Peripheral Nerve Injury

PT MS 2
Neurologic Physical Therapy
Learning Objectives
- Identify the basic anatomical and physiological principles of nerve
- Classify the different nerve injury stages
- Identify the non-traumatic and traumatic causes of peripheral nerve injuries
- Determine the different nerves that belongs to the brachial plexus and its
injuries
- Determine the different nerve injuries of the upper and lower extremities
Wallerian Degeneration
● active process of anterograde degeneration of the distal end of an axon
● Caused by a nerve lesion
○ UMNL - Stroke, TBI, MS, SCI*
○ LMNL - Peripheral nerve injuries, GBS, Lyme Disease
● 3 Stages
○ Axon Degeneration
○ Myelin Clearance
○ Regeneration
Some
Idiots
In
Georgia

Likes
Facial
Oh!
Peripheral Nerve Injury
 PERIPHERAL NERVE INJURIES: MONONEUROPATHIES OF UPPER AND LOWER EXTREMITY

UPPER EXTREMITY
NERVE/S AFFECTED HISTORY/ONSET/CAUSES SENSORY NERVES/MUSCLES CLINICAL MANIFESTATIONS TREATMENT
AFFECTED

BRACHIAL PLEXOPATHY

Upper Trunk - Trauma Motor: ● Weakness of muscles affected Management of brachial plexopathy includes
(C5-C6) ● Supraspinatus, infraspinatus ● Waiter’s tip position proper positioning with orthoses to stabilize
- Closed Injury (traction - when head and neck forcibly bent ● Upper portion pectoralis major ● Paralysis or limpness of the shoulder, affected joints and improve function.
Aka Erb Palsy, Erb-Duchenne Palsy away from the shoulder) ● Biceps arm and elbow
● Pronator teres, flexor carpi radialis ● Burners or stinging sensation in arms
Suprascapular - Open Injuries (knife and missile wounds) ● Brachioradialis
Lateral pectoral ● Deltoid Long thoracic Range-of-motion exercises and
Musculocutaneous - Fracture of clavicle and shoulder Serratus anterior physiotherapy
Lateral portion median Sensory: ● Winging of the medial scapular border at are important to reduce contractures and
Portion of radial - Newborns during delivery (upper trunk is mostly affected) ● Lateral antebrachial cutaneous (LAC) rests strengthen recovering motor function.
Axillary ● Median ●
- Shoulder dystocia ● Radial ● Shoulder abduction and flexion limited to
90°
- Forceps delivery and prolonged labor ●
● Sensory normal
- Lung (Pancoast tumor), breast metastatic tumors and Medication management is appropriate for
lymphoma Suprascapular neuropathic pain, which can be prominent.
Supraspinatus
Infraspinatus
● Weakness of abduction and external
rotation Surgical treatment can consist of neurolysis
Middle (C7) Long thoracic Motor: ● Tenderness at suprascapular notch or
Serratus anterior Latissimus dorsi ● May be difficult to differentiate from primary nerve repair.
Thoracodorsal Teres major rotator cuff tear
Subscapular Traumatic All radial muscles (except brachioradialis)
Radial Surgery: thoracotomy, radical mastectomy, axillary node Pronator teres, flexor carpi radialis Axillary
Lateral portion median resection, Deltoid
first rib resection Sensory: ● Weakness abduction (intact Tendon or nerve grafting and transfer can be
Acute brachial plexitis Median supraspinatus may used if there is no improvement or if there is
Idiopathic Radial ● compensate) a
● Small area of sensory loss over deltoid plateau in recovery
Suprascapular
Supraspinatus Musculocutaneous
Lower Trunk (C8-T1) Motor:
Infraspinatus Biceps
Lower pectoralis major
Brachialis
Medial Pectoral All ulnar muscles
Trauma: blunt, scapular fracture ● Weakness of elbow flexion
Ulnar All median muscles except pronator teres and
Compression at suprascapular notch or spinoglenoid notch ● Sensory loss radial aspect of forearm
Medial Portion Median flexor
Sports: baseball, volleyball
carpi radialis
 Acute brachial plexitis Spinal accessory
Sensory: (cranial nerve 11)
Axillary Ulnar to fifth digit Sternocleidomastoid
Deltoid Medial Trapezius
● Shoulder depressed, weakness of
Cords Trauma: Shoulder dislocation, fracture neck of humerus, Motor: shoulder shrug,
blunt Biceps ● flexion, abduction
Lateral (C5-C7) trauma Pronator teres ● Lateral winging of scapula
Injections, shoulder surgery Flexor Carpi Radialis
Musculocutaneous nerve Positional (prone with arms over head)
Lateral portion median Acute brachial plexitis Sensory:
LAC
Musculocutaneous Median to first digit
Biceps
Brachialis
Posterior (C5-C8, T1) Motor:
Latissimus dorsi
Trauma-humerus fracture, stab, gun shot
Thoracodorsal Teres major
Strenuous exercise, violent elbow extension
Subscapular Deltoid
Axillary All radial muscles
Spinal accessory
Radial
(cranial nerve 11)
Sensory:
Sternocleidomastoid
Median to third digit
Trapezius
Radial to first and third digits
Cervical lymph node dissections, radical neck dissection,
carotid
Medial (C8-T1) endarterectomy All ulnar muscles
Blunt injury to posterior neck, compression from slings All median muscles excepts pronator teres and
Ulnar Heavy lifting with turning of head flexor carpi radialis
Median half of median
Sensory:
Ulnar to fifth digit
MAC

Median Neuropathies
(C6, C7, C8, T1)
Nerves Affected
● Anterior Interosseous Nerve
○ Anterior Interosseous
Syndrome
● Palmar Cutaneous Branch
● Digital Cutaneous Branch
Anterior Interosseous Syndrome Motor Anterior Interosseous Syndrome For Anterior Interosseous Syndrome
History - Pronator teres m. ● Muscle weakness ● Conservative treatment
- Purely motor syndrome - Flexor carpi radialis ● Pain in the forearm ○ NSAIDs
- Weakness of flexion of IPl joint of the thumb and - Flexor digitorum superficialis ○ Posterior elbow splint
DIP joints of the index and middle fingers - Flexor digitorum profundus (second Pronator Syndrome ● Surgical decompression
Onset and third digits) ● Pain ○ If there is no motor
- Direct trauma, inflammation, strenuous exercise, - Flexor pollicis longus ● Paresthesia (digits 1st-3rd) recovery
variant of brachial neuritis, compression by - Pronator quadratus ● Muscle weakness ● Avoidance of repetitive elbow
anomalus fibrous bands in this region - Abductor pollicis brevis ● Tenderness flexion, pronation, or forced
Causes - Opponens pollicis brevis gripping.
- repetitive forearm flexion or pronation - Lumbrical 1 and 2 Carpal Tunnel Syndrome
- elbow or forearm fracture ● Paresthesia and numbness (2nd-3rd
- brachial neuritis Sensory digits) For Pronator Syndrome
● Numbness ● Nocturnal awakening ● Conservative treatment
Pronator Syndrome ● Paresthesias ● Muscle weakness ● Surgical decompression
History ● Pain ● Atrophy
- Mimics CTS For Carpal Tunnel Syndrome
- Involvement of the skin over the thenar eminence ● Conservative treatment
- (-) Nocturnal Pain ○ Wrist Splint (0 to 5
Onset degrees of extension)

Ulnar Mononeuropathies
(C8-T1)
(Merge to form the lower trunk of the
brachial plexus)
Ulnar nerve:
- Branch to palmaris brevis
- Superficial terminal branch
- Deep branch
- Opponens digiti
- Hypothenar muscles
- Interossei
- Lumbricals 3 and 4
- Adductor pollicis
- Flexor pollicis brevis
● Medial ante-brachial cutaneous
branch
● Compression of median nerve as it passes ○ NSAIDs
between the: ○ Oral Steroids
○ two heads of pronator teres ○ Carpal tunnel injection
○ facial band of flexor digitorum ● Ultrasonography (US)
superficialis ● Avoidance of exacerbating
○ Biceps aponeurosis activities (repetitive or excessive
Causes wrist flexion and extension and
- Trauma from repetitive overuse gripping)
- Tight casting
- Penetrating injuries
- intravenous catheter
- carrying bag with arm flexed (“grocery
bag neuropathy”)
Carpal Tunnel Syndrome
History
- Women > men
- Often bilateral but more severe in dominant hand
- Medical conditions assoc: DM, hyperthyroidism,
RA, obesity, pregnancy
- Majority are idiopathic
Onset
- Median entrapment at wrist
Causes
- Repetitive hand and wrist movement
- Obesity, pregnancy, lupus etc.
Ulnar neuropathy at the elbow (UNE) Motor: Ulnar Neuropathy at the Elbow Non surgical tx:
History: ● Flexor carpi ulnaris ● Prevent prolonged elbow flexion
- Incidence rates 25.2-32.7 for men & 17.2-18.9 for ● Flexor digitorum profundus - Dysesthesia by using a splint
women ● Palmar cutaneous branch - sensory change over the ulnar aspect of ● Avoid repetitive elbow flexion
Onset: ● Dorsal cutaneous branch the hand ● Avoid power gripping
- Dysesthesia ● Branch to palmaris brevis - entire hand feels numb ● Use of cushion on the
- Sensory change over the ulnar aspect of the hand ● Branch to palmaris brevis - pain or discomfort over the medial posterior-medial elbow to prevent
- Pain or discomfort over the medial aspect of the ● Deep branch aspect of the forearm nerve compression
forearm ● Opponens digiti - loss of dexterity and grip strength ● Patient education: avoid tobacco
Progression: ● Hypothenar muscles - difficulty with eating and dressing use
- Loss of dexterity ● Interossei - altered sensation in the ulnar distribution Surgical tx:
- Loss of grip strength ● Lumbricals 3 and 4 of the hand ● Transposition of nerve
- Diff. with eating and dressing ● Adductor pollicis ● Release of fascia associated with
- (+) Tinel's sign ● Flexor pollicis brevis Ulnar Neuropathy at Wrist the twin heads of the flexor carpi
Causes: - altered sensation in the fourth and fifth ulnaris
- Repetitive elbow flexion digits
- Gripping - sparing of the dorsal ulnar region of the
- External pressure over the ulnar groove hand
- Older age - weakness of all the ulnar innervated
- Male gender hand muscles
- Smoking - sparing of hypothenar musculature and
sensation
Ulnar neuropathy at the wrist (UNW) - weakness in the interossei
History: - sensory loss without weakness
- Rare compared with UNE and CTS and has a
more varied presentation

Radial Mononeuropathies
(C5-C8)
- Radial nerve = Largest terminal
branch of brachial plexus
- Posterior
interosseous nerve
- Superficial radial
sensory nerve.
Onset:
- Sensory s motor loss
- Motor s sensory loss
- sparing of hypothenar musculature and sensation
Cause:
- Nerve is compressed within the Guyon canal
- Pt has altered sensation in the 4th and 5th digits
- sparing of the dorsal ulnar region of the hand
- Weakness of all the ulnar innervated hand
muscles
Radial Neuropathy at the Spiral Groove ● Triceps Radial Neuropathy at the Spiral Groove RMN at the spinal groove
History: ● Brachioradialis - delayed radial nerve palsy ● d/t fracture: no recovery w/in
- Injury to the radial nerve occurs at the radial ● Extensor carpi radialis longus and - wrist drop and inability to extend the 8-10wks: surgical exploration
groove from fracture of the humerus as a result of brevis fingers
● No return of function after 1yr.:
the nerve’s close association with the humerus in ● Supinator - Spared Extension of the elbow
the spiral groove. ● Digitorum communis - Elbow flexion might be mildly weak tendon transfer
Onset: ● Extensor carpi ulnaris - Median and ulnar innervated muscles ● Cock-up splint - used after surgery
- Wrist drop ● Extensor pollicis longus and brevis should be strong to maintain wrist and finger in
- Inability to extend fingers ● Abductor pollicis longus - Finger abduction can falsely appear extension
- Mildly weak elbow flexion ● Extensor indicis weak
- Weak finger abduction unless the ● Extensor digiti minimi - Sensation is abnormal in the lateral Posterior interosseous neuropathy
metacarpophalangeal joints of the hand are held aspect of the dorsum of the hand and
● Avoidance of provocative activities
in passive extension the dorsum of digits one through four.
- Abnormal sensation in the lateral aspect of the - Brachioradialis reflex is diminished or ● Oral NSAIDs
dorsum of the hand and the dorsum of digits 1-4 absent ● Splint
- Brachioradialis reflex is diminished or absent - Triceps and biceps reflexes are spared. ● Surgery: no improvement after
- Diminished triceps reflex (radial lesion is more - Weakness of the deltoid muscle 4-12wks and severe ms atrophy
proximal) ● Surgical exploration: if there is
Cause: mass lesion
- External compression from tourniquets.
● Tendon transfer: if there is no
- Prolonged sleep or unconsciousness
- Honeymooner’s paralysis return of strength
- Pt arm is draped over a chair for a long period
(saturday night palsy)
- Poorly placed injections
- humeral fracture as a result of compression or
entrapment within the healing callous.
Posterior Interosseous Neuropathy (PIN)
History:
- The posterior interosseous nerve (PIN) is most
commonly entrapped at the arcade of Frohse
(also known as supinator syndrome)
Onset:
- usually insidious and can be associated with
strenuous use of the forearm, particularly
pronation and supination
- Weakness in finger extensors & extensor carpi
ulnaris
Cause:
- Entrapment at the arcade of Frohse (supinator
syndrome)
- Elbow fractures
 - Laceration
- Lipomas
- Neurofibromas
- Schwannomas
- Hematomas
- Elbow synovitis from RA

LUMBOSACRAL PLEXOPATHIES

Lumbar Plexus - Trauma (direct compression or traction, usually pelvic and Motor: ● Pain In symptomatic management, analgesics
(formed within the psoas muscle from L1 hip fractures) ● Psoas major ● Weakness and sensory loss and muscle relaxants could be given.
to L3 nerve roots with contributions from ● Iliacus
T12 and L4) - Concurrent root avulsion in assoc. with separation of SI Analgesics include:
joint Sensory: ● NSAIDs
Terminal branches: ● Subcostal ● Pregabalin
● Ilioinguinal - Compressive lesions ● Iliohypogastric ● Gabapentin
● Iliohypogastric ● Inguinal ● Duloxetine
● Genitofemoral - Tumor through direct extension from adjacent tissues ● Genito femoral ● Amitriptyline
● Femoral ● Lateral cutaneous of thigh ● Opioids
● Lateral - Metastatic disease adjacent to the plexus ● Femoral
● Femoral cutaneous ● Lumbosacral trunks
● Obturator - Retroperitoneal hemorrhage ● obturator

Sacral plexus - Radiation-induced

(forms within the pelvis anterior to the
piriformis muscle) - Obstetric injury

Terminal branches: - Diabetes

● Superior/inferior gemelli
● Obturator internus
● Piriformis
● Superior and inferior gluteal
● Posterior femoral cutaneous
● Sciatic

LOWER ABDOMINAL NEUROPATHIES

Ilioinguinal - Nerve compression by space-occupying lesions of the Motor: ● Pain affecting the inguinal region ● Use of US or nerve stimulation for
Iliohypogastric psoas muscle ● Psoas ● Weakness of the anterior abdominal localization
Genitofemoral ● Transverse abdominis muscle ● Neurolysis or resection
- Entrapment in the transversus abdominus near the ASIS Sensory: ● (+) Tinel sign near the ASIS
● Inguinal ligament ● (-) Cremasteric reflex
- Blunt trauma ● Forward flexed posture d/t extension of
spine
- Scar tissue entrapment after surgery in the inguinal region

Femoral Neuropathies ● L2 - L4 Spinal roots form the femoral nerve Motor: ● Weak quadriceps muscle Surgical Tx:
● The nerve then travels between the psoas and ● Rectus Femoris ● Weakness on knee extension ● Avoid extreme hip flexion, external
iliacus muscles, innervating the iliacus just before ● Vastus Lateralis ● (-) knee jerk rotation, and abduction to prevent
it passes under the inguinal ligament. ● Vastus Intermedius ● Groin Pain and Decreased sensation compression as the nerve passes
● The femoral nerve is usually injured within the ● Vastus Medius over med and ant thigh and lower legin under the inguinal ligament.

Lateral Femoral Cutaneous Neuropathies
retroperitoneal space in the pelvis or under the
inguinal ligament
● Hematomas caused by anticoagulant therapy and
blood dyscrasias are also common causes of
femoral neuropathy.
● AKA Meralgia paresthetica, is a common and
benign cause of anterolateral thigh numbness
● Purely sensory nerve arising from the L2 and L3
nerve.
● Meralgia paresthetica is usually idiopathic and
associated with obesity, pregnancy, and diabetes.
● External sources of compression include heavy
tool belts, habitually leaning against a table, or
wearing tight waist bands
sapheous nerve
Sensory: ● Depressed or absent patellar reflex
● Medial & Intermediate cutaneous ● Unilateral thigh weakness
branch ● Numbness of ant thigh and leg
● Saphenous Nerve
● Ilioinguinal Ligament
Motor: ● Pure sensory syndrome at the lateral
● Tensor Fascia Latae thigh including unpleasant paresthesias,
● Quadriceps Femoris burning or dull ache
● (-) motor symptoms
Sensory: ● Aggravated by prolonged standing or
● Pain walking
● Numbness ● Sensory abnormalities
● Anterolateral thigh muscle ● weakness of thigh muscles
● depressed patellar reflex
Non Surgical Tx:
● Early physical therapy for
strengthening and range of motion
should be initiated.
● Training to activate the gluteal
muscles and/or plantar flexors in
stance phase can help to augment
weak knee extension.
● With mild to moderate knee
extension weakness, Use of
ankle–foot orthosis with
dorsiflexion stop can create an
extension moment at the knee to
compensate. If the weakness is
severe, a knee-ankle-
foot orthosis may be indicated.
● Use of walker to keep the ground
reaction force anterior to the knee
axis of rotation during stance is
often more functional.
● If there is no improvement after 3
to 6 months, either clinically or
electrodiagnostically, surgical
intervention might be indicated.
● Eliminating exacerbating factors,
such as tight clothing or tool
belts and weight loss will often
resolve the symptoms.
● When painful paresthesia is
present, topical agents such as
Capsaicin cream and Lidoderm
patches can be helpful.
● Oral agents used for neuropathic
pain such as tricyclic
antidepressants or antiseizure
medications such as gabapentin,
pregabalin, or carbamazepine
can also control symptoms.
● Local corticosteroid injections
might provide temporary relief.
● Surgery might be indicated in
refractory cases, with high
success rates reported for both
 ● Occasionally injury can occur during surgery, decompression and
particularly during hernia repair, renal neurectomy, although patients will
transplantation, harvesting of iliac bone graft, hip be left with a persistent area
surgery, and aortic valve and coronary bypass of numbness with the latter
surgery. procedure.

Obturator Neuropathies
● L2-L4 nerve roots and runs anterior to the SI Joint
● Following the wall of the lateral pelvis the nerve Motor: ● Loss of sensation of med thigh ● Most obturator injuries recover
passes through a fibro-osseous canal between ● Gracilis ● Weakness of adduction and internal well with conservative
the obturator muscles and the obturator sulcus of ● Adductor Longus rotation of the hip management.
the pubic bone. ● Adductor Brevis ● deep aching pain
● Pelvic trauma, especially when involving ● Adductor Magnus ● weakness with exercise
disruption of the sacroiliac joint, rarely injures this ● In those with compression at the
nerve in isolation but is usually accompanied by Sensory: obturator canal, surgical release
damage to other nerves of the lumbar plexus or ● Lumbar plexus may be indicated, particularly in
nerve roots. ● Distal ⅔ of medial thigh muscle those who fail conservative
● Entrapment in the fascia overlying the adductor ● Weakness treatment
brevis has been described in athletes, resulting in ● Deep aching pain and respond temporarily to a
deep aching pain and weakness with exercise. diagnostic block, especially
athletes.

FIBULAR NEUROPATHIES
Nerves affected:
● Deep peroneal nerve
● Superficial peroneal nerve
Causes
● Compression from prolonged positioning during
surgery or bed rest particularly in cachetic patients
● Improperly placed splints, braces, and casts can
cause direct pressure over the nerve at femoral
head
● Prolonged squatting can place excessive traction
on the nerve
● Trauma particularly with fractures of the fibular
head
Motor
● Tibialis anterior
● Extensor hallucis longus
● Extensor digitorum longus
● Fibularis (peroneus) tertius
● Extensor hallucis brevis
● Extensor digitorum brevis
● Fibularis longus
● Fibularis brevis
● Weakness of ankle dorsiflexion
● Complete foot drop; steppage gait
● Foot slap after heel strike
● Diminished sensation on lower ⅔ of
lateral leg and dorsum of foot
● Positive Tinel’s sign
● Offloading of fibula using pillows
and pressure-relieving ankle-foot
orthosis
● Re-evaluation of casts and braces
for pressure points at fibular head
● Elimination of exacerbating factors
such as prolonged knee flexion
and leg crossing

Sensory
● Common peroneal division of sciatic
nerve

TIBIAL AND PLANTAR
MONONEUROPATHIES
(L5- S2)
Nerves affected:
● Calcaneal Branch
● Medial plantar nerve
● Lateral plantar nerve
Proximal tibial neuropathies
● Baker’s cysts
Ankle under flexor retinaculum
● Tarsal tunnel syndrome
Causes Medial Plantar Nerve Tarsal Tunnel Syndrome ● NSAIDs
● Idiopathic (most cases) ● Local corticosteroid injections
Others Motor ● Paresthesias ● An anklefoot orthosis (AFO) with
● Ankle trauma ● Abd. hallucis ● Pain in the sole of the foot and heel dorsiflexion stop can partially
● Arthritis ● Flexor digitorum brevis ● Exacerbated by standing and walking compensate for weakness of the
● Deformity of the heel ● Flexor hallucis bre ● Sensory loss in the lateral or medial medial gastrocnemius.
● Masses such as ganglion cysts or lipomas. plantar distribution, ● Surgical release can be indicated
Sensory for those who do not respond
● Medial sole, first to third toes management
Lateral Plantar Nerve
Motor
● Abd. digiti quinti
● Flexor digiti quinti
 ● Add hallucis
● Interossei

Sensory
● Lateral sole, fourth to fifth toes

SURAL NEUROPATHI History, Onset and Cause: Motor ● Neurolysis and Incision of the
● Gastrocnemius gastrocnemius fibrous arch can
Sural Nerve: Injury/trauma related: relieve symptoms in athletes with
compression at the aponeurosis.
● Sensory branch: ● Proximal injury (rarely) Sensory ● (+) Abnormal sensations to the lateral
● Distal nerves: injury to the Achilles tendon, the ● Posterolateral aspect of the distal third calf and foot.
● Fibular andTibial ankle, and fracture of the fifth metatarsal of the lower leg and the lateral aspect ● (+) Pain d/t exercise
Nerves ● Iatrogenic injury can occur with ankle surgery or of the foot. ● (+) Hemorrhage of Gastrocnemius
Achilles tendon repair muscle
● Sural nerve is sacrificed in graft harvesting to ● (+) Masses on Gastrocnemius muscle
repair Fibular nerve and brachial plexus injuries.
● Compression d/t thickened gastrocnemius
aponeurosis has been reported in athletes.

Hemorrhage of Gastrocnemius muscle

(+) Masses on Gastrocnemius mm d/t:

o heterotopic ossification

o Baker cysts in the popliteal fossa

SCIATIC NEUROPATHIES
Sciatic Nerve:
● L4 to S2 nerve roots forming:
● Tibial division
● Fibular division
History, Onset and Cause: Motor (Absent or reduced)
The sciatic nerve is made up of fibers from the L4 to S2 ● Fibular Muscles
nerve roots, forming: ● Tibial Muscle
● Tibial and Fibular division of Sciatic nerve. Electromyographic Evaluation of Foot Drop:
The tibial and fibular nerves contribute sensory branches to ● Anterior Tibialis (abnl)
form the sural nerve ● Peroneus Longus (abnl)
● Medial Gastrocnemius (abnl)
● Commonness ● Biceps Femoris (Short Head) (abnl)
By Sciatic Division:
● (Powerful) tibial innervated hamstring
and plantar flexor muscles, making
● (subtle weakness) Fibular nerve less
obvious than with muscles innervated
Needle Examnation:
● Denervation: (+) Paresthesia and (+)
Muscle weakness.
● Decompression may be indicated
if a compressive lesion is
identified, such as a tumor or
hematoma.
● Nerve grafting outcomes are
guarded due to the size and
length of the sciatic nerve.

○ (more) purely tibial nerve

○ (less) purely fibular nerve
Sensory (Absent or reduced)
● hip fracture ● Sural nerves
● posterior hip dislocation ● Superficial fibular nerve
● hip surgery (total hip arthroplasty)
● Superficial Peroneal Sensory Nerve
(decreased)
● Poorly placed intramuscular gluteal injections
 ● knife or gunshot wounds
● compression d/t: improper positioning during
hospitalization with thin body habitus
● lithotomy position.

Space-occupying lesions such as: (d/t: compression of

the sciatic nerve)

● tumors
● hematoma
● aneurysm
● heterotopic ossification

Injury related:
● (most common) Fibular Division.