Sacral Plexus and the Pudendal Nerve in Man by Use of Computer Aided Three-Dimensional Reconstruction
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Gluteal Region-II
Gluteal Region-II Dr Garima Sehgal Associate Professor King George’s Medical University UP, Lucknow Structures in the Gluteal region • Bones & joints • Ligaments Thickest muscle • Muscles • Vessels • Nerves Thickest nerve • Bursae Learning Objectives By the end of this teaching session Gluteal region –II all the MBBS 1st year students must be able to: • Enumerate the nerves of gluteal region • Write a short note on nerves of gluteal region • Describe the location & relations of sciatic nerve in gluteal region • Enumerate the arteries of gluteal region • Write a short note on arteries of gluteal region • Enumerate the arteries taking part in trochanteric and cruciate anastomosis • Write a short note on trochanteric and cruciate anastomosis • Enumerate the structures passing through greater sciatic foramen • Enumerate the structures passing through lesser sciatic foramen • Enumerate the bursae in relation to gluteus maximus • Enumerate the structures deep to gluteus maximus • Discuss applied anatomy Nerves of Gluteal region (all nerves in gluteal region are branches of sacral plexus) Superior gluteal nerve (L4,L5, S1) Inferior gluteal nerve (L5, S1, S2) FROM DORSAL DIVISIONS Perforating cutaneous nerve (S2,S3) Nerve to quadratus femoris (L4,L5, S1) Nerve to obturator internus (L5, S1, S2) FROM VENTRAL DIVISIONS Pudendal nerve (S2,S3,S4) Sciatic nerve (L4,L5,S1,S2,S3) Posterior cutaneous nerve of thigh FROM BOTH DORSAL &VENTRAL (S1,S2) & (S2,S3) DIVISIONS 1. Superior Gluteal nerve (L4,L5,S1- dorsal division) 1 • Enters through the greater 3 sciatic foramen • Above piriformis 2 • Runs forwards between gluteus medius & gluteus minimus • SUPPLIES: 1. Gluteus medius 2. Gluteus minimus 3. Tensor fasciae latae 2. -
Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions
Hindawi International Journal of Rheumatology Volume 2020, Article ID 2919625, 13 pages https://doi.org/10.1155/2020/2919625 Review Article Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions Worku Abie Liyew Biomedical Science Department, School of Medicine, Debre Markos University, Debre Markos, Ethiopia Correspondence should be addressed to Worku Abie Liyew; [email protected] Received 25 April 2020; Revised 26 June 2020; Accepted 13 July 2020; Published 29 August 2020 Academic Editor: Bruce M. Rothschild Copyright © 2020 Worku Abie Liyew. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lumbar disc degeneration is defined as the wear and tear of lumbar intervertebral disc, and it is mainly occurring at L3-L4 and L4-S1 vertebrae. Lumbar disc degeneration may lead to disc bulging, osteophytes, loss of disc space, and compression and irritation of the adjacent nerve root. Clinical presentations associated with lumbar disc degeneration and lumbosacral nerve lesion are discogenic pain, radical pain, muscular weakness, and cutaneous. Discogenic pain is usually felt in the lumbar region, or sometimes, it may feel in the buttocks, down to the upper thighs, and it is typically presented with sudden forced flexion and/or rotational moment. Radical pain, muscular weakness, and sensory defects associated with lumbosacral nerve lesions are distributed on -
4-Brachial Plexus and Lumbosacral Plexus (Edited).Pdf
Color Code Brachial Plexus and Lumbosacral Important Doctors Notes Plexus Notes/Extra explanation Please view our Editing File before studying this lecture to check for any changes. Objectives At the end of this lecture, the students should be able to : Describe the formation of brachial plexus (site, roots) List the main branches of brachial plexus Describe the formation of lumbosacral plexus (site, roots) List the main branches of lumbosacral plexus Describe the important Applied Anatomy related to the brachial & lumbosacral plexuses. Brachial Plexus Formation Playlist o It is formed in the posterior triangle of the neck. o It is the union of the anterior rami (or ventral) of the 5th ,6th ,7th ,8th cervical and the 1st thoracic spinal nerves. o The plexus is divided into 5 stages: • Roots • Trunks • Divisions • Cords • Terminal branches Really Tired? Drink Coffee! Brachial Plexus A P A P P A Brachial Plexus Trunks Divisions Cords o Upper (superior) trunk o o Union of the roots of Each trunk divides into Posterior cord: C5 & C6 anterior and posterior From the 3 posterior division divisions of the 3 trunks o o Middle trunk Lateral cord: From the anterior Continuation of the divisions of the upper root of C7 Branches and middle trunks o All three cords will give o Medial cord: o Lower (inferior) trunk branches in the axilla, It is the continuation of Union of the roots of the anterior division of C8 & T1 those will supply their respective regions. the lower trunk The Brachial Plexus Long Thoracic (C5,6,7) Anterior divisions Nerve to Subclavius(C5,6) Posterior divisions Dorsal Scapular(C5) Suprascapular(C5,6) upper C5 trunk Lateral Cord C6 middle (2LM) trunk C7 lower C8 trunk T1 Posterior Cord (ULTRA) Medial Cord (4MU) In the PowerPoint presentation this slide is animated. -
Pudendal Nerve Entrapment Syndrome Caused by Ganglion Cysts Along
Case report eISSN 2384-0293 Yeungnam Univ J Med 2021;38(2):148-151 https://doi.org/10.12701/yujm.2020.00437 Pudendal nerve entrapment syndrome caused by ganglion cysts along the pudendal nerve Young Je Kim1, Du Hwan Kim2 1Department of Rehabilitation Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea 2Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea Received: June 5, 2020 Revised: June 22, 2020 Pudendal nerve entrapment (PNE) syndrome refers to the condition in which the pudendal nerve Accepted: June 23, 2020 is entrapped or compressed. Reported cases of PNE associated with ganglion cysts are rare. Deep gluteal syndrome (DGS) is defined as compression of the sciatic or pudendal nerve due to a Corresponding author: non-discogenic pelvic lesion. We report a case of PNE caused by compression from ganglion cysts Du Hwan Kim, MD, PhD and treated with steroid injection; we discuss this case in the context of DGS. A 77-year-old Department of Physical Medicine woman presented with a 3-month history of tingling and burning sensations in the left buttock and Rehabilitation, Chung-Ang and perineal area. Ultrasonography showed ganglion cystic lesions at the subgluteal space. Mag- University Hospital, Chung-Ang netic resonance imaging revealed cystic lesions along the pudendal nerve from below the piri- University College of Medicine, 102 formis to the Alcock’s canal and a full-thickness tear of the proximal hamstring tendon. Aspira- Heukseok-ro, Dongjak-gu, Seoul tion of the cysts did not yield any material. -
LECTURE (SACRAL PLEXUS, SCIATIC NERVE and FEMORAL NERVE) Done By: Manar Al-Eid Reviewed By: Abdullah Alanazi
CNS-432 LECTURE (SACRAL PLEXUS, SCIATIC NERVE AND FEMORAL NERVE) Done by: Manar Al-Eid Reviewed by: Abdullah Alanazi If there is any mistake please feel free to contact us: [email protected] Both - Black Male Notes - BLUE Female Notes - GREEN Explanation and additional notes - ORANGE Very Important note - Red CNS-432 Objectives: By the end of the lecture, students should be able to: . Describe the formation of sacral plexus (site & root value). List the main branches of sacral plexus. Describe the course of the femoral & the sciatic nerves . List the motor and sensory distribution of femoral & sciatic nerves. Describe the effects of lesion of the femoral & the sciatic nerves (motor & sensory). CNS-432 The Mind Maps Lumber Plexus 1 Branches Iliohypogastric - obturator ilioinguinal Femoral Cutaneous branches Muscular branches to abdomen and lower limb 2 Sacral Plexus Branches Pudendal nerve. Pelvic Splanchnic Sciatic nerve (largest nerves nerve), divides into: Tibial and divides Fibular and divides into : into: Medial and lateral Deep peroneal Superficial planter nerves . peroneal CNS-432 Remember !! gastrocnemius Planter flexion – knee flexion. soleus Planter flexion Iliacus –sartorius- pectineus – Hip flexion psoas major Quadriceps femoris Knee extension Hamstring muscles Knee flexion and hip extension gracilis Hip flexion and aids in knee flexion *popliteal fossa structures (superficial to deep): 1-tibial nerve 2-popliteal vein 3-popliteal artery. *foot drop : planter flexed position Common peroneal nerve injury leads to Equinovarus Tibial nerve injury leads to Calcaneovalgus CNS-432 Lumbar Plexus Formation Ventral (anterior) rami of the upper 4 lumbar spinal nerves (L1,2,3 and L4). Site Within the substance of the psoas major muscle. -
Diagnosis, Rehabilitation and Preventive Strategies for Pudendal Neuropathy in Cyclists, a Systematic Review
Journal of Functional Morphology and Kinesiology Review Diagnosis, Rehabilitation and Preventive Strategies for Pudendal Neuropathy in Cyclists, A Systematic Review Rita Chiaramonte 1,* , Piero Pavone 2 and Michele Vecchio 1,3,* 1 Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy 2 Department of Clinical and Experimental Medicine, University Hospital “Policlinico-San Marco”, 95123 Catania, Italy; [email protected] 3 Rehabilitation Unit, “AOU Policlinico G.Rodolico”, 95123 Catania, Italy * Correspondence: [email protected] (R.C.); [email protected] (M.V.); Tel.: +39-(095)3782703 (M.V.); Fax: +39-(095)7315384 (R.C.) Abstract: This systematic review aims to provide an overview of the diagnostic methods, preventive strategies, and therapeutic approaches for cyclists suffering from pudendal neuropathy. The study defines a guide in delineating a diagnostic and therapeutic protocol using the best current strategies. Pubmed, EMBASE, the Cochrane Library, and Scopus Web of Science were searched for the terms: “Bicycling” OR “Bike” OR “Cyclists” AND “Neuropathy” OR “Pudendal Nerve” OR “Pudendal Neuralgia” OR “Perineum”. The database search identified 14,602 articles. After the titles and abstracts were screened, two independent reviewers analyzed 41 full texts. A total of 15 articles were considered eligible for inclusion. Methodology and results of the study were critically appraised in conformity with PRISMA guidelines and PICOS criteria. Fifteen articles were included in the systematic review and were used to describe the main methods used for measuring the severity of pudendal neuropathy and the preventive and therapeutic strategies for nerve impairment. Future Citation: Chiaramonte, R.; Pavone, P.; Vecchio, M. Diagnosis, research should determine the validity and the effectiveness of diagnostic and therapeutic strategies, Rehabilitation and Preventive their cost-effectiveness, and the adherences of the sportsmen to the treatment. -
15-1040-Junu Oh-Neuronal.Key
Neuronal Control of the Bladder Seung-June Oh, MD Department of urology, Seoul National University Hospital Seoul National University College of Medicine Contents Relevant end organs and nervous system Reflex pathways Implication in the sacral neuromodulation Urinary bladder ! body: detrusor ! trigone and bladder neck Urethral sphincters B Preprostatic S Smooth M. Sphincter Passive Prostatic S Skeletal M. Sphincter P Prostatic SS P-M Striated Sphincter Membraneous SS Periurethral Striated M. Pubococcygeous Spinal cord ! S2–S4 spinal cord ! primary parasympathetic micturition center ! bladder and distal urethral sphincter ! T11-L2 spinal cord ! sympathetic outflow ! bladder and proximal urethral sphincter Peripheral innervation ! The lower urinary tract is innervated by 3 principal sets of peripheral nerves: ! parasympathetic -pelvic n. ! sympathetic-hypogastric n. ! somatic nervous systems –pudendal n. ! Parasympathetic and sympathetic nervous systems form pelvic plexus at the lateral side of the rectum before reaching bladder and sphincter Sympathetic & parasympathetic systems ! Sympathetic pathways ! originate from the T11-L2 (sympathetic nucleus; intermediolateral column of gray matter) ! inhibiting the bladder body and excite the bladder base and proximal urethral sphincter ! Parasympathetic nerves ! emerge from the S2-4 (parasympathetic nucleus; intermediolateral column of gray matter) ! exciting the bladder and relax the urethra Sacral somatic system !emerge from the S2-4 (Onuf’s nucleus; ventral horn) !form pudendal nerve, providing -
Lower Extremity Focal Neuropathies
LOWER EXTREMITY FOCAL NEUROPATHIES Lower Extremity Focal Neuropathies Arturo A. Leis, MD S.H. Subramony, MD Vettaikorumakankav Vedanarayanan, MD, MBBS Mark A. Ross, MD AANEM 59th Annual Meeting Orlando, Florida Copyright © September 2012 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 Printed by Johnson Printing Company, Inc. 1 Please be aware that some of the medical devices or pharmaceuticals discussed in this handout may not be cleared by the FDA or cleared by the FDA for the specific use described by the authors and are “off-label” (i.e., a use not described on the product’s label). “Off-label” devices or pharmaceuticals may be used if, in the judgment of the treating physician, such use is medically indicated to treat a patient’s condition. Information regarding the FDA clearance status of a particular device or pharmaceutical may be obtained by reading the product’s package labeling, by contacting a sales representative or legal counsel of the manufacturer of the device or pharmaceutical, or by contacting the FDA at 1-800-638-2041. 2 LOWER EXTREMITY FOCAL NEUROPATHIES Lower Extremity Focal Neuropathies Table of Contents Course Committees & Course Objectives 4 Faculty 5 Basic and Special Nerve Conduction Studies of the Lower Limbs 7 Arturo A. Leis, MD Common Peroneal Neuropathy and Foot Drop 19 S.H. Subramony, MD Mononeuropathies Affecting Tibial Nerve and its Branches 23 Vettaikorumakankav Vedanarayanan, MD, MBBS Femoral, Obturator, and Lateral Femoral Cutaneous Neuropathies 27 Mark A. Ross, MD CME Questions 33 No one involved in the planning of this CME activity had any relevant financial relationships to disclose. -
Human Distal Sciatic Nerve Fascicular Anatomy: Implications for Ankle Control Using Nerve-Cuff Electrodes
Volume 49, Number 2, 2012 JRRDJRRD Pages 309–322 Human distal sciatic nerve fascicular anatomy: Implications for ankle control using nerve-cuff electrodes Kenneth J. Gustafson, PhD;1–2* Yanina Grinberg, MS;1 Sheeba Joseph, BS;3 Ronald J. Triolo, PhD1–2,4 1Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH; 2Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; 3Case Western Reserve University School of Medicine, Cleveland, OH; 4Department of Orthopedics, Case Western Reserve University, Cleveland, OH Abstract—The design of neural prostheses to restore standing eversion of the talocrural (ankle) joint and are therefore balance, prevent foot drop, or provide active propulsion during critical for standing balance and walking functions. The ambulation requires detailed knowledge of the distal sciatic sciatic nerve originates in the lumbar and sacral spinal nerve anatomy. Three complete sciatic nerves and branches cord and supplies motor and sensory innervation to the were dissected from the piriformis to each muscle entry point lower limb. It has two major terminal branches, the tibial to characterize the branching patterns and diameters. Fascicle nerve and common fibular nerve. The common fibular maps were created from serial sections of each distal terminus (common peroneal) branches into the deep and superfi- below the knee through the anastomosis of the tibial and com- cial fibular (SF) nerves and is commonly targeted in neu- mon fibular nerves above the knee. Similar branching patterns ral prostheses used to correct foot drop [1–5]. The deep and fascicle maps were observed across specimens. Fascicles innervating primary plantar flexors, dorsiflexors, invertors, and fibular (DF) branch innervates the tibialis anterior mus- evertors were distinctly separate and functionally organized in cle, which dorsiflexes and inverts the foot. -
Tarsal Tunnel Syndrome Secondary to the Posterior Tibial Nerve Schwannoma
Case Report http://dx.doi.org/10.12972/The Nerve.2015.01.01.034 www.thenerve.net Tarsal Tunnel Syndrome Secondary to the Posterior Tibial Nerve Schwannoma Jung Won Song1, Sung Han Oh1, Pyung Goo Cho1, Eun Mee Han2 Departments of 1Neurosurgey, 2Pathology, Bundang Jesaeng General Hospital, Seongnam, Korea A 77-year-old female presented with complaint of burning pain and paresthesia along the medial aspect of ankle, heel and sole of the left foot. An ankle MRI, electromyelogram (EMG) with nerve conduction velocity (NCV) and pathologic findings were all compatible with Tarsal tunnel syndrome caused by the posterior tibial nerve Schwannoma. Operative release of the Tarsal tunnel and surgical excision of Schwannoma were performed under the microscopy. It is necessary to have a possible lump in mind when Tarsal tunnel syndrome is suspected, such as posterior tibial nerve Schwannoma. Key Words: Posterior Tibial NerveㆍSchwannomaㆍTarsal Tunnel Syndrome diagnose neurofibromatosis was insufficient. An ankle magne- tic resonance imaging (MRI) revealed about a 22×19×9 mm- INTRODUCTION sized ovoid soft tissue mass in the posterior ankle connected to the posterior tibial nerve. The mass lies beneath the flexor Although Schwannomas are the most common peripheral retinaculum of ankle and showed relatively strong enhance- nerve sheath tumor, Schwannoma of the posterior tibial nerve ment (Fig. 1). and it branch is a rare etiology causing Tarsal tunnel syndrome. The NCV study showed no response sensory nerve action We report a case of Tarsal tunnel syndrome caused by the pos- potentials of the left medial and lateral plantar nerves. Motor terior tibial nerve Schwannoma and mention surgical strategy conduction study of the deep peroneal and tibial nerves was with literature review. -
35. Lumbar Plexus. Sacral Plexus. Coccygeal Plexus
GUIDELINES Students’ independent work during preparation to practical lesson Academic discipline HUMAN ANATOMY Topic LUMBAR PLEXUS. SACRAL PLEXUS. COCCYGEAL PLEXUS 1. Relevance of the topic Lumbar, sacral and coccygeal plexuses innervate the skin of the abdomen, lower back and lower extremities and all the muscles of the lower limbs. Acquired knowledge is the basis for many fields of practical medicine, such as neurology, surgery and traumatology. 2. Specific objectives After the lesson the student should know and be able to: - describe the sources of the formation of the lumbar plexus; - classify the nerves of the lumbar plexus; - to be able to demonstrate and define the branches of the lumbar plexus; - describe sources of sacral plexus formation; - classify sacral plexus nerves; - be able to demonstrate and identify short and long branches of the sacral plexus; - describe the sources of formation coccygeal plexus; - classify coccygeal plexus nerves; - be able to demonstrate and identify branches of coccygeal plexus; - to explain the innervation of muscles and skin in the areas of the lower back and lower extremity. 3. Basic level of preparation For practical this lesson a student should know and be able: - to know the anatomy of the spine, pelvis, lower extremities; - to analyze and show large and small pelvis, their bones; - to analyze and demonstrate bones and joints of the lower limbs; - to demonstrate muscles of the abdomen, perineum, pelvic girdle and lower limbs; - to know the anatomy (external and internal structure) of the spinal cord; - to know the spinal nerve anatomy. 4. Tasks for independent work during preparation for the classes 4.1. -
Pudendal Nerve Compression Syndrome
Società Italiana di Chirurgia ColoRettale www.siccr.org 2009; 20: 172-179 Pudendal Nerve Compression Syndrome Bruno Roche, Joan Robert-Yap, Karel Skala, Guillaume Zufferey Clinic of Proctology Dept. of Visceral Surgery HUG, Geneva, Switzerland Introduction The pudendal nerve primarily innervates the pelvic ring fractures, penetrating injuries, and perineum. This nerve can be gradually deep hematomas due to injections as well as stretched and damaged by vaginal deliveries by bullet and stab wounds. Moreover, it can be (esp. traumatic births), prolapse of pelvic damaged by overstretching, for example with organs and by pelvic floor descent. This leads repositioning or reduction of fractures on the to uni- or bilateral pudendal nerve damage. A orthopedic table or by long-continuous direct lesion of the pudendal nerve is rare as it stretching due to sitting for prolonged periods, lies deep in the pelvis and is well protected by for example, on a bicycle [1]. the pelvic ring. It can be injured however, by Anatomical Basis As the final branch of the pudendal plexus the scrotum in the man, the labia majora in the pudendal nerve is predominantly a somatic woman. It supplies the motor component to the nerve, which has its origin in the ventral spinal bulbospongiosus, ischiocavernosus, nerve roots S2-S4 (Fig. 1). It leaves the pelvic transversus superficialis and profundus perinei floor by the major ischial foramen below the muscles as well as the outer striated urethral piriformis muscle (infrapiriformis foramen). sphincter. Its final branch is also involved in the After it circles the sciatic spine, the nerve sensitivity of the penis or the clitoris.