Download EXAMINATION OF NERVES OF LOWER LIMB

EXAMINATION OF NERVES OF LOWER
LIMB
OBJECTIVES
At the end of this lecture the students should know:
•The sensory and motor nerve supplies of the different regions of
lower limb
•Examination of nerves of lower limb
•Significance of lesions of different nerves of lower limb and what
abnormality would appear in case of a lesion
Major Nerve supply of lower limbs
Through Lumbar and Sacral Plexuses:
•Femoral Nerve
•Obturator Nerve
•Lateral Cutaneous Nerve of thigh
•Sciatic Nerve
Lumbar and Sacral Plexus
Femoral Nerve (L2, L3, L4)
•Motor Supply
–Iliopsoas (HIP FLEXORS)
–Quadriceps Group (KNEE EXTENSORS)
•Rectus Femoris
•Vastus Medialis
•Vastus Lateralis
•Vastus Intermedius
–Sartorius Muscle
•Sensory (Saphenous Nerve)
–Skin on the medial aspect of the thigh (inner thigh) and inner
calf
•Reflex
–Knee jerk (requires the quadriceps to be working)
Examination Of Femoral Nerve
Inspection
Look for:
• Swelling in the groin & evidence of trauma
• Bruising
• Wasting of the Quadriceps
• Inability to bear weight on the affected leg
• Muscle fasciculation, muscle atrophy (QUADRICEPS)
• The back (L2-4) for evidence of disease
Palpation
Palpate the:
• Inguinal ligament for pain
• Inguinal area (bone and soft tissue)
• Spine
• Flanks
• Quadriceps (for tone)
Motor Examination of Femoral Nerve
HIP FLEXION (LYING)
HIP FLEXION (SITTING)
Motor Examination of Femoral Nerve
KNEE EXTENSION (LYING)
KNEE EXTENSION (SITTING)
Motor Examination Of Femoral Nerve
KNEE REFLEX (LYING)
KNEE REFLEX (SITTING)
Sensory Examination of Femoral Nerve
•Medial aspect of the thigh through anterior cutaneous branch of Femoral
nerve.
•Calf through Saphenous nerve
Sciatic Nerve (L4, L5, S1, S2)
Supplies :
ALL OF THE MUSCLES BELOW THE KNEE via:
•The Tibial nerve
•Common Peroneal nerve.
THIGH (Motor)
–Hamstring Group (KNEE FLEXORS)
–Semimembranosus
–Semitendinosus
–Long
and Short heads of biceps
–Adductor Magnus
Nerve splits just above popliteal fossa to become tibial nerve and common
peroneal nerve
Examination of Sciatic Nerve
KNEE FLEXION
Common Peroneal Nerve (L4, L5, S1)
Division of Sciatic nerve
Divides into superficial and deep branches
•SUPERFICIAL PERONEAL NERVE
–Motor
•Foot Evertors (Peroneus longus and Peroneus
–Sensory
•Sural nerve
•DEEP
brevis)
sensation to lateral calf and dorsum of the foot
PERONEAL NERVE
–Motor
•Foot dorsiflexors (Tibialis anterior)
•Toe dorsiflexors (Extensor digitorum
–Sensory
•Small area
longus, extensor hallucis longus)
of web space between the 1st and 2nd toes
Examination of Deep Peroneal Nerve
DORSIFLEXION
TOE DORSIFLEXION
Tibial Nerve (L4, L5, S1, S2)
•Division of Sciatic nerve
Motor
•Foot plantarflexors (Gastrocnemius, Soleus, Popliteus)
•Foot Invertors (Tibialis Posterior)
•Toe Flexors (Flexor digitorum longus, Flexor hallucis longus)
Reflex
•Ankle reflex (S1, S2)
•Continues on as the Posterior tibial nerve
•Supplies the muscles of the foot via the medial and lateral plantar nerves.
Examination Of Tibial Nerve
TOE PLANTARFLEXION
PLANTARFLEXION
Ankle Reflex
Sensory Examination of Sciatic
Nerve
COMMON PERONEAL NERVE
•Deep peroneal nerve
•Superficial peroneal nerve
•Lateral sural cutaneous nerve
TIBIAL NERVE
•Sural nerve
•Medial sural cutaneous nerve
•Calcaneal nerve
•Medial and lateral planter nerve
Obturator Nerve (L2, L3, L4)
Motor
–Adductor group (HIP ADDUCTORS)
•Adductor Brevis
•Adductor Magnus
•Adductor Longus
–Gracilis
Sensory
–Distal medial thigh
Examination Of Obturator Nerve
Sensory Examination of Obturator
Nerve
Distal medial thigh
Superior Gluteal Nerve
•
Hip Abduction
•
•
Gluteus medius
Gluteus minimus
•
Nerve root: L4, L5, S1
Inferior Gluteal Nerve
•
Hip extension
•
Gluteus maximus
•
Nerve root: L5, S1, S2