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Lower-extremity peripheral nerve syndromes

Lower-extremity peripheral nerve syndromes
Nerve Site of injury Cause Symptoms Signs
Common peroneal Fibular neck, just below the knee Prolonged lying, leg crossing, squatting, leg cast; vasculitis Foot drop, paresthesias and/or sensory loss over dorsum of foot and lateral shin Weakness on foot dorsiflexion and eversion; sensory loss on dorsum of foot; reflexes normal
Deep peroneal Ankle or fibular neck, just below the knee Prolonged lying, leg crossing, squatting, leg cast; vasculitis; tight-fitting shoe rim or strap Foot drop, ankle pain, minimal weakness and sensory loss over web space between digits 1 and 2 Weakness on dorsiflexion and sensory loss over web space between digits 1 and 2; reflexes normal
Posterior tibial Tarsal tunnel of ankle Fracture or dislocation of talus, calcaneus, medial malleolus, rheumatoid arthritis, tumor Aching, burning, numbness, tingling on sole of foot, distal foot, toes, and occasionally heel Positive Tinel sign over nerve posterior to medial malleolus; sensory loss on sole of foot; atrophy of foot muscles if severe
Sciatic Sciatic notch/gluteal region Trauma (hip dislocation, fracture, or replacement), prolonged bed rest, deep-seated pelvic mass, piriformis syndrome Leg pain and weakness affecting most lower leg muscles and hamstrings Weakness in dorsiflexion, inversion, eversion, plantarflexion, and knee flexion; sensory loss in peroneal, tibial, and sural territories; may spare medial calf and arch of foot; normal knee reflex; absent ankle reflex
Mid-thigh Femur fracture, mass, vasculitis Similar to above but sparing hamstrings Similar to above, but preserved knee flexion strength
Femoral Pelvis and anterior thigh Hip or pelvic fracture, hip replacement, lithotomy position, diabetes mellitus Difficulty lifting leg and extending knee; falls due to knee giving out; may or may not have numbness over thigh and medial calf Quadriceps weakness, hip flexion weakness; sensory loss over anterior and medial thigh extending down medial shin to arch of foot; reduced or unobtainable knee jerk
Lateral femoral cutaneous Inguinal ligament (meralgia paresthetica) Obesity, tight-fitting belts, diabetes mellitus, idiopathic Paresthesias and pain radiating down the lateral thigh to knee Sensory loss on lateral thigh
Graphic 78221 Version 4.0

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