Lower limb nerve entrapment syndromes

Abstract

The largest nerve in the body, the sciatic nerve, divides into the peroneal and tibial nerves proximal to the popliteal fossa. Patients with peroneal nerve injury present with foot drop, frequent falls, and dysesthesias over lateral half of anterior leg and/or dorsum of the foot. Gender-related concerns in peroneal neuropathy include prolonged knee flexion during parturition, female prevalence of gastric bypass, and female prevalence of ligamentous knee injuries. Patients with tibial nerve injury present with dysesthesias over medial malleolus and/or sole of the foot including the toenails, nocturnal exacerbation of symptoms, and motor weakness in plantar flexion and/or inversion of ankle. Gender issues in tibial neuropathy include prevalence of rheumatologic disease and ligamentous injuries in women. Nerve lesions can afflict the upper or lower lumbar plexus. Patients with upper lumbar plexopathies present any combination of the following: weakness in hip flexion, knee extension, and hip abduction; sensory abnormality in anterior pelvic area and anterior, medial, or lateral thigh with radiation down to posterior-medial leg; and absent or decreased deep tendon reflex at the patellar tendon. Patients with lower lumbosacral plexopathies present with any combination of the following: weakness in hip extension, hip abduction, knee flexion, and motion at the ankle or toes; sensory abnormality in the posterior thigh, all of the leg except for saphenous nerve area, and both dorsum and sole of the foot; and absent or decreased deep tendon reflex at the Achilles tendon. Gender issues in plexopathy include parturition-related injuries and breast and gynecologic cancers.