M. Shuja Tahir Faisalabad, Pakistan IR-038

115 April to June, 2010 I N D E P E N D E N T R E V I E W S

Anatomy CLINICAL ASSESSMENT The root value of lateral popliteal LOOKnerve is lumbar 4,5 - sacral1,2. It is Look for abnormalities;lateral branch of sciatic nerve at superior angle of popliteal fossa. It Foot drop is seen.winds around the fibular neck Equino varus deformity is seen.where it is susceptible to injury. It gives following branches; Check gait;! Communicating sural nerve. It is slapping and excess pressure is ! Lateral cutaneous nerve of the seen on outer side of the foot. The

calf. toe of shoe is scuffed.! Extensors and abductors of leg.! Evertors of foot. FEEL! Skin over peroneal and Check sensations;

extensor compartment of the f ine touch, pin pr ick and leg temperature sensat ions are

! Knee joint and superior tibio checked.fibular joint.

There is loss of sensations over the It is injured due to injury just below lateral and anterior aspect of leg the knee joint. It is associated with along with medial aspect of the fracture neck of fibula or in tight dorsum of the foot.fitting plasters.

MOVEIt may also be injured accidently Check for eversion of foot against during surgery for varicose veins. resistance;Its injury leads to loss of function of muscles of anterior and lateral Failure to do so is due to paralysis of compartments of the leg below everters such as;knee and short extensor muscles of the toes. Peroneus longus and peroneus

brevis SPECIAL INTERVIEWQuestions should be asked to find Examine extension / dorsiflexion at out difficulty in walking and history the ankle and other joints of the foot of injury or plaster application. and toes.

Failure to do so is due to paralysis of

EXAMINATION OF COMMON

PERONEAL NERVE

Clinical Skills

116April to June, 2010 I N D E P E N D E N T R E V I E W S

Ankle jerk

t h e m u s c l e s o f e x t e n s o r performed and its record is kept for compartment. future reference and comparison.

Motor function grading is described REFLEXESas below ;Ankle jerk is absent on the affected

side.

GRADINGSensory, motor and vasomotor changes are examined to have adequate assessment of the neuronal injury. The grading of muscle power (motor function) is

Testing fine touch sensationGrade Power

No contractionFlicker or trace of contractionActive movement in a plane perpendicular to gravityActive movement against gravityActive movement against gravity and resistance (weaker than normal)Normal power

012

34

5

SPECIAL INTERVIEW

LOOK

for Foot drop Equinovarus deformity High stepping gait

FEEL

Sensation at lateral and anterior aspectof leg with medial part of dorsum of foot

MOVE

Eversion of footDorsiflexion of toes and ankle Ankle reflex

CHECK LIST

The author :Muhammad Shuja Tahir

FRCS (Ed), FCPS (Hon)

is professor and head of the department of Surgery at Independen t Med ica l College Faisalabad.shuja@iu-hospital.com