Anatomy, injury of nerve

1. OBTURATOR
NEUROPATHY
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2. ANATOMY
The obturator nerve is the chief nerve of the medial
compartment of the thigh
ROOT VALUE – L2,L3,L4
Arising from ventral division of the ventral primary
rami of lumbar plexus
MOTOR SUPPLY
oAnterior division of nerve
•Adductor longus
•Adductor brevis
•Pectineus
•Gracilis
oPosterior division of nerve
•Adductor magnus
•Adductor brevis
•Obturator externus
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4. CAUSES
• Dislocation of the hip joint
• Hernia through the obturator foramen
• Prolonged difficult labor
• Compression of the nerve against the wall of the pelvis by any mass
such as tumor or foetus
• Pelvic fracture
• Disease or injury to the sacroiliac or hip joints.
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5. SIGN & SYMPTOMS
Sensory
loss of sensation over the distal medial aspect of the thigh and medial
aspect of the knee.
Motor
The nerve that are paralyzed due to lesion to the anterior division of
the obturator nerve are adductor longus, adductor brevis, gracilis and
pectineus.
The muscles that are paralyzed due to lesion to the posterior division of
the obturator nerve are adductor magnus, obturator externus and
occasionally adductor brevis.
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6. Gait : - Walks with decreased base of support (<2 inch)
ROM:-
Active ROM loss – hip adduction , hip lateral rotation
Passive ROM full & free unless there is soft tissue tightness
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7. DEFORMITY
Due to paralysis of the adductor muscles, the tensor fascia lata overacts
hence pulls the hip into flexion, abduction deformity
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8. FUNCTIONAL DISABILITY
Pt is dependent for functional activities such as walking, squatting,
dressing, transfers, toilet activities
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9. INVESTIGATION
RADIOGRAPH :- shows whether there is presence of fracture
MRI :- To delineate complete avulsion of nerve roots
SD CURVE:- abnormality in conduction can be verified. Sharp curve, long
chronaxie, low rheobase and the absence of contraction with repetitive
stimuli indicates denervation. If it is done 2-3 weeks after injury, it
shows the sign of denervation and to find out whether it is moderate or
severe injury
NCV:- To find out the severance of nerve fibers with wallerian
degeneration.
EMG:- it will help to find out reversible and irreversible nerve damage
and will help map out whether it pre ganglionic/ post ganglionic lesion
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10. TYPES OF INJURIES
In Neuropraxia  pain, numbness, muscle weakness,
minimal muscle wasting is present. Recovery occurs within
minutes to days
In Axonotmesis  there is pain, evident muscle wasting,
complete loss of motor, sensory and sympathetic functions.
Recovery time– months (axon regeneration at 1-1.5
mm/day)
In Neurotmesis  no pain, complete loss of motor, sensory
and sympathetic functions. Recovery time – months and
only with surgery
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11. SPECIAL TESTS
1. TINNEL’S SIGN
2. SLUMP TEST
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12. TREATMENTS
Conservative treatment is only option in the initial stages as tendon
transfers for large muscles of the hip is not possible.
Physiotherapy
•IG stimulation to the adductor muscles.
•Stimulation of gracilis, pectineus and obturator externus is not possible.
•Stretching exercises for the TFL to prevent them from going into
contracture and deformity.
•Once the muscles gets innervated then re-education and strengthening
is carried out as usual.
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13. THANK YOU
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