NERVE INJURY OF THE LOWER LIMB
Sherly Jose
NERVES OF LOWER LIMB
• Arise from lumbar and sacral plexus
• Main nerves of lumbar plexus are
• 1. Femoral nerve
• 2. Obturator nerve
• 3. Lateral cutaneous nerve of thigh
• Main nerves of sacral plexus are
• 1. Superior gluteal nerve
• 2. Inferior gluteal nerve
• 3. Pudendal nerve
• 4. Sciatic nerve which terminates in popliteal fossa into
• a. Tibial nerve
• b. Common peroneal nerve
FEMORAL NERVE INJURY
• (A) Motor
• 1. Wasting of the quadriceps
femoris.
• 2. Loss of knee extension.
• This can be compensated by the
adductors in walking.
• 3. Some loss of hip flexion
( iliacus & pectineus).
FEMORAL NERVE INJURY
• (B) Sensory Loss Over:
• 1. The front and medial
side of the thigh
(anterior and medial
cutaneous nerves of the
thigh).
FEMORAL NERVE
• 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).
OBTURATOR NERVE INJURY
• Causes :
• Pressure of the fetal head
during labour.
• Pelvic wall malignancy.
• Motor :
• Incomplete loss of adduction
( ischial part of adductor
magnus is functioning).
OBTURATOR NERVE INJURY
• Sensory loss :
• Minimal over the middle of
the medial thigh.
SCIATIC NERVE INJURY
• Causes :
• 1. Badly placed
intramuscular injection.
SCIATIC NERVE INJURY
• 2. Posterior dislocation
of the hip joint.
• 3. Fracture of the pelvis.
SCIATIC NERVE INJURY
• Motor :
• 1. Marked wasting of the muscles
below the knee.
• 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.
SCIATIC NERVE INJURY
• Sensory loss :
• Below the knee.
• EXCEPT :
• The area supplied by
the Saphenous nerve.
• Trophic ulcers in the
sole.
SCIATICA
• It is pain in the leg extending
from the buttock towards the
heel.
• Causes :
• Pressure on the sciatic nerve or
its roots by prolapsed
intervertebral disc (L4-5) or
cancer deposits adjacent to the
nerve.
SCIATICA
• Diagnosis :
• 1. Straight leg raising is
diminished by the pain of
sciatica.
• 2. Sensory loss over the
lateral side of the leg .
• 3. Loss of ankle reflex.
COMMON PRONEAL NERVE INJURY
• 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.
COMMON PRONEAL NERVE INJURY
• Motor
• Loss of:
• 1. Dorsiflexion
(extensor muscles) 2.
Eversion ( peronei).
• The foot – drops.
• And becomes inverted.
FOOT DROP
• Foot drop is a gait abnormality in which the dropping of the
forefoot happens due to weakness, damage to the common
fibular nerve or paralysis of the muscles in the anterior portion
of the lower leg.
• It is usually a symptom of a greater problem, not a disease in
itself. It is characterized by inability or impaired ability to raise
the toes or raise the foot from the ankle (dorsiflexion).
• Foot drop may be temporary or permanent, depending on the
extent of muscle weakness or paralysis and it can occur in one
or both feet. In walking, the raised leg is slightly bent at the
knee to prevent the foot from dragging along the ground.
• Foot drop can be caused by nerve damage alone or by muscle
or spinal cord trauma, abnormal anatomy, toxins or disease..
• It may also occur as a result of hip replacement surgery.
FOOT DROP
COMMON PRONEAL NERVE INJURY
• 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 foot comes down
suddenly.
COMMON PRONEAL NERVE INJURY
• Sensory loss over:
• 1. Lateral and anterior
sides of the leg.
• 2. Dorsum of the foot
and toes.
• 3. Medial side of the big
toe.
DEEP PERONEAL NERVE INJURY
• Motor :
• 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.
DEEP PERONEAL NERVE INJURY
• Sensory Loss :
• Between the first and
second toes.
SUPERFICIAL PERONEAL NERVE INJURY
• Motor :
• Evertion by the peroni is
lost.
• The foot becomes inverted.
SUPERFICIAL PERONEAL NERVE INJURY
• Sensory Loss :
• 1. Lateral side of the
leg.
• 2. Dorsum of the foot
and toes.
• 3. Medial side of the big
toe.
TIBIAL NERVE INJURY
• Motor :
• All the muscles in the back
of the leg and sole of the
foot are paralysed.
• The foot is dorsiflexed and
everted.
• An attitude referred to as
Calcaneovalgus.
TIBIAL NERVE INJURY
• Sensory loss over :
• 1. Lateral side of the leg
and foot.
• 2. Trophic ulcers in the
sole.
Tibial nerve dysfunction
• The entrapment of the tibial nerve
beneath the flexor retinaculum causes
the tarsal tunnel syndrome,
characterized by pain, numbness and
tingling of the medial plantar surface of
the foot.
• The situation is aggravated by standing
and walking, and often worse at night.
REFERENCES
• Palastanga, N, Field, D. and Soames, R. (2012).
Anatomy and human movement, 6th edition.
Edinburgh: Butterworth-Heinemann.
• Field, D. (1997). Anatomy, Palpation and
surface marking. Butterworth-Heinemann.
• Wange, A. (2011). Anatomy and physiology in
health and illness, 11th edition. Edinburgh.
