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Posterior dislocation of hip, fracture of pelvis, inter-muscular injections can injure the [sciatic nerve]
- Fracture of head of fibula [common fibular nerve]
- Popliteal fossa trauma [tibial and common fibular]
- ASIS [lateral cutaneous nerve of thigh
- Lumbar nerve roots [back pain]
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What are the surface markings of the sciatic nerve?
- Halfway between PSIS and ishial tuberosity
- Half way between iscial tuberosity and greater trochanter
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State consequences of complete sciatic nerve palsy
- Motor: Paralysis of hamstrings; Paralysis of entire leg and foot
- Sensory: Numbness of skin on lateral side of leg, and lateral side of sole of foot
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State consequences of damage to common peroneal nerve
- Motor: Weakness of everters and dorsiflexors inversion and foot drop (aquinovarus)
- Sensory: Numbness of dorsum of foot, and 1st cleft, anterolateral side of the leg
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State consequences of damage to the tibial nerve
- Motor: Paralysis of posterior compartment of leg, intrinsic muscles of sole of the foot
- Sensory: numbness of posterolateral side of leg, toes, sole of the foot,
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Name the roots of the lateral cutaneous nerve of the thigh
L2, L3
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Discuss damage to the lateral cutaneous nerve of thigh
- Damaged by belt tightening / trauma
- Loss of sensation on lateral thigh
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Why does back pain occur?
- Compromised thoracic or lumbar vertebrae, sacroiliac joint, or the hip
- Nerve damage
- Herniated disc
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Discuss spinal disk herniation
- Natural degenreation of intervertebral disc
- Tearing of annulus fibrosis
- Herniation of nucleus palposus; this substance is very inflammatory
- Inflammatory response near spinal column; nerve irritation; release of substance P; causes pain
- Compression of nerve causes motor weakness; sensory abnormalities;
- If compression in lumbar area, classical cause of sciatica
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Where do most herniation occur ?
Between L5 and S1
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Important dermatomes of the lower limb:
- L1, L2: femoral triangle
- L4: tibia to the big toe
- L5: fibula
- L4, L5, S1: sole and dorsum of foot
- S1: under 5th toe
- S2: popliteal fossa
- S3: where you sit
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State the spinal values for the following joint movements of the lower limb
- Hip joint:
- Flexion, Adduction, Medial rotation: L2, 3
- Extension, abduction, lateral rotation: L4, L5, S1
- Knee joint:
- Extension: L3, 4 (knee jerk)
- Flexion: L5, S1
- Ankle Joint:
- Dorsi flexion: L4, 5
- Plantarflexion: S1, 2 (ankle jerk)
- Foot:
- Inversion: L4
- Eversion: L5, S1
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What is shenton’s line?
- Radiographic curve
- Formed by top of obturator foramen and inner side of neck of femur
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Name reasons for a pateelar dislocation
- Weakness of quads
- Dysplasia of lateral femoral condyle
- Twisting injury
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Which way does the patella USUALLY dislocate?
Laterally
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Is it the medial or lateral ligaments of the foot that is usually injured? Why?
- Lateral one more commonly injured (particularly the Anterior Talo-Fibular ligament)
- Due to over inversion i.e. skateboarding oooh yeaAH
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The medial ligament is stronger
Associated with fracture of medial malleolus
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Discuss fractur dislocations of the foot
Due to overeversion and external rotation of the foot
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