Lower Extremity

Question 1

Adduction

Answer 1

Adduction - A motion that pulls a structure or part towards the midline of the body

Question 2

Dorsiflexion

Answer 2

Dorsiflexion - flexion of the entire foot superiorly, or upwards

Question 3

Plantarflexion

Answer 3

Plantarflexion - Flexion of the entire foot inferiorly, or downwards

Question 4

Eversion

Answer 4

Eversion - the movement of the sole of the foot away from the median plane.

Question 5

Inversion

Answer 5

Inversion - the movement of the sole towards the median plane

Question 6

Lumbar plexus are what roots?

Answer 6

L2- S3
L2-4 lateral cutaneous of the thigh, obturator, and femoral nerves all innervate anterior leg (anterior to the pelvis)
L4, L5, S1-4 Sciatic nerve (innervates posterior leg) then divides to become the tibial (posterior tibial and sural) and common peroneal*****

Question 7

What forms the sciatic nerve?

Answer 7

The LS plexus is created by the nerve roots of L4-L5 and S1-S3 and primarily forms the SCIATIC nerve

Question 8

Motor and sensory to the posterior aspect of the lower extremity and foot is what?

Answer 8

The SCIATIC nerve supplies innervation, both motor and sensory, to the POSTERIOR aspect of the entire Lower Extremity and the foot

Question 9

Which is the largest nerve?

Answer 9

The Sciatic nerve is the LARGEST nerve in the body, usually measuring about 2.5 cm wide (about as wide as your thumb)

Question 10

Sciatic block complication

Answer 10

Nerve injury*** due to an internerual injection

Question 11

Common peroneal nerve stimulation does what?

Answer 11

Common peroneal nerve** (foot drop) (lateral side)

Dorsiflexion and eversion**

Question 12

Tibial nerve stimulation does what?

Answer 12

Tibial nerve***

Plantarflexion and inversion***

Question 13

What are the 5 nerves for the ankle block?

Answer 13

3 superficial nerves

• -Saphenous (femoral) (cant do an ankle sx with this)
• -Sural (tibial) (terminal branch) (lateral)
• -Superficial Peroneal (common peroneal) (terminal branch)

2 Deep nerves

• -Posterior Tibial Nerve (tibial) (terminal branch)
• -Deep peroneal (common peroneal) (terminal branch)

Question 14

How do you block the deep peroneal nerve?

Answer 14

• -Finger on the groove just lateral to the extensor hallucis longus
• -Needle hits bone w/d 1-2 cm
• -Inject 5 ml of LA
• -FAN

Question 15

How do you block the posterior tibial nerve?

Answer 15

• –To block the Tibial nerve, the Tibial artery is palpated and anterior to the arterial pulse, a 25g needle is inserted and 5-8cc of LA is injected
• -If the artery can’t be palpated, inject just posterior to the medial malleolus, aspirating before and after injection
• -Make sure you aspirate prior to this particular injection since you are in very close proximity to the Tibial artery

Question 16

Posterior TibIAL is medIAL, how do you block it?

Answer 16

=Needle groove behind the medial malleolus

-Hit bone w/d 1cm and fan injection of 3ml

Question 17

Block superficial peroneal, sural and saphenous nerves at the ankle, how?

Answer 17

• -All superficial to deep fascia
• -Injection of LA in territory in which they descend.
• -Fan about 4-5 cc of LA at each site
• -No EPI

Question 18

Saphenous is blocked where?

Answer 18

Saphenous = medial, in front of the malleolus

Question 19

Superficial Peroneal is blocked where?

Answer 19

SQ infiltration of LA over lateral aspect of foot.

Question 20

SuRAL is where?

Answer 20

SuRAL is lateRAL