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Download Lower Extremity Nerve Roots Pain Distribution Causative lesions
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Lower Extremity Nerve Roots Pain Distribution Causative lesions Reflex Arc Tests Notes Obturator L2-L3-L4 Medial thigh Sensory – Medial surface of thigh Motor – Obturator Externus Pectineus Adductors Gracilis Pelvic neoplasm Pregnancy Pelvic surgery Adductor jerk (L3) Hip adductors (L2, L3) – adductors Pectineus may be innervated by obturator or femoral nerves Femoral L2-L3-L4 Ant thigh Med leg to ankle Sensory – Anterior aspect of thigh & medial aspect of leg down to medial malleolus Motor – Quads Pectineus Iliacus Diabetes Femoral hernia Retroperitoneal – haematoma Femoral art. Aneurysm Post. Abdomen Neoplasm Psoas abscess Knee jerk L3-L4 Knee extension L3L4 Fem n. lesion will affect both knee ext & hip Flex. (psoas not affected tho) NB: Reflex arc conveyed purely in L4. Pressure palsy at fibula neck Hip fracture / dislocation Penetrating trauma to buttock Piriformis syndrome Lateral hamstring jerk (S1) Lateral cutaneus nerve of the thigh L2-L3 Sciatic – Fibular L4-L5-S1 Diabetic Amyotrophy – mm wasting in front of thigh w/ weakness & wastage due to vasc changes supplying n Sensory – anterolateral aspect of thigh Often only dorsum of foot Sensory – Anterolateral leg dorsum of ankle & foot up to distal interphalangeal joints Deep branch 1st interdigital cleft Motor – Short head biceps femoris Fibularis Longus & Brevis (Sup Fibular Foot dorsiflexion L4L5 – Tibialis anterior Big toe ext L5 - EHL Ext of toes (L5, S1) – EDL Foot eversion L5-S1 – Fib longus & brev5s Medial hamstring jerk – Medial reflex is carried in the tibial div Cause foot drop x6 more likely to be damaged than tibial div nerve) Tibialis anterior, EDL, EHL. P tertius (Deep fibular nerve) Sciatic – Tibial L4-L5-S1S2 Often painless uncommon Sensory – Sole and lat border of foot, around nail beds Motor – Hamstrings (not short head biceps fem) plantaris, popliteus TP, Gastroc, soleus, FDL, FHL and small foot muscles Posterior cutaneus nerve of the thigh S1-S2-S3 Sensory – central posterior thigh Superior gluteal nerve L4-L5-S1 Gluteus minimus Gluteus medius Tensor fascia lata Inferior gluteal nerve L5-S1-S2 Gluteus Maximus Rarely injured even in buttock Misplaced injections! Piriformis syndrome Ankle jerk S1 Medial hamstring jerk S1 Knee flexion L5-S1 – hamstrings Plantarflexion S1 – Gastrocnemius Foot inversion L4, L5 – tibialis Post. Medial hamstring jerk – Medial reflex is carried in the tibial div
