Great toe drop following knee ligament reconstruction: A case report.

Case Description: A 17-year-old male post anterior cruciate ligament reconstruction complained of the inability to extend his great toe immediately following surgery. Background: Neurological injuries following knee arthroscopy have been reported to occur between 0.6%-2.5%. The most commonly injured nerves are the saphenous and common fibular nerve (CFN). Great toe-drop secondary to isolated denervation of the extensor hallucis longus (EHL), has only been reported one time in the literature. This report describes a case of isolated denervation of the EHL following knee cruciate ligament reconstruction. A detailed description of the anatomy of the CFN is reviewed as well as how electroneuromyographic (EMG/NCS) testing can assist in the diagnosis, prognosis, and intervention of this type of injury. Outcomes: EHL paralysis did not functionally limit the patient from participating in a post-surgical rehabilitation regime. The patient successfully completed his ACL reconstruction rehabilitation and was released to return to sporting activities 9 months postsurgery. Twelve months post-surgery, the patient regained full great toe extension and strength. Discussion: It is important to note that physical therapists can identify the need for, refer, and in some instances perform EMG/NCS testing on patients with neuromuscular disorders. Isolated injury of the CFN branch that innervates the EHL is extremely rare. Understanding the anatomy of the CFN and its branches is critical for the physical therapist when performing an examination and interpreting the findings. It is also important to understand the potential causes and management approaches following this type of injury.

Survey of gross anatomy, microscopic anatomy, neuroscience, and embryology courses in medical school curricula in the United States.

Directors of courses in the basic anatomical sciences in allopathic and osteopathic medical schools in the United States were surveyed regarding the present composition of their courses. Results indicate the majority of gross anatomy courses are in the range of 126 to 200 total course hours, and that laboratory dissection is a key component of these courses. The majority of microscopic anatomy courses are in the range of 61 to 100 total course hours, generally divided equally between lecture and laboratory components. Additionally, despite the availability of computer technology, microscopes are still used in the vast majority of microscopic anatomy courses. The majority of neuroscience courses are in the range of 71 to 90 total course hours, with most of these hours devoted to lectures. Embryology is usually taught in conjunction with gross anatomy, although some schools present it with the microscopic anatomy course or as a separate course. Most embryology courses are in the range of 6 to 20 total course hours, with only a few having a laboratory component.