORYLOSSExamFindingMusclePNRootFtplantflexGASTROCTIBS1,S2To
