第三期第三期课件3 1.pptVIP

Pathophysiology through clinical cases- Leg and Foot -CLINICAL CASE 1 TakeCare Osteopathic Academy Milano - Italy Patient Presentation A 38-year-old male complains of numbness on the dorsum of his right foot and difficulty lifting the front part of the foot History The previous day he was stuck by a car No serious injuries, but subsequently: Numbness over the dorsum of his right foot Having to make a “high step” to avoid dragging his toes when he walks Progressive loss of the ability to raise his toes Clinical Case Clinical Case Physical Examination Sensory deprivation to the entire dorsum of the right foot Dorsiflexion and eversion against resistance weaker on the right side compared to the left side Right foot drop and high steppage during the swing phase of gait Tenderness, edema and hematoma just distal to the head of the right fibula Normal deep tendon reflexes for the quadriceps and calcaneal tendons Stable knee and ankle joints Laboratory Tests Nothing relevant Imaging Studies Radiographic imaging: nondisplaced fracture of the neck of the right fibula Clinical Reasoning This patient presents with signs and symptoms indicating a clinical condition of foot drop Clinical Problems to Consider Anterior compartment syndrome Common fibular nerve trauma Clinical Case injury to both deep and common fibular nerve can result in foot drop differential diagnosis is required Relevant Anatomy Skeletal elements that contribute to the lateral aspect of knee region: Lateral condyle of the femur Lateral condyle of the tibia Proximal end of the fibula, articulated with lateral condyle of the tibia and providing distal attachment for the tendon of biceps femoris and the lateral collateral ligament of the knee Clinical Case Relevant Anatomy Common fibular nerve (L4-S2) palpable on the neck of the fibula No sensory distribution It innervates the short head of biceps femoris The subcutaneous position of the common fibular nerve on the fibular neck makes it vulnerable with trau