sciatic nerve

Manifestations of Tibial Nerve Injury(Complete division): 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.

CAUSES OF SCIATIC NERVE INJURY

- Badly placed intramuscular injections in the gluteal region. - Posterior dislocation of the hip joint

branches of sciatic Nerve

- Cutaneous: -

Course of Sciatic Nerve

- 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. Ø

EFFECTS OF SCIATIC NERVE INJURY

- MOTOR EFFECTs - SENSORY EFFECTs

Site of Sacral Plexus

- On the posterior wall of the pelvis - In front of Piriformis muscle.

termination and division of Sciatic Nerve

- Termination: In the middle of the back of the thigh It divides into 2 branches: Ø Tibial Ø Common Peroneal (Fibular).

Muscular branch of sciatic Nerve

- 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.

Muscular Branches of Tibial Nerve

1. Muscles of posterior compartment of leg: - Planter flexors of ankle - Flexors of toes - ONE Invertor of foot (tibialis posterior). 2. Intrinsic muscles of sole

division of Tibial Nerve

2 terminal branches (Medial & Lateral planter nerves).

Manifestations of Common Peroneal Nerve Injury: 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.

Tibial Nerve Injury

Because of its deep and protected position, the tibial nerve is rarely injured.

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, behind medial malleolus) to reach the sole of foot where it divides into 2 terminal branches (Medial & Lateral planter nerves).

The common peroneal nerve is commonly injured In

Fractures of the neck of the fibula and By pressure from casts or splints.

Common Peroneal (Fibular) Nerve Course

Leaves popliteal fossa & turns around the lateral aspect of neck of fibula, (Dangerous Position) Then divides

Muscular Branches of Common Peroneal (Fibular) Nerve

Muscles of anterior & lateral compartments of leg: 1. Dorsi flexors of ankle, 2. Extensors of toes, 3. Evertors of foot.

SENSORY EFFECTs OF SCIATIC NERVE INJURY

Sensation is lost below the knee, except for a narrow area down the medial side of the lower part of the leg 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).

Manifestations of Tibial Nerve Injury(Complete division): sensory

Sensation is lost on the Lateral side of the leg and foot & Trophic ulcers in the sole. (also seen in case of Sciatic nerve injury)

Manifestations of Common Peroneal Nerve Injury: Sensory

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.

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).

Cutaneous branch of sciatic Nerve

To all leg & foot EXCEPT: Areas supplied by the saphenous nerve (branch of femoral nerve).

how to avoid Badly placed intramuscular injections in the gluteal region

To avoid this, injections should be done into the gluteus maximus or medius (into the upper outer quadrant of the buttock).

Sacral Plexus Formation

Ventral (anterior) rami of a part of L4 & whole L5 (lumbosacral trunk) + S1,2,3 and most of S4.

Most nerve lesions are incomplete, and in 90% of injuries, the common peroneal (part of the nerve) is the most affected. Why?

b\c The common peroneal nerve fibers lie superficial in the sciatic nerve.

SCIATICA

condition in which patients have pain along the sensory distribution of the sciatic nerve.

Common Peroneal (Fibular) Nerve division

divides into: Ø Superficial peroneal or (Musculocutaneous) : to supply the Lateral compartment of the leg. Ø Deep peroneal or (Anterior Tibial): Ø to supply the Anterior compartment of the leg.

The short head of biceps innervation

receives its branch from the lateral popliteal (common peroneal) nerve.

the area of pain in sciatica

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.

sciatic nerve Origin

Ø From Sacral the Plexus. Ø (L4,5, S1, 2,3). Ø It is the largest branch of the plexus Ø the largest nerve of the body.

Causes of Sciatica

Ø Prolapse of an intervertebral disc, with pressure on one or more roots of the lower lumbar and sacral spinal nerves. Ø Pressure on the sacral plexus or sciatic nerve by an intrapelvic tumor. Ø Inflammation of the sciatic nerve or its terminal branches.

MOTOR EFFECTs OF SCIATIC NERVE INJURY

• 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).