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    L18 - Sciatic Nerve

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    L18 -Sciatic nerve

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    L18 - Sciatic Nerve

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    Somchai Pt
    9 views13 pages
    L18 -Sciatic nerve

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    L18 -Sciatic nerve

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    L18 -Sciatic nerve

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    9 views13 pages

    L18 - Sciatic Nerve

    Uploaded by

    Somchai Pt
    L18 -Sciatic nerve

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 13

    Lecture 18

    SCIATIC
    NERVE
    BJECTIVES

    Describe the anatomy (origin, course


    and distribution) of the sciatic nerve.

    List the branches of the sciatic nerve.

    Describe briefly the main motor and sensory


    manifestations in case of injury of the sciatic
    nerve or its main branches.

    Color Index:
    Main text
    Boys' Slides
    Girls' Slides
    Important
    Dr's Notes
    Extra

    Editing File
    Formation:
    Ventral (anterior) rami of a part
    of L4 & whole L5 (lumbosacral
    trunk) & S1,S2,S3 and most of S4
    Sacral
    plexus
    Site:
    On the posterior pelvic wall.
    2- posterior dislocation of hip joint.
    In front of Piriformis muscle

    Origin Course & Distribution Termination

    From the Sacral The sciatic nerve leaves In the middle (the
    Plexus the pelvis through greater lower third) of the
    (L4,L5,S1,S2,S3) sciatic foramen, below the back of the thigh it
    It is the largest piriformis muscle.
    divides into 2
    branch of the It passes in the gluteal
    terminal branches:
    region midway (between
    plexus. 1. Tibial
    ischial tuberosity &
    It is the largest 2. Common Peroneal
    greater trochanter)
    nerve of the body. Then it enters the (Fibular).
    Med443 note: any plexus is posterior compartment of
    from ventral (anterior) rami the thigh.
    Branches of Sciatic Nerve
    To all leg & foot

    EXCEPT: Areas supplied by the saphenous nerve (branch of


    femoral nerve).
    Note439:saphenous nerve supplies the medial part of the leg and
    medial foot

    Cutaneous

    Hamstrings:
    (flexors of knee & extensors of the hip).
    (through tibial part) to:
    Long head of Biceps Femoris, Semitendinosus ,
    Semimembranosus, Hamstring part of Adductor Magnus
    The short head of biceps receives its branch from the lateral
    popliteal (common peroneal) nerve.

    Muscular
    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.

    In the sole it divides into 2 terminal branches:

    1.Medial planter nerve.


    2.Lateral planter nerve.

    Muscular Branches

    Muscles of posterior
    compartment of leg ONE invertor of the foot
    Intrinsic muscles of sole.
    (Planter flexors of the (tibialis posterior)
    ankle, Flexors of toes.)
    Common peroneal
    (fibular) Nerve
    Course:

    1
    Leaves popliteal fossa & turns around superficial peroneal or
    (musculocutaneous) to supply
    lateral aspect of neck of fibula lateral compartment of the leg
    (dangerous position) (uncovered by
    muscle)

    2
    then divides into: Deep peroneal or (anterior
    tibial) to supply anterior
    compartment of the leg

    Muscular Branches
    Muscles of anterior & lateral compartment of the leg.

    Dorsiflexors Extensors of Extensors of


    of ankle foot toes
    Sciatic nerve injury
    Causes Effects

    1- Badly placed intramuscular injection


    Motor effect:
    in the gluteal region. (most common
    1. Marked wasting of the muscles below the
    sciatic nerve injury)
    knee.
    2. Weak flexion of the knee (sartorius &
    To avoid this, injections should be done
    gracilis are intact) because they have
    into the gluteal maximus or medius .(into
    different nerve supply.
    the upper outer quadrant of the
    3. Weak extension of hip (gluteus Maximus
    buttock).
    is intact)
    4. All muscles below the knee are
    Most nerve lesions are incomplete,and in
    paralyzed,the weight of the foot causes it to
    90% of injuries, the common peroneal
    assume the plantar-flexed position or foot
    (part of nerve) is most affected.Why?
    drop (due to gravity).
    Because the common peroneal nerve
    5. (Stamping gait) or (high stamping gait)
    fibers lies superficial in the sciatic nerve.

    Sensory effect:
    Sensation is lost below the knee,
    except for narrow area down the medial
    2- posterior dislocation of hip joint. 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
    saphenous nerve (femoral nerve)
    Effect of sciatic nerve
    injury Cont...

    muscles affected movement affected

    hamstrings (paralysis) flexion of the knee and extension of the hip

    all muscles of the leg and foot (paralysis) all the movements of the leg and foot

    in terms of sensory effect:


    loss of sensation in the areas supplied by the sciatic nerve (below the knee) EXCEPT
    areas supplied by the saphenous nerve (which is a branch of the femoral nerve)

    Sciatica ‫عرق النّس ا‬

    Sciatica describes the condition in which


    patients have pain along the
    sensory distribution of the sciatic nerve.
    (motor work effectively)

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

    Pressure on the Inflammation of the


    Pressure on the nerve
    nerve by a Tumor nerve
    by herniated disc

    Common Peroneal
    (Fibular) Nerve Injury
    The common peroneal nerve is in an exposed
    position as it leaves the popliteal fossa through its
    lateral angle.

    Then it winds around neck of the fibula to enter


    the peroneus longus muscle, (Dangerous Position)

    The common peroneal nerve is commonly injured


    In Fractures of the neck of the fibula and By
    pressure from low casts or splints.
    Manifestations of Common
    Peroneal (Fibular) Nerve Injury

    Motor Sensory

    The muscles of the anterior and lateral Sensation is lost:


    compartments of the leg are paralyzed.
    Between the first and second toes.
    As a result, the opposing muscles, the
    plantar flexors of the ankle joint and the Dorsum of the foot and toes.
    invertors of the subtalar joints, cause
    the foot to be Plantar Flexed (Foot Medial side of the big toe.
    Drop) and Inverted, an attitude
    referred to as Talipes Equinovarus. Anterior and 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 Sensory

    All the muscles in the back of the leg and


    the sole of the foot are paralyzed. Sensory loss on the Lateral side of the
    The opposing muscles Dorsiflex the foot leg and foot & trophic ulcers in the sole.
    at the ankle joint and Evert the foot at
    the subtalar joint, an attitude referred to (Also seen in case of sciatic nerve injury)
    as Talipes Calcaneovalgus
    MCQs
    1 The sciatic nerve leaves the pelvis through

    C.greater sciatic
    A.ischial tuberosity B.piriformis muscle D.greater trochanter
    foramen

    2 The action of the muscular branch of the sciatic nerve

    A.extensor of B.flexor of C.flexor of D.flexor of knee,lateral


    knee,flexor of hip knee,extensor of hip knee,adductor of hip rotation of hip

    3 What muscles are affected by a sciatic nerve injury?

    B)muscles of the leg and C)quadriceps femoris


    A)hamstrings D) A+B
    foot and dorsum of the foot

    4 A)dorsiflex at the foot


    the Motor effect in a tibial nerve injury

    B)plantarflex at the foot


    C) Evertion at the
    D) A+C
    subtalar

    5 A)dorsum of the foot


    The sensory loss of Peroneal nerve injury is in

    B)between the second C)Plantar side of the


    D)medial side of the leg
    and toes and third toes foot and toes

    1-C 2-B 3-D 4-D 5-A


    SAQs
    What are the 2 terminal branches of the back of the thigh?

    1 Tibial (medial popliteal) ,Common Peroneal, or lateral popliteal(Fibular)

    What are the 2 terminal branches of the sole?

    2 medial planter nerve and lateral planter nerve

    Mention Three Causes of Sciatica

    3 1-pressure by a prolapsed disc


    2-pressure by a tumor
    3-inflammation of the sciatic nerve

    Why is the peroneal nerve susceptible to Injuries?

    4 Because of it’s Exposed position, it goes laterally after leaving the popliteal
    fossa and winds around the neck of the fibula
    LECTURE DONE BY
    Seeta bin Aqeel
    Abdulmohsen Alrahaimi

    TEAM LEADERS
    Nisreen Alotaibi Abdulaziz Alanazi
    Ritaj Alsubaie Saad Aldosari
    Shaden Alotaibi

    [email protected]

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