orthopedics 5th year, 10th/part two & 11th lectures (dr. bakhtyar)
TRANSCRIPT
Sciatic nerve
AnatomySupplies:Hamstrings (posterior of thigh)Above knee divided into :(1)Common peroneal:
Superficial peroneal: The two peronei Skin of lateral of leg and dorsum of foot except 1st cleft
Deep peroneal: Muscles of anterior compartment of the leg Skin of 1st cleft
(2)Tibial nerve: muscles of the calf Skin of the sole
Causes of injury of the main trunkGunshot Operative accidentsTrauma following hip dislocation or fractures of the acetabulum
Symptoms and signs
Paralysis of (1) Hamstrings (2) All muscles below the kneeFoot dropAbsent sensation in most of the legTrophic ulcers ±
Treatment
Urgent reduction of hip dislocation
Proper treatment of fractures
Open wounds: Repair
While recovery is awaited a drop-foot splint is fitted
Prognosis
•Poor
•At best it will be delayed and incomplete
•If there is no recovery whatever, amputation may be preferable to a
flail, deformed, insensitive limb
Common peroneal nerve injury
Causes
Varus force in the knee
Pressure from a splint or plaster cast
Lying with the leg externally rotated
Anterior compartment syndrome (pressure on deep peroneal nerve)
Symptoms and signs
Wasting of dorsiflexor and peronei muscles
Drop foot
Loss of sensation of dorsum of foot
Nerve entrapment syndromes
Whenever peripheral nerves traverse fibro-osseous tunnels,
they are at risk of entrapment or compression
Causes
↑ in soft tissue bulk( pregnancy, myxoedema, RA)
Local obstruction (ganglion, osteophyte,old #)
Idiopathic
Sites
Carpal tunnel at the wrist (Median nerve)
Cubital tunnel at the elbow( ulnar nerve)
Tarsal tunnel below the ankle( Posterior tibial nerve)
Lateral part of inguinal ligament (lateral cutaneous of the thigh)
Thoracic outlet( C8+ T1)
Clinical features
Intermittent tingling OR pain OR numbnessThese symptoms are related to specific postures which compromise the nerve. e.g. CTS : flexion or hyperextension of the wrist Ulnar neuropathy : flexion of the elbow for a long time(driving, using telephone)
Areas of altered sensation
Motor weakness
Muscle wasting
Treatment
Avoiding compromising postures
Light splints
Local steroid injection
If all above failed : Surgical decompression
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