Case 1 Peroneal Nerve Injury

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TRUNK AND LOWER EXTREMITY

Name

Date

LEFT LEG MUSCLE

PERIPHERAL NERVES

ERECTOR SPINAE

SERRATUS POST SUP

TRANS THORACIS

INT INTERCOSTALS

EXT INTERCOSTAL S

SUBCOSTALES

LEVATOR COSTARUM

OBLIQUUS EXT ABD

RECTUS ABDOMINIS

OBLIQUUS INT ABD

TRANSVERSUS ABD

SERRATUS POST INF

QUAD LUMBORUM

PSOAS MINOR

PSOAS MAJOR

QUADRICEPS

ADDUCTOR BREVIS

ADDUCTOR LONGUS

OBTURATOR EXT

ADDUCTOR MAGNUS

GLUTEUS MEOIUS

GLUTEUS MINIMUS

TENSOR FAS LAT

GLUTEUS MAXIMUS

GEMELLUS SUP

OBTURATOR INT

GEMELLUS INF

QUADRATUSFEM

BICEPS (SHORT H)

BICEPS (LONG H)

SEMITENDINOSUS

SEMIMEMBRANOSUS

C5 I TIBIALIS ANTERIOR

0 lEXTHALLLONG

Q I EXT DIGIT LONG Q I PERONEUS TERTI US

EXT DIGIT BREVIS

PERONEUS LONGUS

PERONEUS BREVIS

GASTROCNEMIUS

TIBIALIS POSTERIOR

FLEX DIGIT LONG

FLEX HALL LONG

FLEX DIGIT BREVIS

ABDUCTOR HALL

FLEX HALL BREVIS

LUMBRICALIS I

ABD DIGIT! MIN

QUAD PLANTAE

FLEX DIGITI MIN

OPP. DIGIT! MIN

ADDUCTOR HALL

PLANT INTEROSSEI

DORSAL INTEROSSEI

SPINAL SEGMENT

0 Dorsal Primary Ramus V Venlral Primary Rams A Arfatr DMsai P Pcsteror DMBD

The patient, on whom muscle and sensory tests were done 6 weeks after onset, had fallen through a glass door and sustained a laceration injury of the left leg. Muscle test findings indicated the following:

Involvement of the nerve branches to the flexor digitorum longus and flexor hallucis longus, without involvement of the tibial nerve and its terminal branches.

Involvement of the superficial peroneal nerve and of the deep peroneal nerve, probably below the level of a proximal branch to the tibialis anterior.

The weakness of the posterior tibial muscle may have been caused by trauma of the muscle rather than by nerve involvement, because it made a complete recovery within 3k months after onset. By that time, the flexor digitorum longus and flexor hallucis longus had made a good recovery, and by the end of 6 months, they had made a complete recovery. Progress was slow, and muscle weakness remained in all muscles supplied by the deep and superficial peroneal nerves.

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Tibial

Tibial

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DIAGNOSTIC CHART FOR NERVE LESIONS: TRUNK AND LOWER EXTREMITY

Name-

Date

DIAGNOSTIC CHART FOR NERVE LESIONS: TRUNK AND LOWER EXTREMITY

Name-

Date

DIAGNOSTIC CHART FOR NERVE LESIONS: TRUNK AND LOWER EXTREMITY

Date.

DIAGNOSTIC CHART FOR NERVE LESIONS: TRUNK AND LOWER EXTREMITY

Date.

ygfi

TRUNK AND LOWER EXTREMITY

Name

Date to

MUSCLE

peripheral nerves erector spinaf serratuspost sup trans thoracis int intercostals

EXT INTERCOSTALS

SUBCOSTALES

levator costarum obuouus ext abo rectus abdominis obliouus int abd transversus abo serratus post inf quad lumborum psoas minor psoas major

ILIACUS

pectbteus

SAHTORIUS

QUADRICEPS

adductor brevis adductor longus gracilis obturator ext adduçtqr^maçjnijs gluteus mechus

GLUTEUS MINIMUS

tensor fa5lat

GLUTEUS MAX (MUS

piriformis gemellus sup obturator int i gemellus inf

1 ouadratus fem a- 7 } biceps ishort hi

1 BICEPS (LONG H)

spinal segment

S 1 7 < SEMITENDINOSUS

"6

SEMIMEMBRANOSUS

tib iaus anterior ext hall long ext digit long peroneus tert1us

EXT DiGrT BREVIS

peroneus longus peroneus brevis plantaris

GASTROCNEMIUS

POPUTEUS

D Dorsal Primary Ramus

V Ventral Primary Ramus

A Anterior Division

P Posterior Dwislon spinal segment j 3 3 3 3 m

Muscle test findings indicate a possible L5 lesion. Numerous muscles that receive innervation from L4 were normal in strength, leading to the assumption that L4 was not involved. The patient was able to stand on one foot at a time and rise on the toes without any difficulty, hence the normal grade for the gas-trocnemius. With the innervation to this muscle from SI and S2, the grade of normal rules out the probability of a disk below L5.

Subsequent examination by a neurologist confirmed a probable disk lesion, and the patient had a complete recovery.

7 tibialis posterior fe flex digit long [ 7 i flex hall long flex digit brevis abductor hall flex hall brevis lumbricaus i abd digiti min

] QUAD PLANTAE

flex dksftl mln opp digiti min adductor hall

PLANT INTEROSSEI

-- i dorsal interossei

I LUMB II.HI.IV

1So-

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1So-

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Domiatomes rodhwn "w" | M , j Keegan and Gamm AMI RM 102-*37va-Cuuiwom OMAufoo ol p*"!*4™ TT ?Mi cd redrawn inyn O/a/i Afl&otry oT iri# ööoy

© 200S Florence P. Kendall.

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