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Lower Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
Therefore, all the leg and foot muscles as well as the posterior thigh are innervated by nerves coming from the major nerve lying on the posterior side of the thigh: the sciatic nerve (Figure 5.1). At the level of the thigh, this major nerve is already divided into the common fibular division of the sciatic nerve and tibial division of the sciatic nerve, which innervate all the posterior muscles of the thigh. A clear separation between the common fibular nerve and the tibial nerve is however usually only seen in the distal region of the thigh. As its name indicates, the common fibular nerve—which as noted above gives rise to the lateral sural cutaneous nerve—divides into two nerves: the superficial fibular nerve and the deep fibular nerve (Plate 5.9). The superficial fibular nerve innervates the lateral muscles of the leg and part of the skin of the antero-lateral side of the leg as well as the skin of the dorsum of the foot and sends dorsal digital nerves to the skin of the toes. The deep fibular nerve is the body’s “trick” to overcome the problem of not having an anterior nerve, such as the femoral nerve or its branches in the thigh, to innervate the anterior muscles of the leg. The deep fibular nerve thus runs obliquely deep in the anterior compartment of the leg, and then runs deep to the short extensors of the foot. It gives rise to the dorsal digital branches of the deep fibular nerve that innervate the skin between the 1st and 2nd toes. The tibial nerve passes through the popliteal fossa to run on the posterior side of the leg (Plate 5.10). As noted above (Box 5.2), it gives rise to the medial sural cutaneous nerve and thus contributes to the formation of the sural nerve, and it innervates all the posterior muscles of the leg. At the calcaneal region, the tibial nerve divides into the lateral plantar nerve and the medial plantar nerve, which innervate all the intrinsic muscles of the foot and give rise to the common and proper plantar digital nerves (Plate 5.16).
Sensory Neuropathy in Parkinson Disease: Electrodiagnostic Evaluation
Published in The Neurodiagnostic Journal, 2020
Otto J. Hernandez Fustes, Olga Judith Hernandez Fustes
Twenty one females (58.3%) with an average age of 69.6 years and fifteen males (41.7%) with an average age of 68.0 years who were submitted for EDX were included in this study. All had a tremor and the average evolution of PD was 5 years. Thirty-two patients were receiving oral levodopa treatment. EDX found neuropathy abnormalities in 22 patients (61.0%) (Table 1), with axonal lesion predominating, and in 90.9% of patients’ sensory neuropathy was confirmed (Figure 3). The most common compromised nerve was the superficial fibular nerve, followed by the sural (Figure 4). Electromyography did not show significant changes.
Neurodynamic mobilization in a collegiate long jumper with exercise-induced lateral leg and ankle pain: A case report
Published in Physiotherapy Theory and Practice, 2018
Terry Cox, Tom Sneed, Herb Hamann
The diagnosis of peripheral neuropathic pain can be difficult. Nerve entrapment injuries do not always present with the classic neurologic signs of motor and sensory loss and/or reflex changes. Typically, peripheral nerve entrapment presents as burning pain brought about by activity and exacerbated by continued exercise with sequela of regional motor and/or sensory symptoms (Kaeding et al, 2005; McCrory et al, 2002). Nerve conduction studies are not always reliable in diagnosing lower extremity nerve lesions as it has been demonstrated that entrapment of the superficial fibular nerve does not necessarily decrease nerve conduction velocity (Styf 1988, 1989). Therefore, the clinician who is suspicious of the implications of nerve injury in an athlete complaining of lateral leg and/or ankle pain must administer a very careful and thorough examination to include the neural tissue. Although variations do exist, an understanding of the anatomical path of the nerve is essential for establishing a diagnosis as well as treatment. Basic knowledge of the microanatomy of peripheral nerve and neurons and of their complex reactions to compression is key to understanding, preventing and treating nerve compression injuries (Rempel and Diao, 2004). Additionally, efficient movement of the extremities requires that soft tissue structures, including peripheral nerves, move relative to adjacent structures and yet still have some intrinsic capacity to deform without being structurally or physiologically compromised (Butler 2000; Ellis and Hing, 2008a; Shacklock 1995). Several studies have shown the excursion of nerves during active or passive movements of the limbs (McLellan and Swash, 1976; Nakamichi and Tachibana, 1995; Wilgis and Murphy, 1986). Traction on the fibular nerve in the foot has been shown to produce a movement of the common fibular nerve ranging from 10 mm to 25 mm (Sunderland 1978). Since some degree of nerve excursion is anatomically and physiologically normal, anything that restricts gliding of peripheral nerves may predispose them to abnormal traction during various motions that result from an ankle injury (Hunt 2003; Rempel and Diao, 2004).