3. ANATOMY
It is the nerve of anterior compartment of thigh
Its cutaneous branch, the saphenous nerve
extend to the medial side of leg and medial
border of foot till the ball of great big toe
ROOT VALUE โ L2,L3,L4
Arising from dorsal division of the ventral
primary rami of lumbar plexus
MOTOR SUPPLY
oAnterior division
โขSartorius
โขPectineus
oPosterior division
โขVastus medialis
โขVastus intermedius
โขVastus lateralis
โขRectus femoris
P/B :- DR NIYATI PATEL 3
5. CAUSES
โข Psoas abscess
โข Pelvic neoplasm
โข Fracture of the pelvis or femur
โข Hip dislocation
โข Inguinal hernia
โข Complication of spinal anesthesia
โข Prolapse intervertebral disc
โข Lumbar spondylosis or stenosis
โข Neuropathy secondary to diabetes mellitus known as diabetic
Amyotrophy
โข Neurapraxia after hysterectomy or gynecological surgery
โข Penetrating wounds of lower abdomen.
P/B :- DR NIYATI PATEL 5
6. SIGN & SYMPTOMS
Sensory
There is loss of sensation over the following areas:
a. Anterior division - anterior and medial aspect of the thigh
b. Posterior division โ Continuous as the saphenous nerve involving the
medial aspect of the leg and foot right up to the ball of the great toe.
Motor
The muscles which are paralyzed due to the lesion of the anterior
division are Sartorius and pectineus.
The muscles which are paralyzed due to the lesion to the posterior
division are rectus femoris, vastus medialis, vastus lateralis and vastus
intermedius.
P/B :- DR NIYATI PATEL 6
7. Reflexes
Quadriceps jerk is lost.
Deformity
Genu recurvatum is seen because as
the quadriceps is paralyzed the
patient will try to lock the knee into
hyperextension to get the center of
gravity well in front of the knee joint
to keep it stable.
P/B :- DR NIYATI PATEL 7
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
P/B :- DR NIYATI PATEL 9
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 timeโ months (axon regeneration at 1-1.5
mm/day)
In Neurotmesis ๏ no pain, complete loss of motor, sensory
and sympathetic functions. Recovery time โ months and
only with surgery
P/B :- DR NIYATI PATEL 10
11. TREATMENTS
โข Underlying cause must be deal with the specific surgeries
โข IG stimulation to the paralyzed muscles
โข Passive movements
โข Orthosis to correct genu recurvatum. Either anterior knee guard or
above knee ankle orthosis
P/B :- DR NIYATI PATEL 11
14. It is also known as โโlateral femoral cutaneous
nerve entrapmentโ
Causes:-
โขTight clothing, such as belts, corsets and tight pants
โขObesity or weight gain
โขWearing a heavy tool belt
โขPregnancy
โขFluid accumulation in the abdomen causing increased
abdominal pressure
โขScar tissue near the inguinal ligament due to injury or past
surgery
P/B :- DR NIYATI PATEL 14
15. Sign and symptoms:-
โขTingling, numbness and burning pain in your lateral
aspect of thigh
โขDecreased sensation
โขIncreased sensitivity and pain to even a light touch
P/B :- DR NIYATI PATEL 15
