Lumbosacral Trunk injury at delivery in asymmetric pelvic brim

Lumbosacral Trunk injury at delivery in asymmetric pelvic brim :  Lumbosacral trunk injury at delivery- second gravida previous  vaginal delivery no issues..LCB -2 yrs. Currently  7 months..all blood investigation and scan are normal. Have  h/o limping gait after 1 month of delivery of first child. No  h/o trauma.  Still she is walking like that.on ex general and reflexes are normal. fhs normal.L/E she was not able to flex her left leg.when I tried to flex it she had severe pain in thigh and knee area..how to proceed ?? Ans Elective CS . Explanation of previous mishap: Lumbodorsal trunk on that side was compressed at the level of S K joint at brim. It is presumable that on that side occiput  pressed the L S nerve trunk for long time due to some irregularity of bony structure of sacrum of that side  forcing the lumbosacral trunk to put forward than the other side( Inlet asymmetry)  . TENS may help after CS in this pregancy and Physiotherapy later. A similar condition arises which is termed as Pudendal neuropathy. In such cases  head is stuck  to ischial spines -à it compressed obsturator nerves at its passage to Obturator  foramen and that may be reason such woman why she can’t  abduct legs in P neuropathy .

Kinds of bony pelvis—One will surprised to know that  there  are 13  types of bony architecture if female pelvis  in addition to parent 4 types .Ideal pelvis fitting well in to 4 principal types are in fact uncommon and some abnormality in forepelvis or hind pelvis or lateral wall are more common.

Though there are four parent type of pelvis but taking posterior bay (post segment) and ant segment of bony pelvis there are about 13 kinds of bony pelvic architecture including beaking of pelvis and straight sacrum. Such are expressed Gynae-Android pelvis which means post part of pelvis  mimic gynaecoid pelvis and ant compartment of pelvis is of  android pattern. In the era of X Ray pelvimetry 1950-1970 people believed that there  can’t be any ideal  Gynaecoid , android, anthropoid or platyplaoid (Flat pelvis).   In this case of unilateral injury of lumbosacral  trunk injury the affected post part of S I joint was beaking in front on that side only making the corresponding  Lumbosacral trunk vulnerable to injury by prolonged compression of Occiput ..

In cases of birth related Pudendal injury in such cases  head may be  stuck at just below the Is spine with resultant Obturator  nerve injury for which she will be  unable to several kinds rotational movement

What is TENS?? Electrical nerve stimulation can reverse spinal cord injury nerve damage in patients. Researchers find that nerve stimulation can improve the function of peripheral nerves damaged by spinal cord injury (SCI). ... Muscles contract when the nerves controlling them are activated by electrical impulses. Transcutaneous electrical nerve stimulation (TENS) is a method of pain relief involving the use of a mild electrical current. A TENS machine is a small, battery-operated device that has leads connected to sticky pads called electrodes. Physiotherapist will attach the pads directly to the corresponding area  skin. Transcutaneous electrical nerve stimulation (TENS or TNS) is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes. TENS, by definition, covers the complete range of transcutaneously applied currents used for nerve excitation although the term is often used with a more restrictive intent, namely to describe the kind of pulses produced by portable stimulators used to reduce pain. The unit is usually connected to the skin using two or more electrodes which are typically conductive gel pads. A typical battery-operated TENS unit is able to modulate pulse width, frequency and intensity. Generally TENS is applied at high frequency (>50 Hz) with an intensity below motor contraction (sensory intensity) or low frequency (<10 Hz) with an intensity that produces motor contraction. While the use of TENS has proved effective in clinical studies, there is controversy over which conditions the device should be used to treat

Another nerve injury  which is  not uncommon is peroneal nerve as it rounds on the lateral  aspect of fibular head ,if stirrup fused at lithotomy position is not properly padded then peroneal nerves / nerve may undergo paraxial changes..