Classic cases

[neglect]

So today I have a classic case. 70s, woman, hip revision of a failed hip replacement. After the surgery, can't walk. Exam: trace movement ipsilateral knee ext, normal hip flex. All else normal.

NCV shows no response ipsi femoral motor. Contralateral saphaneous could not be elicited. Sural not elicited. EMG shows active denervation in the quad, no motor units.

I love classics. I feel like that guy on the A-team, I love it when the history, exam, and NCV come together.

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[PMR 4 MSK]

So today I have a classic case. 70s, woman, hip revision of a failed hip replacement. After the surgery, can't walk. Exam: trace movement ipsilateral knee ext, normal hip flex. All else normal.

NCV shows no response ipsi femoral motor. Contralateral saphaneous could not be elicited. Sural not elicited. EMG shows active denervation in the quad, no motor units.

I love classics. I feel like that guy on the A-team, I love it when the history, exam, and NCV come together.

And the orthopod who did the surgery now hates you...

 

[SSdoc33]

i had thought that a foot drop was more "classic" or nerve damage post-arthroplasty. was this an anterior approach and the surgeon sliced up the femoral nerve?

 

[neglect]

And the orthopod who did the surgery now hates you...

The orthopod who shouldn't have been mucking around in her hip is at another institution. He/She already knows what they did. In clear cases of surgical nerve lesions there's no way to be nice. Now the person who is going to hate me is the one who gets her case for exploration of the injury.

SS: I think this is true. The peroneal portion of the sciatic nerve is easily lesioned, but I have seen femoral nerve damage after hips - it usually comes right back.

Anyway, I just love simple answers sometimes. Doing ancient people with subclinical cubital and CTS and axonal neuropathies and multi level radics - not fun. Doing a few nerves and getting one answer that actually explains the question: nice! It makes my cortex and limbic system happy.

 

[PMR 4 MSK]

It makes my cortex and limbic system happy.

I thought it was the limbic system that makes the cortex happy...

 

[neglect]

I thought it was the limbic system that makes the cortex happy...

My limbic system, contented pig, doesn't know why it's happy.

 

[caedmon]

The peroneal division of the sciatic is very susceptible to injury when mucking around near the hip or with hip dislocation. I actually had a patient who had had a THA and the sciatic had subluxed (?surgically transposed on accident) anterior to the hip joint. Needless to say, she had a foot drop. Gotta love the short head of the biceps femoris.

 

[neglect]

The peroneal division of the sciatic is very susceptible to injury when mucking around near the hip or with hip dislocation. I actually had a patient who had had a THA and the sciatic had subluxed (?surgically transposed on accident) anterior to the hip joint. Needless to say, she had a foot drop. Gotta love the short head of the biceps femoris.

What if you have no block or slowing around the fibular head and denervation in the TA, none in the PT? Then all you're left with is a peroneal neruopathy within the sciatic nerve. Of course, the short head is a nice confirmation.

Do you do bicep fem for all peroneal mononeuropathies? I don't for those in which I can demonstrate block with inching.