Nerve Injuries in the Lower Limb

Nerve Injuries in the Lower Limb

Neurotmesis

• Division of nerve by open wound, no recovery without surgical intervention
• Axons may fail to reach distal segment or target organ (neuroma)
• Healing occurs through disintegration and regeneration of axon

Clinical Features

• History of fracture, dislocation, or injury
• Numbness, weakness, and abnormal position (foot or wrist drop)
• Diagnosis:
  • Tinel's sign for progressive recovery
  • EMG and NCS

Femoral Nerve

• Injuries caused by gunshot, traction during operation, hematoma
• Clinical features: weakness of knee extension, depressed knee reflex, sensation problems in thigh and leg
• Treatment: early evacuation of hematoma, suturing or grafting of cut nerve

Sciatic Nerve

• Injuries caused by trauma, dislocation, gunshot, and iatrogenic accidents
• Clinical features: foot drop, numbness, paresthesia, and pain in leg and foot
• Treatment: reduction of dislocation, exploration in open lesions, splinting
• Prognosis: poor, late, and partial; tendon transfer or amputation may be necessary

Peroneal Nerve

• Causes: knee trauma, varus, splints, and slaps
• Clinical features: foot drop, eversion loss, leg and dorsum sensory loss
• First cleft sensation loss due to deep peroneal nerve
• Anterior compartment syndrome may cause deep peroneal nerve palsy
• Treatment: open lesion exploration, compartment syndrome release, splinting, and skin care
• Tendon transfer for disability