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FEMORAL NERVE INJURY (A) Motor (A) Motor 1. Wasting of the quadriceps femoris. 1. Wasting of the quadriceps femoris. 2. Loss of knee extension. 2. Loss.

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Presentation on theme: "FEMORAL NERVE INJURY (A) Motor (A) Motor 1. Wasting of the quadriceps femoris. 1. Wasting of the quadriceps femoris. 2. Loss of knee extension. 2. Loss."— Presentation transcript:

1 FEMORAL NERVE INJURY (A) Motor (A) Motor 1. Wasting of the quadriceps femoris. 1. Wasting of the quadriceps femoris. 2. Loss of knee extension. 2. Loss of knee extension. This can be compensated by the adductors in walking. This can be compensated by the adductors in walking. 3. Some loss of hip flexion ( iliacus & pectineus). 3. Some loss of hip flexion ( iliacus & pectineus).

2 FEMORAL NERVE INJURY (B) Sensory Loss Over: (B) Sensory Loss Over: 1. The front and medial side of the thigh (anterior and medial cutaneous nerves of the thigh). 1. The front and medial side of the thigh (anterior and medial cutaneous nerves of the thigh).

3 FEMORAL NERVE 2. The medial side of the lower part of the leg. 2. The medial side of the lower part of the leg. 3. The medial border of the foot as far as the ball of the big toe (Saphenous nerve). 3. The medial border of the foot as far as the ball of the big toe (Saphenous nerve).

4 OBTURATOR NERVE INJURY Causes : Causes : Pressure of the fetal head during labour. Pressure of the fetal head during labour. Pelvic wall malignancy. Pelvic wall malignancy. Motor : Motor : Incomplete loss of adduction ( ischial part of adductor magnus is functioning). Incomplete loss of adduction ( ischial part of adductor magnus is functioning).

5 OBTURATOR NERVE INJURY Sensory loss : Sensory loss : Minimal over the middle of the medial thigh. Minimal over the middle of the medial thigh.

6 SCIATIC NERVE INJURY Causes : Causes : 1. Badly placed intramuscular injection. 1. Badly placed intramuscular injection.

7 SCIATIC NERVE INJURY 2. Posterior dislocation of the hip joint. 2. Posterior dislocation of the hip joint. 3. Fracture of the pelvis. 3. Fracture of the pelvis.

8 SCIATIC NERVE INJURY Motor : Motor : 1. Marked wasting of the muscles below the knee. 1. Marked wasting of the muscles below the knee. 2. Weak flexion of the knee ( sartorius & gracilis are functioning). 2. Weak flexion of the knee ( sartorius & gracilis are functioning). 3. The foot assumes the position of foot drop (planter flexed position) by its weight. 3. The foot assumes the position of foot drop (planter flexed position) by its weight.

9 SCIATIC NERVE INJURY Sensory loss : Sensory loss : Below the knee. Below the knee. EXCEPT : EXCEPT : The area supplied by the Saphenous nerve. The area supplied by the Saphenous nerve. Trophic ulcers in the sole. Trophic ulcers in the sole.

10 SCIATICA It is pain in the leg extending from the buttock towards the heel. It is pain in the leg extending from the buttock towards the heel. Causes : Causes : Pressure on the sciatic nerve or its roots by prolapsed intervertebral disc (L4-5) or cancer deposits adjacent to the nerve. Pressure on the sciatic nerve or its roots by prolapsed intervertebral disc (L4-5) or cancer deposits adjacent to the nerve.

11 SCIATICA Diagnosis : Diagnosis : 1. Straight leg raising is diminished by the pain of sciatica. 1. Straight leg raising is diminished by the pain of sciatica. 2. Sensory loss over the lateral side of the leg. 2. Sensory loss over the lateral side of the leg. 3. Loss of ankle reflex. 3. Loss of ankle reflex.

12 COMMON PRONEAL NERVE INJURY It is the most liable nerve to be injured in the lower limb. Because of its superficial position. It is the most liable nerve to be injured in the lower limb. Because of its superficial position. The nerve may be severed during fracture of the neck of fibula or when the knee joint is injured or dislocated. The nerve may be severed during fracture of the neck of fibula or when the knee joint is injured or dislocated.

13 COMMON PRONEAL NERVE INJURY Motor Motor Loss of: Loss of: 1. Dorsiflexion (extensor muscles) 2. Eversion ( peronei). 1. Dorsiflexion (extensor muscles) 2. Eversion ( peronei). The foot – drops. The foot – drops. And becomes inverted. And becomes inverted.

14 COMMON PRONEAL NERVE INJURY The toes drag on the floor in walking. The toes drag on the floor in walking. The patient has to raise his foot high to keep the toes from hitting the ground. The patient has to raise his foot high to keep the toes from hitting the ground. The foot comes down suddenly. The foot comes down suddenly.

15 COMMON PRONEAL NERVE INJURY Sensory loss over: Sensory loss over: 1. Lateral and anterior sides of the leg. 1. Lateral and anterior sides of the leg. 2. Dorsum of the foot and toes. 2. Dorsum of the foot and toes. 3. Medial side of the big toe. 3. Medial side of the big toe.

16 DEEP PERONEAL NERVE INJURY Motor : Motor : Loss of dorsiflexion of the foot and toes. The foot becomes planter flexed and inverted because of the unopposed action of Tibialis posterior. Loss of dorsiflexion of the foot and toes. The foot becomes planter flexed and inverted because of the unopposed action of Tibialis posterior. An attitude referred to as Equinovarus. An attitude referred to as Equinovarus.

17 DEEP PERONEAL NERVE INJURY Sensory Loss : Sensory Loss : Between the first and second toes. Between the first and second toes.

18 SUPERFICIAL PERONEAL NERVE INJURY Motor : Motor : Evertion by the peroni is lost. Evertion by the peroni is lost. The foot becomes inverted. The foot becomes inverted.

19 SUPERFICIAL PERONEAL NERVE INJURY Sensory Loss : Sensory Loss : 1. Lateral side of the leg. 1. Lateral side of the leg. 2. Dorsum of the foot and toes. 2. Dorsum of the foot and toes. 3. Medial side of the big toe. 3. Medial side of the big toe.

20 TIBIAL NERVE INJURY Motor : Motor : All the muscles in the back of the leg and sole of the foot are paralysed. All the muscles in the back of the leg and sole of the foot are paralysed. The foot is dorsiflexed and everted. The foot is dorsiflexed and everted. An attitude referred to as Calcaneovalgus. An attitude referred to as Calcaneovalgus.

21 TIBIAL NERVE INJURY Sensory loss over : Sensory loss over : 1. Lateral side of the leg and foot. 1. Lateral side of the leg and foot. 2. Trophic ulcers in the sole. 2. Trophic ulcers in the sole.

22 THANK YOU BEST WISHES


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