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    Sciatic Nerve - Iippt

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    Praneetha Nouduri
    The document describes the anatomy and clinical implications of injuries to the sciatic, common peroneal, and tibial nerves. It details the formation, branches, and distribution of the sacral plexus and sciatic nerve. Causes of injury and resulting motor and sensory deficits are outlined for each nerve.

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    Sciatic Nerve - Iippt

    Uploaded by

    Praneetha Nouduri
    99 views21 pages
    The document describes the anatomy and clinical implications of injuries to the sciatic, common peroneal, and tibial nerves. It details the formation, branches, and distribution of the sacral plexus and sciatic nerve. Causes of injury and resulting motor and sensory deficits are outlined for each nerve.

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    4. Sciatic Nerve.iippt[1]

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    The document describes the anatomy and clinical implications of injuries to the sciatic, common peroneal, and tibial nerves. It details the formation, branches, and distribution of the sacral plexus and sciatic nerve. Causes of injury and resulting motor and sensory deficits are outlined for each nerve.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    99 views21 pages

    Sciatic Nerve - Iippt

    Uploaded by

    Praneetha Nouduri
    The document describes the anatomy and clinical implications of injuries to the sciatic, common peroneal, and tibial nerves. It details the formation, branches, and distribution of the sacral plexus and sciatic nerve. Causes of injury and resulting motor and sensory deficits are outlined for each nerve.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    You are on page 1of 21

    Dr.

    Ganesh Khemnar
    Origin
    From Sacral the
    Plexus:
     (L4,5, S1,
    2,3and4).
    It is the largest
    branch of the
    plexus
     It is the largest
    nerve of the body.
    Sacral Plexus
    Formation:
     Ventral (anterior)
    rami of (L4,5 S1,2,3
    &4) 4
     Part of L4 & whole L5
    (lumbosacral trunk) + 5
    S1,2,3 and most of S4.
     Site:
     On the posterior
    pelvic wall.
     In front of Piriformis
    muscle.
    Course & Distribution
     It leaves the pelvis through
    greater sciatic foramen,
    below the piriformis &
    passes in the gluteal region
    (between ischial tuberosity
    & greater trochanter) then
    to posterior compartment
    of thigh.
     Termination:
    In the middle of the back of the
    thigh It divides into 2 terminal
    branches:
     Tibial &
     Common Peroneal (Fibular).
    Branches of Sciatic Nerve

    1. Cutaneous:
    To all leg & foot
    EXCEPT:
    Areas supplied by
    the saphenous
    nerve (branch of
    femoral nerve).
     2. Muscular:
    • To Hamstrings:
    (flexors of knee & extensors of
    the hip).
    (through tibial part) to:
    1. Hamstring part of Adductor
    Magnus.
    2. Long head of Biceps Femoris.
    3. Semitendinosus.
    4. Semimembranosus.
    NB. The short head of biceps
    receives its branch from the
    lateral popliteal (common
    peroneal) nerve.
    Tibial Nerve
     Course:
    Descends through
    popliteal fossa to
    posterior compartment
    of leg, accompanied with
    posterior tibial vessels.
    Passes deep to flexor
    retinaculum (through
    the tarsal tunnel,
    tunnel behind
    medial malleolus)
    malleolus to
    reach the sole of foot
    where it divides into 2
    terminal branches
    (Medial & Lateral planter
    nerves.
    Muscular Branches
    1. Muscles of posterior
    compartment of leg
    (Planter flexors of
    ankle, Flexors of toes
    2. Intrinsic muscles of
    sole.
    3. ONE Invertor of foot
    (tibialis posterior).
    Common Peroneal (Fibular) Nerve
     Course:
    Leaves the lateral angle of
    the popliteal fossa & turns
    around the lateral aspect of
    neck of fibula, (Dangerous
    Position).
    Then divides into:
     Superficial peroneal or
    (Musculocutaneous):
    which supply the Lateral
    compartment of the leg.
     Deep peroneal or
    (Anterior Tibial):
    which supply the
    Anterior compartment of
    the leg.
    Muscular Branches

    To muscles of anterior &


    lateral compartments of
    leg:
    1. Dorsi flexors of ankle,
    2. Extensors of toes,
    3. Evertors of foot).
    CAUSES OF SCIATIC  The sciatic nerve is most
    NERVE INJURY frequently injured by…?
    I- Badly placed
    intramuscular injections
    in the gluteal region.
     To avoid this,
    injections should be done into
    the gluteus maximus or
    II-Posterior medius (into the upper
    dislocation of outer quadrant of buttock
    the hip joint  Most nerve lesions are
    incomplete, and in 90% of
    injuries, the common
    peroneal nerve is the mostly
    affected. Why?
    - The common peroneal
    nerve fibers lie superficial
    in the sciatic nerve.
    SCIATIC NERVE INJURY
     MOTOR EFFECT:
    • Marked wasting of the
    muscles below the knee.
    • Weak flexion of the knee
    (sartorius & gracilis are
    intact).
    • Weak extension of hip
    (gluteus maximus is
    intact).
    All the muscles below the
    knee are paralyzed, and the
    weight of the foot causes it to
    assume the plantar-flexed
    position, or Foot Drop.
    (Stamping gait).
    Sensory Loss

    Sensation is lost below the


    knee, except for a narrow
    area down the medial
    side of the lower part of
    the leg (blue) and along
    the medial border of the
    foot as far as the ball of the
    big toe, which is supplied
    by the saphenous nerve
    (femoral nerve).
    EFFECT OF SCIATIC NERVE INJURY
    MOTOR EFFECT Paralysis of Movements affected

    Hamstrings Flexion of knee &


    Extension of hip
    All muscles of All movements of
    Leg & Foot the leg & Foot

    SENSORY EFFECT Loss of sensation EXCEPT area


    of the areas supplied by the
    (Saphenous nerve).
    supplied by
    sciatic nerve
    (below knee).
    SCIATICA
    Sciatica describes the
    condition in which
    patients have pain
    along the sensory
    distribution of the
    sciatic nerve.
    Thus the pain is
    experienced in the
    posterior aspect of
    the thigh, the
    posterior and
    lateral sides of the
    leg, and the lateral
    part of the foot.
    Causes of Sciatica :
     Prolapse of an intervertebral disc, with pressure on
    one or roots of the lower lumbar and sacral spinal
    nerves,
     Pressure on the sacral plexus or sciatic nerve by an
    intrpelvic tumor,
     Inflammation of the sciatic nerve or its terminal
    branches.
    Common Peroneal Nerve
    Injury

    The common peroneal nerve


    is in an exposed position as it
    leaves the popliteal fossa it
    winds around neck of the
    fibula to enter peroneus longus
    muscle, (Dangerous
    Position)!!!!!!!!!!!!!

    The common peroneal nerve is commonly injured


    In Fractures of the neck of the fibula and
    By pressure from casts or splints.
    Manifestations of
    Common Peroneal Nerve
    Injury
     The following clinical features
    are present:
    Motor:
     The muscles of the anterior and
    lateral compartments of the leg
    are paralyzed,
     As a result, the opposing
    muscles, the plantar flexors of
    the ankle joint and the
    invertors of the subtalar joints,
    cause the foot to be Plantar
    Flexed (Foot Drop) and
    Inverted, an attitude referred
    to as Talipes
    Equinovarus.
    Common Peroneal Nerve
    Injury

    Superficial
    Sensory peroneal
    Sensation is lost between the
    first and second toes.
    Dorsum of the foot and toes.
    Medial side of the big toe.
    Lateral side of the leg.
    Tibial Nerve Injury
     Because of its deep and
    protected position, the tibial
    nerve is rarely injured.
     Complete division results in the
    following clinical features:
     Motor:
     All the muscles in the back of
    the leg and the sole of the foot
    are paralyzed.
     The opposing muscles Dorsiflex
    the foot at the ankle joint and
    Evert the foot at the subtalar
    joint, an attitude referred to as
    Taleps Calcaneovalgus.
    Tibial Nerve Injury

    Sensory loss:
    On the Lateral
    side of the leg
    and foot &
    trophic ulcers
    in the sole.

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