NCV FINDINGS IN LOWER

LIMBS

Lumbosacral plexopathy

Clinical picture:
Lumbar plexopathy
Abrupt onset of pain
Location :- ante aspect of thigh
Muscle wasting and weakness after 2-3
weeks
Absent knee jerk
Tenderness of the femoral nerve
Positive femoral stretch sign

 Sacral plexopathy
Location of pain: buttock ,posterior
thigh
Weakness of knee flexors
Absent ankle reflex
Positive SLR
NCS of femoral, peroneal,sural and
saphenous nerves normal
Amplitude is reduced

FEMORAL NERVE

Causes:Diabetes mellitus
Intrapelvic hematoma
Abscess
Pelvic surgery
Tumor of vertebra
Femoral vein and arterial cannulation
Compression by inguinal ligament
during coma

Femoral neuropathy:clinical picture

Weakness and wasting quadriceps
Absent knee reflex
Variable sensory loss anteromedial
aspect of thigh, medial aspect of leg.

 NCS:
Motor conduction studies :slowing of
conduction velocity
Small CMAP amplitude
At level of inguinal ligament:
conduction block
Stimulate above and below the
inguinal ligament and compare CMAP

 Sensory functions-> conduction in

saphenous nerve
PARAMETERS

FEMORAL
NEUROPAT
HY

LUMBARPLEXOPA
THY

WEAKNESS

QUADRICEPS QUADRICEPS
ADDUCTORS

ILIOPSOAS
QUADRICEPS
ADDUCTORS OF
THIGH

SAPHENOUS
SNAP

REDUCED

NORMAL

EMG CHANGES

QUADRICEPS QUADRICEPS
ADDUCTORS OF
THIGH

REDUCED

L3
RADICULOPAT
HY

PARASPINAL
ILIOPSOAS
ADDUCTORS OF
THIGH,QUADRIC
EPS

SAPHENOUS NERVE
Uncommonly injured
Presents as-sensory impairment in
the medial aspect of knee, leg, foot
Causes:
Laceration injuries
Entrapment in subsartorial canal
Surgery for varicose vein

 NCS- stimulation 1cm above the

infe. Border of the patella btw gracilis
and sartorious.
Recording 15cm distal to the point of
stimulation, medial border of the tibia.
Conduction in the distal part checked
by-nerve stimulation btw the medial
head of the gastronemius and tibia,
12-14cm prox. To medial malleolus.

 Recording electrodeanterior to the

medial malleolus
Ncv 49.03+_ 3.36
SNAP amplitude 3.54+_1.52

LATERAL CUTANEOUS NERVE OF

THIGH

Cause :Entrapment at inguinal canal due to;

Corsets, seat belts , obesity
Psoas major abscess, retroperitoneal
tumor
Post op scarring of iliac fossa

NCS:Recording electrode 17-20 cm distal

to ASIS
Reference electrode 3cm distal to
the active electrode
Antidromic stimulation:
Stimulation above inguinal ligament
1cm medial to ASIS and below the
inguinal ligament over origin of
sartorius
Latency 2.8+_0.4 ms
Amplitude 6.0+_1.5 micro volts

SCIATIC NERVE

Sciatic neuropathy results from:

Fracture dislocation of hip
THR surgery
Prolonged compression during coma
Gluteal injections
Muscle scarring
Stretch injury following lithotomy
position

 Clinical picture:
Severe lesion weakness of
hamstrings
Muscles below the knee joint
The neurophysiological evaluation of
a patient s/o sciatic neuropathy
involves motor conduction studies of
peroneal and posterior tibial nerves.

 Sciatic nerve conduction: Recording electrode- ext. dig. Brevis

/abd. hallucis
Stimulating electrode: below gluteal fold
Distally stimulation
Medial trunk apex of politeal fossa
Lateral trunk- head of fibula
Normal ncv 52.75+_4.66 m/s

Difference btw.sciatic neuropathyand

L5-s1 radiculopathy
SCIATIC
NEUROPATHY

L5 -S1
RADICULOPATHY

GLUTEAL WEAKNESS

SENSORY LOSS

NERVE DISTRIBUTION

DERMATOMAL

DENERVATION:
PARASPINAL MUSCLES -

GLUTEAL MUSCLES

SURAL SNAP

ABNORMAL

NORMAL

COMMON PERONEAL NERVE

Causes :-compression as it winds
around the neck of the fibula
Fracture neck of fibula
Plaster cast
Tight bandage
Ganglia
Cyst
leprosy

Clinical picture:
Weakness of dorsiflexors
Weakness of evertors
Slapping gait
Sensory loss to superficial peroneal
nerve distribution

Peroneal conduction:
Surface electrodes extensor
digitorum brevis
Stimulating electrodes
1.ankle 2cm distal to fibular neck
2.Neck of fibula
3. 5-8 cm above the fibular neck

 Ncv below knee 48.3+_3.9 m/s

Above knee 52.0+_6.2 m/s
Latency on ankle stimulation
3.77+_0.86 ms
Distal CMAP amplitude 5.1+_2.3 mV

 Superficial peroneal nerve

conduction:
Recording active electrode-above
junction of lateral third of a line
connecting the malleoli
Reference electrode- 3cm distal to
the active electrode
Anti dromic surface stimulation 1015cm proximal to the upper edge of
lateral malleolus
Ncv 49.0+_3.4m/s
SNAP 3.5+_1.5 microV

 In peroneal neuropathy Conduction

block 22% reduction ofCMAP or
reduced NCV exceeding 10m/s across
head of the fibula localise the lesion
at this site.
In common peroneal nerve lesions
the superficial peroneal nerve or its
fasicles may not get damaged so
fidnings are normal.

SURAL NERVE

Compression may occur by:

Bakers cyst
Upper edge of ski boot
Tendon sheath ganglia
Fracture fifth metatarsal bone
Paresthesia and numbness

 Recording lateral malleolus and

tendoachilles
Stimulation10-16cm proximal to
the recording electrode, distal to
lower border of gastronemius
Ncv 50.9+_5.4 m/s
SNAP 18.0+_10.5 micro V

TIBIAL NERVE

Compression by:
Bakers cyst
Nerve sheath ganglia
Popliteal artery aneurysm
Frequently affected by leprosy
Clinical picture;
Weakness of plantar flexors, invertors,
intrinsic foot muscles
Sensory loss on sole

TARSAL TUNNEL SYNDROME

Compression in the tarsal tunnel:

CausesIll fitting foot wear
Tight plaster cast
Post traumatic fibrosis
Tenosynovitis
RA
Tendon sheath cyst

 Clinical picture
Pain and paresthesia of sole
Rarely, weakness of intrinsic foot
muscles

 Recording electrodeabductor
hallucis/abd.digiti quinti
Stimulating electrodebehind and
proximal to medial malleolus and in
popliteal fossa along flexor crease of
the knee
NCV 48.3+_4.5 m/s

 Tarsal tunnel syndrome:

The site of block can be accurately
localised by serial stimulation at 1
cm interval along the tibial nerve
across the tarsal tunnel.
Site of block-abrupt prolonged latency