Bovine Neurologic Diseases 0749-0720/87 $0.00 + .

20

Diseases of the Peripheral Nerves

D. K. Ciszewski, D. V.M., * and

N. Kent Ames, D.V.M., M.S.t

Although the incidence of peripheral nerve dysfunction in cattle

is relatively low, a thorough understanding of common peripheral
nerve disorders is essential if the practitioner is to make the correct
diagnostic and prognostic evaluations. Recognition of abnormalities
in motor and sensory function along with a complete anatomic un-
derstanding is necessary to successfully associate observed clinical
signs with specific nerve impairment.
The etiology of peripheral nerve dysfunction is most commonly
the result of trauma. 11 Trauma to a nerve may be associated with
direct injury or it may arise secondary to pressure from edema, neo-
plasia, or fractures. Etiology also influences prognosis. Fortunately,
many cases are induced by pressure, and if the pressure source can
be removed, nerve function may return rapidly. The prognosis
worsens when a nerve has been severed. Peripheral nerves are
rather inefficient at regeneration once they have been transected. 11
Peripheral nerve injury often has no specific treatment. In addi-
tion to supportive care of the animal, major therapeutic objectives
should include (1) removal of the inciting cause (pressure); (2) sup-
port of involved tissues; and (3) prevention of additional musculoskel-
etal trauma.
Table 1 lists the peripheral nerves of clinical significance, which
will be detailed in the following chapter.

FORELIMB

Suprascapular
The suprascapular nerve arises from cervical spinal segments 6
and 7. 1,11,24 It innervates both the supraspinatus and infraspinatus
muscles, which act to extend the shoulder and stabilize the lateral

* Resident, Department of Large Animal Clinical Sciences, Michigan State University

College of Veterinary Medicine, East LanSing, Michigan
t Associate Professor, Department of Large Animal Clinical Sciences, Michigan State
University College of Veterinary Medicine, East Lansing, Michigan

Veterinary Clinics of North America: Food Animal Practice- Vol. 3, No.1, March 1987
193
194 D. K. CISZEWSKI AND N. KENT AMES

aspect of the shoulder joint. 11 ,24 There is no sensory cOlnponent to

the suprascapular nerve. 11,26
Paralysis of the suprascapular nerve is generally a result of
trauma. The injury may be due to stretching or direct traulna as the
nerve courses superficially near the neck of the scapula (Fig. 1).1,11 A
spinal injury in the area of the 6th and 7th cervical vertebrae Inay
also cause suprascapular nerve paralysis. 11
An animal suffering from paralysis of the suprascapular nerve has
a characteristic gait and stance. The stride is shortened, and there is
abduction of the leg and shoulder when weight is placed on the af-
fected limb. At rest, the shoulder joint is dropped and the animal
Inay be reluctant to bear weight on the limb. Chronic paralysis of the
suprascapular nerve results in atrophy of the supraspinatus and infra-
spinatus muscles, which is termed "sweeny. "24
Although there is no specific treatment for suprascapular nerve
damage, most cases in cattle are not severely incapacitating, pro-
viding concurrent injury to additional support structures (tendons,
ligaments, shoulder joint capsule) has not occurred. 11,24
Median and Ulnar Nerves
The median and ulnar nerves originate from the last cervical and
the initial thoracic spinal roots. These nerves descend the forearm
medial to the humerus and eventually innervate the flexor muscles of
the carpus, fetlock, and digits (Fig. 2). They give sensory fibers to the
skin on the caudal aspect of the leg. 1,11,24
Damage to these nerves is rare but can conceivably occur from
trauma in the axillary area. The ulnar nerve runs subcutaneously in
this region, thereby increasing its susceptibility to trauma. 11
Clinically, the animal will "goose step" on the affected limb due
to retained action of the extensor muscles without the antagonistic
effect of the flexor group. Hyperextension of the carpus, fetlock, and
digits is noted over a period of days or weeks.l I
Brachial Plexus
The brachial plexus is a mingling of nerve fibers in the axillary
area that originate from spinal nerves C6 to T2. Fibers comprising
the suprascapular, radial, axillary, musculocutaneous, median, and
ulnar nerves contribute to the brachial plexus. Nearly all of the in-
nervation to the forelimb passes through the brachial plexus. 11,13,24
Damage to the brachial plexus may result from excessive trac-
tion at the time of calving or from severe abduction of the forelimb. 13
Any direct trauma to the axillary region could also result in brachial
plexus injury. 11
The clinical signs of trauma to the brachial plexus are variable
and difficult to describe. The signs exhibited by the animal are de-
pendent upon the specific nerves that have been damaged, and there
often are signs of multiple nerve injury.lI,I3 Reference to Table llnay
be helpful in cases of brachial plexus trauma with multiple nerve
DISEASES OF THE PERIPHERAL NERVES 195

Figure 1. Diagram depict-

ing course of the suprascapular
nerve.

involvement. Diagnostic differentials for suspected brachial plexus

trauma would include forelimb fractures and dislocations.
A clinical case report of brachial plexus injury resulting from
manual traction at the time of parturition has been described. The
affected calf could not extend or bear weight on the involved fore-
limb. There were areas of partial and complete analgesia plus muscle
atrophy corresponding to specific nerve damage. 13
196 D. K. CISZEWSKI AND N. KENT AMES

Median
Nerve

Figure 2. Diagram depict-

ing course of the median and
ulnar nerves.

The administration of anti-inflammatory agents and the use of

limb support have been recommended as treatment following the
diagnosis of brachial plexus trauma. The prognosis varies depending
upon the severity of the lesion. Satisfactory recovery is possible if
complete avulsion of the nerve plexus has not occurred. 13
Radial Nerve
The radial nerve arises from spinal roots C7, C8, and Tl. It de-
scends among the caudal muscles of the arm (triceps group), often
furnishing branches to these important extensors of the elbow en
route. It crosses the lateral aspect of the humerus along the musculo-
spiral groove just proximal to the elbow. At the elbow, the nerve
divides into numerous branches that innervate the extensor muscles
of the carpus and digit. The radial nerve also supplies sensory inner-
vation to the skin on the lateral side of the fore lim b from the elbow to
the carpus. The area of sensitivity then spirals cranially to the ante-
rior side of the limb from the carpus to the digits (Fig. 3).1,11,17
Paralysis of the radial nerve may result in the inability to extend
the elbow, carpus, and digits. There is a marked gait abnormality and
an inability to support weight on the affected limb. The affected
elbow is "dropped," and the leg is dragged, often causing injury tc
the cranial aspect of the digits (Fig. 4).1,11,17
The extent of the clinical signs depends on the level and severit)
of the injury. Both complete and partial radial paralysis is possible.
Complete radial nerve paralysis has the poorer prognosis but rare I)
occurs. Injury to the brachial plexus,I,11,17,26 humeral fractures,8 01
DISEASES OF THE PERIPHERAL NERVES 197
Table 1. Peripheral Nerves of Clinical Significance in Cattle
NERVE SPINAL ROOTS ACTION AREA OF SENSITIVITY

Forelimb
Suprascapular C6 and C7 Extend shoulder None
Median -ulnar C6, C7, and C8; T1 Flexion of carpus Caudal aspect of leg
and T2 and digits
Radial C7 and C8; T1 Extend elbow, Lateral aspect-
carpus, and digits elbow to carpus
Cranial aspect-
carpus to digits
Hindlimb
Femoral L4, LS, and L6 Extend stifle and Medial aspect of
flex hip stifle, hock
Obturator LS and L6 Adduction of limb None
Sciatic L6; S1 and S2 Extend hip Lateral side, stifle
to hock
Peroneal L6; S1 and S2 Extend digit, flex Cranial aspect of
hock tarsus and
metatarsus
Tibial L6; S1 and S2 Flex digit,- extend Caudal aspect of
hock metatarsus and
digits

trauma that severs the radial nerve proximal to the musculospiral

groove 24 can result in complete radial paralysis. If the injury occurs
distal to the branches supplying the triceps brachii muscle, no elbow
abnormality will be noted and partial radial paralysis develops.24 Par-
tial radial paralysis commonly develops as a result of pressure on the
radial nerve while an animal is recumbent on a surgery table or cast
on a hard surface. Partial radial paralysis due to casting and tabling
animals can be avoided by taking the following precautions:
1. The shoulder and proximal radius should be padded carefully.I,ll,I8
Care must be taken to avoid the corners and edges of the pads and
all hardware on the pads, such as buckles, snaps, and rings.
2. Animals under general anesthesia should have the down leg ex-
tended forward and sufficiently padded. 18
3. Cattle that have their feet tied to a table should not have the up side
forefoot pulled down tightly against the table. This greatly increases
the pressure on the down leg and radial nerve, especially in heavily
muscled animals. A block or other device may be placed under the
up side leg, or the leg may be tied very loosely.
Radial nerve paralysis resulting from casting or tabling has a fa-
vorable prognosis. Most signs of radial paralysis diminish in a few
minutes. If the signs persist, the use of anti-inflammatory drugs in
combination with hydrotherapy will generally result in improve-
ment. It is also advisable to bandage the distal part of the limb to
198 D. K. CISZEWSKI AND N. KENT AMES

Figure 3. Diagram depict-

ing course of the radial nerve.

avoid unnecessary trauma to its anterior surface. The animal should

be maintained in an area with excellent footing.

HINDLIMB

Femoral Nerve
The femoral nerve originates from the ventral branches of the
fourth, fifth, and sixth lumbar spinal nerves (Fig. 5). It directly sup-
plies motor innervation to the iliopsoas muscle (flexion of the hip)
and to the quadriceps femoris group (extension of the stifle). Within
DISEASES OF THE PERIPHERAL NERVES 199

Figure 4. Radial nerve paralysis in a calf. Extensor paralysis is accompanied by an

inability to support weight on the affected limb.

the iliopsoas muscle, the femoral nerve branches, giving rise to the
saphenous nerve. The saphenous branch supplies motor innervation
to the sartorius muscle (adduction of the limb and flexion of the hip)
as well as sensory innervation to skin on the medial surface of the
hindlimb from the midthigh down to the tarsus. 11,24
Pressure from hematomas, abscesses, or neoplasia has been re-
ported to result in femoral nerve paralysis.24 A more common cause
of femoral injury is thought to be overstretching of the nerve or of the
muscles innervated by the nerve. 11 ,22 Damage by overstretching can
occur when a cow slips and its hindlimbs spread lateral in opposite
directions,22 in downer cattle vigorously struggling to rise,17 in cattle
attempting to free a hindlimb trapped in a fence or gate, or in pas-
tured calves roped and dragged by a hindleg. 9
Femoral nerve paralysis is most commonly encountered in new-
born calves of the heavy-muscled, larger-framed breeds (Charlois,
Simmental, Maine-Anjou, Holstein). 12,22 Affected calves are born in
the anterior, longitudinal presentation and usually to primiparous
heifers. Some births are natural, but most require obstetric assis-
tance of varying degrees and duration. Because of the disparity in
size between the maternal pelvis and the fetal hindquarters, it is hy-
pothesized that the stifle joints of the calf catch on the cranial brim of
the pelvis. As traction is applied, hyperextension of the fetal femur
occurs. The quadriceps femoris muscle becomes severely stretched,
resulting in damage to its neural and vascular supplies. 22
Some affected calves remain permanently recumbent after
birth, whereas others gradually learn to stand and walk. Because of
200 D. K. CISZEWSKI AND N. KENT AMES

Figure 5. Diagram depict-

ing course of the femoral nerve.

an inability to extend the stifle, weight cannot be supported by the

afflicted limb without the calf collapsing (Fig. 6). The resting stance
is characterized by constant, simultaneous flexion of the stifle, hock,
and all distal joints. 11,16,22,24 The tips of the claws only lightly touch
the ground (Fig. 7).24 The limb is advanced with difficulty, and hypo-
metria is commonly observed. However, knuckling is absent and the
foot is rarely dragged. l l ,16,24 Neurogenic atrophy precludes the
normal development of the quadriceps muscle group (Fig. 8). At-
rophy is apparent within 10 days of birth,22 and by 2 months, the
affected quadriceps muscle decreases to approximately three fourths
its normal size. 16 As muscular atrophy progresses, fibrosis of the re-
maining muscle mass occurs and the femoral shaft becomes readily
palpable beneath the skin.l 6,22,24 Eventually, the gluteals, the poste-
DISEASES OF THE PERIPHERAL NERVES 201

Figure 6. Calf with femoral nerve paralysis. Attempts to bear weight on the af-
fected hindlimb result in sudden collapse.

rior muscles of the thigh, and even the felTIur atrophy as a result of
disuse. 22 ,24 Diminished quadriceps tone permits excessive patellar
laxity, and patellar luxation is readily induced with only minimal
manual effort. 16,22,24 Paralysis of the femoral nerve does not always
result in concurrent damage to the saphenous nerve;22 therefore, the
absence of skin sensation on the medial aspect of the affected leg is
not a consistent clinical sign.
A list of differentials for femoral nerve paralysis would include
femoral fractures, coxofemoral dislocation, primary patellar luxa-
tion,22 and rupture of the quadriceps femoris muscle. 16 The excessive
patellar laxity usually accompanying femoral paralysis may be mistak-
enly diagnosed as the primary problem. Also, fractures of the femoral
neck and separation of the proximal femoral epiphysis have been re-
ported to occur simultaneously with femoral nerve paralysis. 22
Treatment consists primarily of good nursing care. High-quality
colostrum should be bottle-fed to the calf soon after birth because
many will be unable to rise and nurse. Clean, dry bedding, muscle
massage, and frequent lifting to encourage weight-bearing is indi-
cated. Analgesics and anti-inflammatories may benefit some cases,
but steroids should be avoided if failure of passive transfer is consid-
ered a possibility. Vitamin E and selenium preparations can be ad-
ministered to ensure adequate levels of these substances. 17 Surgical
imbrication of the fibrous joint capsule and parapatellar structures
202 D. K. CISZEWSKI AND N. KENT AMES

Figure 7. Resting stance of

a calf with femoral nerve paral-
ysis. Note the simultaneous
flexion of the stifle and hock
joints. The tips of the claws only
lightly touch the ground.

has been attempted in an effort to limit flexion and improve the

weight-bearing capability of the stifle joint. 12,25 The results of surgery
have been discouraging, primarily because of the underlying neuro-
logic deficit. Surgical intervention is no longer advocated. 8,12
The prognosis varies with the extent of the injury. Total recovery
is possible in mild cases of paresis. One study reported complete
regeneration of nerve and muscle tissue in a research calf by the sixth
month following experimental femoral neurectomy. 16 Affected calves
that remain recumbent and demonstrate little attempt to rise by the
third week after birth warrant a poor prognosis. Ambulatory calves
may be retained for slaughter or breeding purposes because any ac-
companying lameness is not painful or extremely debilitating, 12
Calving Paralysis
Calving paralysis (obturator/sciatic paralysis) is a syndrome char-
acterized by hindlimb weakness, ataxia, abduction, and/or paralytic
recumbency in postparturient cattle following dystocia of fetoma-
ternal disproportion (Fig. 9). In the classic situation, fetal arrest
within the birth canal results in compressive injury to pelvic
nerves. 21 Calving paralysis occurs most frequently in heifers, 11,19,24
although it occasionally is observed in multiparous cows following
seemingly normal parturition. 24
DISEASES OF THE PERIPHERAL NERVES 203

Figure 8. Atrophy of the

quadriceps femoris muscle group
in a 4-week-old calf with femoral
nerve paralysis. Note the "hol-
lowed-out" appearance between
the hip and stifle and the in-
creased prominence of the
biceps femoris muscle.

Most cases of calving paralysis probably involve simultaneous

damage to both the obturator nerve and the lumbar root (L6) of the
sciatic nerve. 3 ,4 The obturator nerve innervates the adductor, gra-
cilis, pectineus, and obturator muscles (adduction of the hindlimb),
and the nerve trunk is very susceptible to compression owing to its
course along the medial aspect of the iliac shaft (Fig. 10).11 The sciatic
nerve supplies innervation to the semimembranosus and semiten-
dinosus muscles (also adductors of the pelvic limb). The lumbar root
of the sciatic nerve passes through the dorsum of the pelvis near the
sacroiliac region and is tightly opposed to a prominent ridge on the
ventral border of the sacrum. 3 ,4 It is at this point that the sciatic root
is vulnerable to trauma during parturition.
Attempts to reproduce experimentally the incapacitating recum-
bency frequently observed in field cases of calving paralysis have
greatly enhanced our understanding of this syndrome. 3 ,4 Bilateral ob-
turator neurectomy was ineffective in producing primary recum-
bency in 17 experimental subjects. Suprisingly, these cattle were
able to stand unassisted within a few hours after surgery. They ap-
peared clinically sound on nonskid surfaces but had experienced ex-
cessive difficulty (ataxia, slipping, falling) when placed on smooth
concrete. Results of these initial studies failed to support obturator
nerve damage as the sole cause of the calving paralysis syndrome.
204 D. K. CISZEWSKI AND N. KENT AMES

Figure 9. Recumbency and total abduction of both hindlimbs were the primary
clinical signs displayed by this postparturient cow with calving paralysis.

However, when transection of the lumbar root of the sciatic nerve

was added to the existing obturator deficit, primary recumbency and
extreme ataxia were readily reproduced. Although injury to the obtu-
rator nerve may predispose cattle to recumbency, simultaneous com-
pression of the sciatic root appears necessary to produce primary par-
alytic recumbency.
The clinical signs associated with calving paralysis vary some-
what with the nerves involved. Simultaneous and bilateral damage to
the obturator nerves and sciatic root produces recumbency with an
inability to rise. Transient fetlock flexion is commonly displayed by
these patients as they struggle unsuccessfully to stand. 3 ,4 Unilateral
injury to the lumbar root of the sciatic nerve also produces recum-
bency, but these animals occasionally are able to rise, stand, and
walk. If ambulatory, these cows drag the affected leg and walk on the
dorsal surface of the flexed fetlock. 21 The changes associated with
unilateral obturator paralysis are extremely subtle irrespective of the
supporting surface. Slight abduction of the affected limb may be ob-
served when the cow is at rest and walking. 11 Any of the milder neu-
rologic deficits may predispose the animal to falling on slippery sur-
faces, thereby resulting in additional complications such as fractures,
dislocations, or ligamentous injuries. 11,12
All conditions capable of producing recumbency in conjunction
with parturition should be considered in the differential diagnosis of
calving paralysis. Severe musculoskeletal injury, such as pelvic or
femoral fractures, dislocation of the coxofemoral joint, separation of
the pelvic symphysis in heifers, and rupture of the gastrocnemius
muscle, must be ruled out. Electrolyte imbalances, especially hypo-
calcemia in multiparous animals, are possibilities. Endotoxemia from
toxic mastitis or metritis as well as exhaustion from difficult parturi-
tion can also result in downers. Ischemic llluscle necrosis or sec-
DISEASES OF THE PERIPHERAL NERVES 205

Figure 10. Diagram depict-

ing course of the obturator nerve.

ondary nerve damage (peroneal or tibial nerve) often follows pro-

longed recumbency resulting from any cause. 2
Proper management of clinical cases requires intensive nursing
and supportive care. Recumbent animals should be moved onto a
soft, dry, nonskid surface. A box stall with either a dirt floor or a solid
straw-manure pack is ideal. 6 A large sheet of thick plywood can be
used as a sled to transport recumbent cattle to a box stall conve-
niently.2
Manual assistance should be offered at regular intervals to aid
recumbent animals in their attempts to stand. The development of
pressure sores and ischemic muscle necrosis can be avoided by
changing the position of down cattle at least four times a day. 21
Muscle massage and exercise of the hindlimbs by passive movement
must also be provided. The judicious use of a hip lift is beneficial
206 D. K. CISZEWSKI AND N. KENT AMES

after the animal has been recumbent for 12 to 24 hours.6 Cattle inca-
pable of partially supporting some weight on the hindlimbs should
never be left suspended by the hip lift.
Steroids may decrease perineural inflammation if ad~inistered
soon after dystocia. 2 Analgesics are useful in maintaining the comfort
and appetite of the recumbent animal. 2 Fresh water, concentrate,
and palatable roughage should be provided within easy reach of the
down animal. Antibiotics may be indicated, especially if there is a
retained placenta, perivaginal trauma, or mastitis. However, the use
of antibiotics could eliminate slaughter for salvage as an option if the
animal does not recover. Recumbent dairy cattle still require com-
plete milk-out on a regular basis. The use of germicidal teat sealants
is advocated to protect the mammary gland against environmental
pathogens.
Heifers and cows that are experiencing mild calving paralysis
but are able to walk should have the hindlimbs hobbled together in
the metatarsal area to prevent excessive abduction. 11,21 A soft rope of
sufficient length (24 to 30 inches)17 is used to allow ease of rising and
walking. Mildly paretic cases will rapidly deteriorate from musculo-
skeletal trauma if allowed to remain on concrete. 21
Ambulatory patients with mild paresis have a favorable prog-
nosis. Recumbency results in a guarded prognosis, but steady im-
provement early in the postparturient period is encouraging. Signs
indicating satisfactory progress include a bright appearance, good ap-
petite, rapid uterine involution, healing of vaginal trauma, absence of
pressure sores, and increasing sensitivity and mobility of the affected
limbs. 21 The prognosis becomes grave after 2 weeks of recum-
bency.11,12 Any complicating conditions further diminish the pros-
pects of a favorable recovery. Reported complications associated with
calving paralysis include trauma to the birth canal, fractures, retained
placenta, metritis, uterine and vaginal prolapse, mastitis, shock, sep-
ticemia or toxemia, peritonitis, enteritis, and emaciation. 20
Sciatic Nerve
The sciatic nerve arises primarily from the ventral roots of the
last lumbar (L6) and the first and second sacral spinal nerves. The
nerve trunk passes over the greater ischiatic notch, courses between
the greater trochanter of the femur and the ischial tuberosity, and
then descends into the thigh between the biceps femoris laterally
and the adductor, semitendinosus, and semimembranosus muscles
medially (Fig. 11). Near the greater trochanter, the sciatic gives off
sensory branches to the skin of the thigh and muscular branches to
the biceps femoris, semitendinosus, and semimembranosus muscles
(extensors of the hip and flexors of the stifle). The nerve terminates
in the mid-thigh region following bifurcation into the peroneal (fib-
ular) and tibial branches. 10,24
Complete sciatic paralysis is rare in adult cattle. 11 ,24 The nerve
appears adequately protected throughout most of its course by a cov-
ering of heavy muscle. However, sciatic damage is conceivable fol-
DISEASES OF THE PERIPHERAL NERVES 207

Sciatic
Nerve
fibial Nerve
Figure 11. Diagram depict-
ing course of the sciatic, pero-
neal, and tibial nerves.

lowing severe trauma to the hip or following fracture of the greater

trochanter or femoral neck. 11,24 The role of sciatic nerve injury in the
calving paralysis syndrome has already been discussed.
A more common cause of sciatic paralysis that is especially prevalent
in neonatal and young calves is injection neuropathy.l7,23 Muscular
development is not as extensive in these young animals, and the
sciatic nerve is susceptible to injury following multiple injections or
injection of irritating substances (for example, tetracycline, vitamins)
into the gluteals or biceps femoris muscle. Intramuscular injections
into the space between the greater trochanter and ischial tuberosity
can also result in sciatic injury in adults as well as calves owing to the
nerve's superficial course in this location. 10
Motor and sensory function of the affected limb is severely com-
promised. Persistent knuckling onto the dorsum of the fetlock is
commonly observed while the animal is standing. The hip and hock
appear slightly dropped. 17 As the animal walks, the affected limb is
dragged forward along its dorsal surface. Weight-bearing does not
result in collapse because extension of the stifle joint is maintained
by the intact femoral nerve. 26 Loss of skin sensation is exten-
sive 11 ,17,24 and analgesia of the hindlimb distal to the stifle is com-
208 D. K. CISZEWSKI AND N. KENT AMES

plete except for an area over the craniomedial aspect of the tibia (sa-
phenous nerve).
The prognosis associated with sciatic nerve injury varies with the
accompanying cause. Most cases of injection neuropathy are only
temporary in duration;7,17,23 however, the exact prognosis for re-
covery depends upon the nature of the injected substance as well as
the proximity of the injection site to the nerve trunk. 7
Treatment of clinical cases consists of hydrotherapy and adminis-
tration of anti-inflammatory agents. 17 Avoid any further injections
into the affected hindlimb. A heavy support bandage or full limb cast
will immobilize the limb, assist ambulation, and prevent further
trauma to the dorsum of the fetlock. 17,23
Peroneal Nerve
Peroneal nerve paralysis is a neuropathy frequently encountered
in cattle and calves subsequent to a period of sustained recumbency.
This condition is particularly common in postparturient dairy cattle 14
following recumbency due to hypocalcemia,11,14,24 toxemia, or dys-
tocia. 5
The common peroneal nerve originates as a terminal branch of
the sciatic in the mid-thigh region. The nerve crosses the lateral
aspect of the stifle joint and then divides into superficial and deep
branches (see Fig. 11). The peroneal nerve supplies motor innerva-
tion to the muscles that flex the hock (cranial tibial, peroneus tertius)
and extend the digits (digital extensors). It also supplies sensory inner-
vation along the cranial aspect of the tarsus and metatarsus. 10,11,14,24
The peroneal nerve assumes a relatively superficial position as it
courses across the stifle joint lateral to the femoral condyle and the
head of the fibula. It is believed that the nerve is subjected to com-
pressive injury at this location while the animal experiences pro-
longed recumbency.11,14,24 This belief is further supported by the
typical abrasions and decubital sores that frequently develop on the
lateral surface of the down stifle in recumbent cattle.1 7 Peroneal
nerve paralysis that closely resembles the syndrome seen in field
cases can be successfully reproduced by local block of the peroneal
nerve on the lateral aspect of the stifle jOint. 14 In one case report
describing peroneal nerve paralysis in a heifer, histopathologic exam-
ination of the affected peroneal nerve revealed significant axonal
disruption distal to the stifle. 5
Hyperflexion of the fetlock joint, inability to extend the pha-
langes, and overextension of the hock are the primary symptoms ac-
companying peroneal nerve injury. 11,14,24 Variability in the severity of
clinical signs often exists among cases. With mild paralysis, occa-
sional knuckling of the fetlock may be the only sign displayed. In
more severe cases, knuckling is marked and weight is borne on the
cranial surfaces of the phalanges and hoof wall (Fig. 12). The hock
appears overextended or straighter on the affected side. Occasionally,
the affected foot may be placed normally, but as the leg is brought
forward, it again will knuckle at the fetlock joint. The area of skin
DISEASES OF THE PERIPHERAL NERVES 209

Figure 12. Peroneal nerve paralysis was evident in this calf following a period of
recumbency due to weakness and dehydration.

desensitization also varies 11 and analgesia may occur over the cranial
and lateral aspect of the tarsus, metatarsus, and fetlock.
Cases of peroneal paralysis resulting from pressure trauma to the
nerve generally possess a favorable prognosis. 11,12,15 Treatment con-
sists of confinement to a dry, softly bedded box stall. 14 Anti-inflam-
matory agents (steroids, phenylbutazone, flunixin meglumine, aspirin)
given in standard dosages may reduce the perineural swelling as-
sociated with trauma. 15,17 A cast or heavy support wrap on the lower
leg will protect the fetlock from continued trauma and excoriation. If
the nerve appears permanently damaged, surgical ankylosis of the
fetlock joint may be attempted in an effort to prevent knuckling. 15
This condition can be prevented in recumbent animals with soft bed-
ding and hourly postural changes. 17
Tibial Nerve
The tibial nerve originates as a caudal, terminal branch of the
sciatic nerve (see Fig. 11). It supplies motor innervation to the gas-
trocnemius IJ1uscle (extensor of the hock), popliteus (flexor of the
stifle), and the superficial and deep digital flexor muscles. It is also
sensory to the skin on the plantar aspect of the metatarsus and
digits. 11,24
Compressive injury subsequent to prolonged recumbency is a
common cause of tibial paralysis in cattle. Injections of irritating
210 D. K. CISZEWSKI AND N. KENT AMES

Figure 13. Clinical signs of

tibial nerve paralysis.

medications into the caudal thigh musculature with inadvertent de-

position of the drug directly on or closely adjacent to the nerve may
also result in tibial paralysis. 23 ,26 Theoretically, the tibial nerve could
also be injured by overstretching in recumbent cattle that are vio-
lently struggling to rise. 11,24
Affected cattle display hyperflexion of the hock and partial, for-
ward knuckling of the fetlock joint. The foot is not dragged along its
cranial aspect (as with peroneal paralysis); instead, the hooves remain
flat on the ground and assume full weight (Fig. 13). Analgesia may be
present over the plantar aspect of the metatarsus. Affected cattle
generally remain ambulatory, although the gait is somewhat spastic
owing to the severe hyperflexion of the hock. 7,11,24,26
The differential diagnosis for tibial paralysis includes mild sciatic
paralysis, peroneal paralysis, and rupture of the gastrocnemius or
DISEASES OF THE PERIPHERAL NERVES 211
biceps femoris muscle. Although unilateral tibial nerve paralysis is
rarely incapacitating, this condition should retain a guarded prog-
nosis. Complete recovery is possible in some cases. ll ,23 Affected
cattle should be removed from slippery, concrete surfaces to prevent
additional, complicating musculoskeletal injuries. Treatment should
also include administration of anti-inflammatory agents, frequent hy-
drotherapy, and muscle massage.

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212 D. K. CISZEWSKI AND N. KENT AMES
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Department of Large Animal Clinical Sciences

College of Veterinary Medicine
Michigan State University
East Lansing, Michigan 48824-1314