CLINICAL ANATOMY NOTES FROM SNELL

UPPER LIMB
Fractures of the The most commonly fractured bone in the body
Clavicle Result of a fall on the shoulder or outstretched hand
Thoracic outlet Compression of the brachial plexus and subclavian artery between
syndrome 1st rib and clavicle.
Pain down the medial side of the forearm and wasting of the small
muscles of the hand.
Fractures of the Usually the result of severe trauma (victims on crashes of automobiles)
Scapula Associated with fractured ribs.
Dropped shoulder Paralysis of the trapezius
Winged Scapula Paralysis of the serratus anterior (Long thoracic nerve injury)
Humeral Head Can occur during process of anterior and posterior dislocation of the
Fractures shoulder joint.
Greater Tuberosity Can be fractured by direct trauma
Fractures Displaced by the glenoid labrum during dislocation of the shoulder joint
Avulsed by violent contractions of the supraspinatus muscle
Lesser Tuberosity Accompanies posterior dislocation of the shoulder joint
Fractures
Surgical Neck Most commonly fractured part of the humerus
Fractures Can be fractured by a direct blow on the lateral aspect of the shoulder
or in an indirect manner by falling on the outstretched hand.
Fractures of the When the fracture line is proximal to the deltoid insertion:
Shaft of the ▪ The proximal fragment is adducted by the pectoralis major,
Humerus latissimus dorsi and teres major muscles.
▪ The distal fragment is pulled proximally by the deltoid, biceps
and triceps
When the fracture line is distal to the deltoid insertion:
▪ The proximal fragment is abducted by the deltoid
▪ The distal fragment is pulled proximally by the biceps and triceps
Radial nerve can be damaged where it lies in the spiral groove on the
posterior surface of the humerus under the cover of the triceps muscle.
Supracondylar Common in children and occur when the child falls on the outstretched
fractures hand with elbow partially flexed.
Injuries to the median, radial and ulnar nerves are not uncommon.
Medial Epicondyle Can be avulsed by the medial collateral ligament of the elbow joint of
fracture the forearm is forcibly abducted.
The ulnar nerve can be injured.
Absent Pectoralis The sternocostal origin is the most commonly missing part
Major Causes weakness in adduction and medial rotation of the shoulder joint
Spontaneous Occurs after excessive and unaccustomed movements of the arm at the
Thrombosis of the shoulder joint.
Axillary vein
Rotator Cuff aka subacromial bursitis, supraspinatus tendinitis, pericapsulitis
Tendinitis Due to wear or tear. Wear is age related.
Excessive overhead activity of the upper limb may be the cause of
tendinitis.
During abduction of the shoulder joint, the supraspinatus tendon is
exposed to friction against the acromion.

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 Friction is reduced by subacromial bursa. Degenerative changes in
bursa → degenerative changes supraspinatus tendon and may extend to
the other tendons.
Characterized by pain in the spasm of the pain in the middle range of
abduction when the diseased area impinges on the acromion.
Rupture of the The main function of the supraspinatus muscle is to hold the humerus
Supraspinatus in the glenoid fossa during abduction.
Tendon Unable to initiate abduction.
Accessory nerve Can be injured as the result of stab wounds of the neck
injury
Axillary nerve Can be injured in dislocations of the shoulder joint
injury
Anterior dislocation Results in the medial end of the clavicle projecting forward beneath the
of the skin.
sternoclavicular It may also be pulled upward by the sternocleidomastoid muscle.
joint
Posterior dislocation Usually follows direct trauma applied to the front of the joint that drives
of the the clavicle backward.
sternoclavicular More serious one because the displaced clavicle may press on the
joint trachea, the esophagus, and major blood vessels in the root of the neck.
Acromioclavicular There is a tendency for the lateral end of the clavicle to ride up over the
dislocation surface of the acromion.
Incurred during on any severe fall that can result in the acromion being
thrust beneath the lateral end of the clavicle, tearing the coracoclavicular
ligament (shoulder separation).
Anterior Inferior The most commonly dislocated large joint.
Dislocation of the Sudden violence applied to the humerus with the joint fully abducted
shoulder joint
Posterior dislocation Caused by direct violence to the front of the joint
of the shoulder joint The rounded appearance of the shoulder is seen to be lost because
the greater tuberosity of the humerus is no longer bulging laterally
beneath the deltoid muscle.
Subglenoid displacement can cause damage to the axillary nerve
Downward displacement of the humerus can cause damage to the
radial nerve.
Shoulder pain The shoulder joint is innervated by axillary nerve and subscapular
nerve.
It is very sensitive to pain, pressure, excessive traction and distention.
The muscles surrounding the joint undergo reflex spasm in response to
pain originating in the joint, which in turn serves to immobilize the joint
and thus reduce the pain.
The pain in the shoulder region can be caused by disease somewhere
else.
Dermatomes and
cutaneous nerves C3 to C6 Lateral margin of the upper limb
C7 Middle finger
C8, T1, T2 Medial margin of the upper limb
Lymphangitis Infection of the lymph vessels.
Characterized by red streaks along the course of the lymph vessels.

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Lymphadenitis Once the infection reaches the lymph nodes, they become enlarged and
tender.
Fractures of the Occurs from falls on the outstretched hand.
head of the radius As the force is transmitted along the radius, the head of the radius is
driven sharply against the capitulum or splintering the head.
Fractures of the Occur in young children from falls on the outstretched hand.
neck of the radius
Fractures of the Displacement of the fragments is usually considerable and depends on
shafts of the radius the pull of the attached muscles.
and the ulna The proximal fragment of the radius:
▪ Supinated by the supinator and the biceps brachii muscles
The distal fragment of the radius:
▪ Pronated and pulled medially by the pronator quadratus muscle.
In fractures of the ulna, the ulna angulates posteriorly.
Monteggia’s The shaft of the ulna is fractured by a force applied from behind.
fracture There is a bowing forward of the ulnar shaft and an anterior dislocation
of the radial head with rupture of the anular ligament.
Galeazzi’s fracture The proximal third of the radius is fractured and the distal end of the
ulna is dislocated at the distal radioulnar joint
Fractures of the Can result from a fall on the flexed elbow or from a direct blow.
olecranon process Avulsion fractures of the olecranon process can be produced by the pull
of the triceps muscles.
Colles’ fracture A fracture of the distal end of the radius resulting from a fall on the
outstretched hand.
Posterior displacement – “Dinner-fork deformity”
Smith’s fracture A fracture of the distal end of the radius resulting from a fall on the
back of the hand.
Anterior displacement
Fracture of the The fracture line goes through the narrowest part of the bone, which
scaphoid bone because of its location is bathed in synovial fluid.
Deep tenderness in the anatomic snuffbox after a fall on the outstretched
hand.
Dislocation of the Occasionally occurs in young adults who fall on the outstretched hand
lunate bone in a way that causes hyperextension of the wrist joint.
Fractures of the Occur as a result of direct violence such as the clenched fist striking a
metacarpal bones hard object.
“Boxer’s fracture” – commonly produces an oblique fracture of the
neck of the fifth and sometimes the fourth metacarpal bones.
The distal fragment is commonly displaced proximally, thus shortening
of the finger posteriorly.
Bennett’s fracture A fracture of the base of the metacarpal of the thumb caused when
violence is applied along the long axis of the thumb or the thumb is
forcefully abducted.
The fracture is oblique and enters the carpometacarpal joint of the
thumb, causing joint instability.
Volkmann’s Contracture of the muscle of the forearm that commonly follows
ischemic fracture of the distal end of the humerus or fractures of the radius
contracture and ulna.
Localized segment of the brachial artery goes into spasm, reducing the
arterial flow to the flexor and the extensor muscles so that they undergo
ischemic necrosis.
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 The muscles are replaced by fibrous tissue, which contracts producing
deformity.
The arterial spasm is usually caused by an overtight cast or fracture
itself.
Absent palmaris May be absent on one or both of the forearm in about 10% of persons.
longus The muscle is relatively weak, its absence produces no disability
Stenosing synovitis Fibrosis of the synovial sheath due to repeated friction between the
of the Abductor tendons and the styloid process of the radius which become
longus and Extensor edematous and swell.
Pollicis Brevis Movement of the tendons becomes restricted.
Tendons
Rupture of the Occur after a fracture of the distal third of the radius.
Extensor Pollicis Roughening of the dorsal tubercle of the radius by the fracture line can
longus cause excessive friction on the tendon which can then rupture.
RA can rupture this tendon.
Anatomic Snuffbox The triangular skin depression on the lateral side of the wrist that is
bounded:
1. Medially by the tendon of the extensor pollicis longus
2. Laterally by the tendons of the abductor pollicis longus and
extensor pollicis brevis.
The scaphoid bone and pulsations of radial artery is most easily
palpated here.
Tennis Elbow Caused by a partial tearing or degeneration of the superficial
extensor muscles from the lateral epicondyle of the humerus.
Characterized by pain and tenderness over the lateral epicondyle of the
humerus, with pain radiating down the lateral side of the forearm.
Common in tennis players, violinists and housewives.
Dupuytren’s A localized thickening and contracture of the palmar aponeurosis,
Contracture which limits hand function and may eventually disable the hand.
Carpal Tunnel It is produced by compression of the median nerve within the tunnel.
Syndrome Causes burning pain or “pins and needles” along the distribution of
the median nerve to the lateral three and a half fingers and weakness
of the thenar muscles.
Tenosynovitis of the Bacterial infection of the synovial sheath from penetration wounds.
Synovial Sheaths of May result in distention of the sheath with pus. The finger is held
the Flexor Tendons semiflexed and is swollen.
It causes pressure within the sheath and will rupture to its proximal end.
Trigger Finger Caused by a presence of a localized swelling of one of the long flexor
tendons that catches on a narrowing of the fibrous flexor sheath anterior
to the metacarpophalangeal joint.
There is a palpable and even audible snapping when a patient is asked
to flex and extend the fingers.
Fascial spaces of the They can become infected and distended with pus as a result of the
Palm and infection spread of infection in acute suppurative tenosynovitis.
Pulp-Space Infection of such a space is common and serious, occurring most often
Infection (Felon) in the thumb and index finger.
Inflammatory exudate within these compartments causes the pressure in
the pulp space to quickly rise.
Mallet finger Avulsion of the insertion of one of the extensor tendons into the distal
phalanges can occur if the distal phalanx is forcibly flexed when the
extensor is taut. The last 20O of active extension is lost.
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Buotonniere Avulsion of the central slip of the extensor tendon proximal to its
Deformity insertion into the base of the middle phalanx results in a characteristic
of deformity.
The deformity results from flexing of the proximal interphalangeal joint
and hyperextension of the distal interphalangeal joint.
Stability of the Stability due to wrench-shaped articulation surface of the olecranon and
elbow joint the pulley-shaped trochlea of the humerus.
In The medial and lateral epicondyles and the top of the
extension olecranon process are in a straight line.
In flexion The bony points form the boundaries of an equilateral
triangle.
Elbow dislocations Dislocations are common and mostly are posterior.
Posterior dislocation usually follows falling on the outstretched hand.
PDs are common in children because the parts of the bones that stabilize
the joint are incompletely developed.
Damage of the The close relationship of the ulnar nerve to the medial side of the joint
Ulnar Nerve with often results in its becoming damaged in dislocations of the joint or in
Elbow Joint Injuries fracture dislocations in this region.
Radioulnar Joint The proximal radioulnar joint communicates with the elbow joint
Disease The distal radioulnar joint does NOT communicate with wrist joint
The strength of the radioulnar joint depends on the integrity of the strong
anular ligament. Rupture of this ligament occurs in cases of anterior
dislocation of the head of the radius on the capitulum of the humerus.
Wrist joint injuries A fall on the outstretched hand can strain the anterior ligament of the
wrist joint, producing synovial effusion, joint pain and limitation of
the movement.
Falls on the 1. Forces are transmitted from the scaphoid to the distal end of the
Outstretched Hand radius
2. From the radius across the interosseous membrane to the ulna
3. From ulna to the humerus
4. Then through the glenoid fossa of the scapula to the
coracoclavicular ligament and the clavicle
5. And finally, to the sternum

Young child Posterior displacement of the distal radial

epiphysis
Teenager Clavicular fracture
Young adult Scaphoid fracture
Elderly Colles’ fracture
Allen Test Used to determine the patency of the ulnar and radial artery
Tendon Reflexes
Biceps brachii tendon C5, C6 Flexion of the elbow joint
reflex
Triceps tendon reflex C6, C7, Extension of the elbow
C8 joint
Brachioradialis tendon C5, C6, Supination of the
reflex C7 radioulnar joint

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Erb-Duchenne Palsy Excessive traction or even tearing of C5 and 6 roots of the plexus.
(Upper lesions of the It occurs in infants during a difficult delivery or in adults after a blow
brachial plexus) to or a fall on the shoulder.
Muscles paralyzed: Supraspinatus, infraspinatus, subclavius, biceps
brachii, brachialis, coracobrachialis, deltoid, teres minor
“Waiter’s tip” palsy
Klumpke Palsy Excessive abduction of the arm, as occurs in the case of a person
(Lower lesions of falling from a height clutching at an object to save him/herself.
the brachial plexus) The 1st thoracic nerve is injured.
Claw hand deformity
Long thoracic nerve Can be injured by blows to or pressure on the posterior triangle of the
neck or during the surgical procedure of radical mastectomy
Winged Scapula (paralysis of the serratus anterior muscle)
Axillary nerve Can be injured by pressure of a badly adjusted crutch pressing
upward into the armpit.
Vulnerable to downward displacement of the humeral head or
fractures of the surgical neck of the humerus.
Paralysis of the deltoid and teres minor muscles
Loss of skin sensation over the lower half of the deltoid muscle
Injuries to the Causes:
Radial Nerve in the ▪ Pressure of the upper end of a badly fitting crutch pressing up into
Axilla the armpit
(Saturday Night ▪ Drunkard falling asleep with one arm over the back of a chair
Palsy) ▪ Fractures and dislocations of the proximal end of the humerus
Motor:
▪ Unable to extend the elbow joint, the wrist joint and fingers.
▪ Wristdrop or flexion of the wrist occurs
Sensory
▪ Small loss of skin sensation occurs down to the posterior surface
of the lower part of the arm and down a narrow strip on the back
of the forearm
▪ Variable area of sensory loss is present on the lateral part of the
dorsum of the hand and on the dorsal surface of the roots of the
lateral three and a half fingers.
Injuries to the Causes:
Radial Nerve in the ▪ Fracture of the shaft of the humerus or subsequently involved
Spiral Groove during callus formation.
▪ Pressure on the back of the arm on the edge of the operating table
in an unconscious patient.
▪ Prolonged tourniquet application to the arm in a person with
slender triceps.
Motor:
▪ Unable to extend the elbow joint, the wrist joint and fingers
▪ Wristdrop occurs
Sensory:
▪ A variable small area of anesthesia is present over the dorsal
surface of the hand and the dorsal surface of the roots of the
lateral three and a half fingers.

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Injuries to the Causes:
Radial Nerve in ▪ Fractures of the proximal end of the radius
Deep Branch ▪ Dislocation of radial head
Motor:
▪ Wrist joint is keep extended and no wrist drop will occur
Musculocutaneous Injury results to paralysis of the biceps and coracobrachialis.
nerve Sensory loss along the lateral side of the forearm.
Injuries to the Causes:
Median Nerve at the ▪ Supracondylar fractures of the humerus
Elbow ▪ Stab wounds or broken glass just proximal to the flexor
retinaculum
Motor:
▪ Flexion of the terminal phalanx of the thumb is lost because of
the paralysis of the flexor pollicis longus
▪ The muscles of the thenar eminence are paralyzed and wasted so
that the eminence is flattened.
▪ The thumb is laterally rotated and adducted.
▪ Apelike hand deformity or Benediction sign
Sensory/Vasomotor/Trophic changes:
▪ Skin sensation is lost on the lateral half or less of the palm of the
hand and the palmar aspect of the lateral three and a half fingers
▪ Warmer and drier due to absence of sweating
▪ Skin is dry and scaly. The nails crack easily. Atrophy of the pulp
fingers.

Injuries to the The muscles of the thenar eminence are paralyzed and wasted so that
Median Nerve at the the eminence is flattened.
Wrist Opposition of the thumb is impossible
Sensory, vasomotor and trophic changes are identical to the elbow
lesions.
Injuries to the Ulnar Cause:
nerve at the Elbow ▪ Fractures of the medial epicondyle
Motor:
▪ The flexor carpi ulnaris and medial half of the flexor digitorum
profundus muscles are paralyzed.
▪ The profundus tendons of the ring and little fingers are not
capable of being markedly flexed
▪ Flexion of the wrist joint will result in abduction, owing to
paralysis of the flexor carpi ulnaris.
▪ The small muscles of the hand will be paralyzed, except the
muscles of the thenar eminence and the first two lumbricals.
▪ The patient is unable to adduct and abduct the fingers and
consequently is unable to grip a piece of paper placed between
the fingers.
▪ It is impossible to adduct the thumb bc the adductor pollicis
muscle is paralyzed.
▪ (+) Froment’s sign – weakened pinch grip
▪ The metacarpophalangeal joints become hyperextended.
▪ The interphalangeal joints are flexed.
▪ “Claw” deformity

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 Sensory/Vasomotor changes:
▪ Loss of skin sensation will be observed over the anterior and
posterior surfaces of the medial third of the hand and the medial
one and a half fingers.
▪ Skin areas are warmer and drier.
Injuries to the Ulnar Motor:
nerve at the Wrist ▪ The small muscles of the hand will be paralyzed, except the
muscles of the thenar eminence and the first two lumbricals.
▪ Clawhand is much more obvious in wrist lesions
Sensory:
▪ Sensory loss will be confined to the palmar surface of the medial
third of the hand and medial one and half fingers and to the dorsal
aspects of the middle third and distal phalanges.

Note: Unlike median nerve injuries, lesions on the ulnar nerve leave a
relatively efficient hand. The sensation over the lateral part of the hand
is intact, and the pincer-like action of the thumb and index finger is
reasonably good, although there is some weakness owing to loss of the
adductor pollicis.

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LOWER LIMB
Head of the Femur Can be palpated on the anterior aspect of the thigh, just inferior
to the inguinal ligament and just lateral to the pulsation of femoral
artery.
Blood Supply to the Femoral head – small branch of obturator artery
Head and Neck of Femoral neck – medial femoral circumflex artery
Femur
Femoral Neck angle
inclined with the Young child 160˚
shaft Adult 125˚
Coxa valga Increase in angle
Congenital dislocation of the hip
Adduction of hip joint is limited
Coxa vara Decrease in angle
Fractures of the neck of the femur and in
slipping of the femoral epiphysis
Abduction of hip joint is limited
Shenton’s line Useful means of assessing the angle of the
femoral neck on a radiograph of the hip region
Subcapital Fracture Occurs in the elderly and is usually produced by a minor trip or
stumble
Common in women after menopause.
Trochanteric Occurs commonly in the young and middle-aged as a result of direct
Fracture trauma
Fracture of the shaft Occurs usually in the young and healthy persons.
of Femur
3 Types:
1. Fractures of the upper third of the shaft
2. Fractures of the middle third of the shaft
3. Fractures of the distal third of the shaft

Considerable traction on the distal fragment is usually required to

overcome the powerful muscles and restore the limb to its correct
length before manipulation and operative treatment to bring the
proximal and distal fragment into correct alignment.

Gluteus maximus The great thickness of this muscle makes it ideal for IM injections.
and IM injections To avoid injury to the underlying sciatic nerve, the injection should
be given well forward on the upper outer quadrant.
Gluteus maximus Bursitis can be caused by acute or chronic trauma. An inflamed
and Bursitis becomes distended with excessive amounts of fluid and can be
extremely painful.

Gluteus medius and These muscles may be paralyzed when poliomyelitis is involves the
minimus and lower lumbar and sacral segments of the spinal cord.
Poliomyelitis Paralysis of these muscles interferes with the ability of the patient to
tilt the pelvis when walking.

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Quadriceps femoris Quadriceps femoris is a most important extensor muscle of the knee
as Knee stabilizer joint.
Its tone greatly strengthens the joint; therefore, this muscle mass
must be carefully examined when disease of the knee joint is
suspected.
The vastus medialis is the first part of the quadriceps muscles to
atrophy in knee joint disease and last to recover.
Rupture of the It can rupture in sudden violent extension movements of the knee
Rectus Femoris joint
Rupture of the It occurs when a sudden flexing force is applied to the knee joint
Ligamentum Patellae when the quadriceps femoris muscle is actively contracting.
Adductor muscles In patients with cerebral palsy who have marked spasticity of the
and Cerebral palsy adductor group of muscles. It is a common practice to perform a
tenotomy of the adductor longus tendon and to divide the anterior
division of the obturator nerve.
Referred Pain from Pain originating from the hip joint to be referred to the front and
the Hip Joint medial side of the thigh. Sometimes hip joint disease gives rise to
pain in the knee joint.
Traumatic It usually caused by motor vehicle accidents.
Dislocation of the The head of the femur is displaced posteriorly out of the acetabulum
Hip and it comes to rest on the gluteal surface of the ilium (posterior
dislocation).
Trendelenburg’s It is a test for patients with defective hip stability, when asked to stand
Sign on one leg with the foot of the opposite leg raised above the ground
then the pelvis will sink downward on the opposite, unsupported side.
(e.g. right-sided congenital dislocation of the hip)
If the patient is asked to walk, he or she will show the characteristic
“dipping” gait.
In patients with bilateral congenital dislocation of the hip, it will show
“waddling” gait.
Arthritis of the Hip Osteoarthritis, the most common disease of the hip joint in adult. It
joint causes pain, stiffness and deformity. The pain may be in the hip joint
itself or referred to the knee.
Patellar dislocations Traumatic dislocation of the patella results from direct trauma to the
quadriceps attachments of the patella.
Patellar fractures Direct violence due to automobile accidents, it is broken into several
fragments.
May result in open fracture.
Indirect violence due to sudden contraction of the quadriceps
snapping the patella across the front of the femoral condyles. May
result in transverse fracture.
Fractures of the Fractures of the tibia and fibula are common.
Tibia and Fibula If only one bone is fractured, the other acts as a splint and
displacement is minimal.
Fractures of the shaft of the tibia are often open.
Fractures of the distal third of the shaft of the tibia are prone to
delayed union and non-union.
Fractures of the proximal end of the tibia, usually results from direct
violence to the lateral side of the knee joint. The tibial condyle may
show a split fracture or be broken up or the fracture line may pass
between both condyles in the region of the intercondylar eminence.
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 Fractures of the distal end of the tibia are considered with the ankle
joint.
Fractures of the Neck fractures – occur during violent dorsiflexion of the ankle joint.
Talus Body fractures – occur during jumping from a height.
Fractures of the Compression fractures result from falls from a height.
Calcaneum The weight of the body drives the talus downward into the calcaneum,
crushing it in such a way that it loses vertical height and becomes
wider laterally.
Fractures of the The base of the 5th metatarsal can be fractured during forced
Metatarsal Bones inversion of the foot.
Stress fracture of a metatarsal bone is common in jogger and in
soldiers after long marches. It occurs frequently om the distal third
of the 2nd, 3rd or 4th metatarsal bone.
Ruptured tendo Common in middle-aged men and occurs frequently in tennis players.
calcaneus It is impossible for the patient to plantar flex the foot.
Plantaris tendon and These tendons can be used for tendon autografts in repairing several
palmaris longus flexor tendons to the fingers.
tendon
Plantar fasciitis Occurs when doing a great deal of standing or walking which causes
pain and tenderness of the sole of the foot. Repeated attacks can cause
calcaneal spur.
Medial collateral Can be torn during forced abduction of the tibia on the femur.
ligament Note:
*Tears of the menisci result in localized tenderness on the joint line.
*Sprains of the medial collateral ligament result in tenderness over
the femoral or tibial attachments of the ligament.
Lateral collateral Forced abduction of the tibia on the femur.
ligament
ACL Most frequently injured ligament in the body.
More common in women bc of the wider pelvis.
Injury to the cruciate ligaments is always accompanied by damage to
other knee structures such as torn collateral ligaments or damaged
capsule.
ACL injury – tibia can be pulled excessively forward on the femur
PCL injury – tibia can be pulled excessively backward on the femur

Note: Tears of the PCL are rare.

Meniscal Injury The medial meniscus is damaged more frequently than the lateral.
Acute Sprains of the Caused by excessive inversion of the foot with plantar flexion of the
Lateral Ankle ankle.
Acute Sprains of the Caused by excessive eversion of the foot.
Medial Ankle
Fracture dislocation Caused by forced external rotation and overeversion of the foot.
of the Ankle joint The talus is externally rotated forcibly against the lateral malleolus of
the fibula.
Hallux valgus The lateral deviation of the great toe at the metatarsophalangeal joint.
Patellar tendon L2, 3, 4 (extension of the knee)
reflex
Achilles tendon S1 and S2 (plantar flexion of the ankle joint)
reflex

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Femoral nerve injury The quadriceps femoris muscle is paralyzed and the knee cannot
be extended.
Skin sensation is lost over the anterior and medial sides of the thigh,
the medial side of the of the lower part of the leg and along the medial
border of the foot up to the big toe.
Sciatic nerve injury Most frequently injured by badly placed IM injections in the gluteal
region.
The hamstrings muscles and all the muscle below the knee are
paralyzed (footdrop).
Sensation is lost below the knee except for the medial side of the lower
part of the leg.
Sciatica – pain along the sensory distribution of the sciatic nerve.
Common peroneal The site is exposed to direct trauma or is involved in fractures of the
nerve injury upper part of the fibula. Injury cases footdrop.
Muscles of the anterior and lateral compartments of the leg are
paralyzed.
Loss of sensation down the anterior and lateral sides of the leg and
dorsum of the foo and toes.
Tibial nerve injury All the muscles in the back of the leg and the sole of the foot are
paralyzed.
Calcaneovalgus occurs.
Sensation is lost in the sole of the foot.

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