Sciatic Nerve Neuropathy in Cynomolgus Monkey Macaca
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Cutaneous Innervation of the Lower Limb Cutaneous Nerves on the Front of the Thigh
Cutaneous Innervation of the Lower Limb https://www.earthslab.com/anatomy/cutaneous-innervation-of-the-lower-limb/ Cutaneous nerves on the front of the thigh • The ilio-inguinal nerve (L1) • The femoral branch of genitofemoral nerve (L1, L2) • The lateral cutaneous nerve of thigh (L2, L3) • The intermediate cutaneous nerve of thigh (L2, L3) • The medial cutaneous nerve of thigh (L2, L3) • The saphenous nerve (L3,4) https://www.slideshare.net/DrMohammadMahmoud/2-front-of-the-thigh-ii https://slideplayer.com/slide/9424949/ Cutaneous nerves of the gluteal region • Subcostal (T12) and ilio- hypogastric (L1) nerves • Posterior primary rami of L1,2,3 and S1,2,3 • Lateral cutaneous nerve of thigh (L2,3) • Posterior cutaneous nerve of thigh (S1,2,3) and perforating cutaneous nerve (S2,3) Cutaneous nerves on the front of leg and dorsum of foot • The infrapatellar branch of the saphenous nerve • The saphenous nerve • The lateral cutaneous nerve of the calf • The superficial peroneal nerve • The sural nerve • The deep peroneal nerve • The digital branches of the medial and lateral plantar nerves Cutaneous nerves on the back of leg • Saphenous nerve (L3, L4) • Posterior division of the medial cutaneous nerve of the thigh (L2, L3) • Posterior cutaneous nerve of the thigh (S1, S2, S3) • Sural nerve (L5, S1, S2) • Lateral cutaneous nerve of the calf (L4, L5, S1) • Peroneal or sural communicating nerve (L5, S1, S2) • Medial calcanean branches (S1, S2) Cutaneous nerves of the sole • Medial calcaneal branches of tibial nerve • Branches from medial plantar nerve • Branches from lateral plantar nerve SEGMENTAL INNERVATION Dermatomes • The area of skin supplied by one spinal segment is called a dermatome. -
Femoral and Sciatic Nerve Blocks for Total Knee Replacement in an Obese Patient with a Previous History of Failed Endotracheal Intubation −A Case Report−
Anesth Pain Med 2011; 6: 270~274 ■Case Report■ Femoral and sciatic nerve blocks for total knee replacement in an obese patient with a previous history of failed endotracheal intubation −A case report− Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea Jong Hae Kim, Woon Seok Roh, Jin Yong Jung, Seok Young Song, Jung Eun Kim, and Baek Jin Kim Peripheral nerve block has frequently been used as an alternative are situations in which spinal or epidural anesthesia cannot be to epidural analgesia for postoperative pain control in patients conducted, such as coagulation disturbances, sepsis, local undergoing total knee replacement. However, there are few reports infection, immune deficiency, severe spinal deformity, severe demonstrating that the combination of femoral and sciatic nerve blocks (FSNBs) can provide adequate analgesia and muscle decompensated hypovolemia and shock. Moreover, factors relaxation during total knee replacement. We experienced a case associated with technically difficult neuraxial blocks influence of successful FSNBs for a total knee replacement in a 66 year-old the anesthesiologist’s decision to perform the procedure [1]. In female patient who had a previous cancelled surgery due to a failed tracheal intubation followed by a difficult mask ventilation for 50 these cases, peripheral nerve block can provide a good solution minutes, 3 days before these blocks. FSNBs were performed with for operations on a lower extremity. The combination of 50 ml of 1.5% mepivacaine because she had conditions precluding femoral and sciatic nerve blocks (FSNBs) has frequently been neuraxial blocks including a long distance from the skin to the used for postoperative pain control after total knee replacement epidural space related to a high body mass index and nonpalpable lumbar spinous processes. -
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. -
Dynamic Phases of Peroneal and Tibial Intraneural Ganglia Formation: a New Dimension Added to the Unifying Articular Theory
J Neurosurg 107:, 2007 Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory ROBERT J. SPINNER, M.D.,1–3 KIMBERLY K. AMRAMI, M.D.,4 ALEXANDRA P. WOLANSKYJ, M.D.,5 NICHOLAS M. DESY, B.SC.,1,6 HUAN WANG, M.D.,1,7 EDUARDO E. BENARROCH, M.D.,8 JOHN A. SKINNER, M.D.,4 MICHAEL G. ROCK, M.D.,2 AND BERND W. SCHEITHAUER, M.D.9 Departments of 1Neurologic Surgery, 2Orthopedics, 3Anatomy, 4Radiology, 5Medicine, 8Neurology, and 9Anatomic Pathology, Mayo Clinic, Rochester, Minnesota; 6McGill University School of Medicine, Montreal, Quebec, Canada; and 7Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China Object. The pathogenesis of intraneural ganglia has been a controversial issue for longer than a century. Recently the authors identified a stereotypical pattern of occurrence of peroneal and tibial intraneural ganglia, and based on an under- standing of their pathogenesis provided a unifying articular explanation. Atypical features, which occasionally are ob- served, have offered an opportunity to verify further and expand on the authors’ proposed theory. Methods. Three unusual cases are presented to exemplify the dynamic features of peroneal and tibial intraneural gan- glia formation. Results. Two patients with a predominant deep peroneal nerve deficit shared essential anatomical findings common to peroneal intraneural ganglia: namely, 1) joint connections to the anterior portion of the superior tibiofibular joint, and 2) dissection of the cyst along the articular branch of the peroneal nerve and proximally. Magnetic resonance (MR) images obtained in these patients demonstrated some unusual findings, including the presence of a cyst within the tibial and sural nerves in the popliteal fossa region, and spontaneous regression of the cysts, which was observed on serial images obtained weeks apart. -
A Rare Bifurcation Pattern of the Sciatic Nerve
CASE REPORT Anatomy Journal of Africa. 2017. Vol 6 (3): 1011 - 1014 . A RARE BIFURCATION PATTERN OF THE SCIATIC NERVE Emranul Huq1, Paul Bailie2 1Assistant Professor (Anatomy), Faculty of Basic Sciences, Saint James School of Medicine – St. Vincent and the Grenadines campus. 2MD Candidate, Saint James School of Medicine – Anguilla campus. Correspondence to Prof. Emranul Huq, Saint James School of Medicine. PO Box 2336. Cane Hall, St. Vincent and the Grenadines. Phone: +1784-496-0236. Email: [email protected]. ABSTRACT Variations in branching patterns of the sciatic nerve are thought to be clinically significant because of the nerve’s extensive distribution area. Here we report a rare and unusual branching pattern of the sciatic nerve which was observed in a male cadaver. Sciatic nerve underwent a high division inside the pelvic cavity, and entered the gluteal region as separate tibial and common fibular nerves. Subsequent distal courses of both nerves into the leg were normal. Knowledge of sciatic nerve variations is useful in treating lower limb neuropathies, such as piriformis syndrome, which tends to be caused by the compression of the sciatic nerve by the piriformis muscle. Keywords: Sciatic nerve bifurcation; sciatic nerve anomalies; piriformis syndrome. INTRODUCTION The sciatic nerve is the largest nerve in the popliteal fossa, the two divisions of the sciatic human body (Williams et al., 1995). It is one nerve occasionally separate from one another of the terminal nerves emerging from the proximal to the apex of the popliteal fossa lumbosacral plexus, and is formed by the (Beaton and Anson, 1937; Williams et al., union of the ventral rami of L4-S3 spinal 1995; Fessler and Sekhar, 2006). -
Intrapelvic Causes of Sciatica: a Systematic Review
DOI: 10.14744/scie.2020.59354 Review South. Clin. Ist. Euras. 2021;32(1):86-94 Intrapelvic Causes of Sciatica: A Systematic Review 1 1 1 1 Ahmet Kale, Betül Kuru, Gülfem Başol, Elif Cansu Gündoğdu, 1 1 2 3 Emre Mat, Gazi Yıldız, Navdar Doğuş Uzun, Taner A Usta 1Department of Gynecology and Obstetrics, University of Health Sciences, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey 2Department of Gynecology and Obstetrics, Midyat State Hospital, Mardin, Turkey 3Department of Gynecology and Obstetrics, Acıbadem University, Altunizade Hospital, İstanbul, Turkey ABSTRACT Submitted: 09.09.2020 The sciatic nerve is the nerve of the lower limb. It is derived from spinal nerves, fourth Accepted: 27.11.2020 Lumbar (L4) to third Sacral (S3). The sciatic nerve innervates the muscles of the posterior Correspondence: Ahmet Kale, thigh and additionally has sensory functions. Sciatica is the given name to the pain sourced by SBÜ Kartal Dr. Lütfi Kırdar Eğitim irritation of the sciatic nerve. Sciatica is most commonly induced by compression of a lower ve Araştırma Hastanesi, Kadın lumbar nerve root (L4, L5, or S1). Various intrapelvic pathologies include gynecological, Hastalıkları ve Doğum Kliniği, İstanbul, Turkey vascular, traumatic, inflammatory, and tumoral disorders that may cause sciatica. Intrapelvic E-mail: [email protected] pathologies that mimic disc herniation are quite always ignored. Surgical approach and a functional exploration by laparoscopy or robotic surgery have significantly increased the intrapelvic pathology’s awareness, resulting in sciatica. After a detailed assessment of the patient, which causes intrapelvic pathologies, deciding whether surgical or medical therapy is needed, notable results in sciatic pain remission can be done. -
Foot Drop Schema Script
CPS Foot Drop Schema Script Hi everyone - my name is Maniraj. I’m excited to narrate this Clinical Problem Solvers schema on foot drop. Foot drop is really a story about a weakness or paralysis in the muscles that dorsiflex the foot. A patient with foot drop will drag their toes while walking. To avoid tripping over their toes while walking, a patient will lift their foot higher off the ground. Since there is no dorsiflexion for a heel strike when bringing their foot down, the patient “overshoots” and slaps their foot on the ground. This is called a steppage gait. What muscles are we talking about? The main dorsiflexor muscles are the tibialis anterior and the extensors of the toes (extensor hallucis longus and extensor digitorum longus). All of these muscles are innervated by the deep peroneal nerve, which is a branch of the common peroneal nerve. The peroneal nerve itself is a terminal branch of the sciatic nerve; the other branch of the sciatic is the tibial nerve. To help anchor the nerve functions we’ll be talking about, I think it’d be beneficial to first review acronyms that can be used to memorize them. The peroneal nerve functions to evert and dorsiflex at the ankle, which can be remembered by the acronym PED. The tibial nerve functions to invert and plantarflex at the ankle, so that becomes TIP. Since the sciatic nerve is really just the bundle of peroneal & tibial nerves, you can remember the sciatic nerve functions as PED + TIP. The sciatic nerve also supplies the hamstrings, which flex the leg at the knee. -
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. -
Nonsystemic Vasculitic Neuropathy: a Clinicopathological Study of 22 Cases
Nonsystemic Vasculitic Neuropathy: A Clinicopathological Study of 22 Cases EVANGELIA KARARIZOU, PANAGIOTA DAVAKI, NIKOS KARANDREAS, ROUBINI DAVOU, and DIMITRIOS VASSILOPOULOS ABSTRACT. Objective. The involvement of the peripheral nervous system in patients with systemic vasculitis has been reported, but nonsystemic peripheral nervous system vasculitis is not so well known. We inves- tigated the clinical, electrophysiological, and pathological features of nonsystemic vasculitic neu- ropathy (NSVN) in order to establish the clinical and histological manifestations and to promote the earlier diagnosis of the syndrome. Methods. Biopsies were selected from over 700 sural nerve biopsies performed at the Section of Neuropathology, Neurological Clinic of Athens University Hospital. The diagnosis of vasculitis was based on established clinicopathological criteria. Other causes of peripheral neuropathy were excluded. Complete laboratory, clinical, electrophysiological, and pathological studies were per- formed in all cases. Results. Nerve biopsies of 22 patients were diagnosed as NSVN. The pathological features were vasculitis and predominant axonal degeneration with a varying pattern of myelinated fiber loss. The vasculitic changes were found mainly in small epineural blood vessels. Mononeuritis multiplex and distal symmetrical sensorimotor neuropathy were equally frequent. Conclusion. NSVN should be suspected in a case of unexplained polyneuropathy without evidence of systemic involvement. Clinical and neurophysiological studies are essential for the detection of nerve involvement, but the specific diagnosis of NSVN may be missed unless a biopsy is performed. (J Rheumatol 2005;32:853–8) Key Indexing Terms: NONSYSTEMIC VASCULITIC NEUROPATHY NONSYSTEMIC VASCULITIS POLYNEUROPATHY AXONAL The syndrome of peripheral neuropathy due to vasculitis We examined the clinical, electrophysiological, and without manifestations of disorders in other systems was histopathological features of 22 patients with NSVN in first reported by Kernohan and Woltman in 19381. -
Review Isolated Vasculitis of the Peripheral Nervous System
Review Isolated vasculitis of the peripheral nervous system M.P. Collins, M.I. Periquet Department of Neurology, Medical College ABSTRACT combination therapy to be more effec- of Wisconsin, Milwaukee, Wisconsin, USA. Vasculitis restricted to the peripheral tive than prednisone alone. Although Michael P. Collins, MD, Ass. Professor; nervous system (PNS), referred to as most patients have a good outcome, M. Isabel Periquet, MD, Ass. Professor. nonsystemic vasculitic neuropathy more than 30% relapse and 60% have Please address correspondence and (NSVN), has been described in many residual pain. Many nosologic, path- reprint requests to: reports since 1985 but remains a poorly ogenic, diagnostic, and therapeutic Michael P. Collins, MD, Department of understood and perhaps under-recog- questions remain unanswered. Neurology, Medical College of Wisconsin, nized condition. There are no uniform 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA. diagnostic criteria. Classifi cation is Introduction E-mail: [email protected] complicated by the occurrence of vas- The vasculitides comprise a broad Received on March 6, 2008; accepted in culitic neuropathies in many systemic spectrum of diseases which exhibit, revised form on April 1, 2008. vasculitides affecting small-to-me- as their primary feature, infl ammation Clin Exp Rheumatol 2008; 26 (Suppl. 49): dium-sized vessels and such clinical and destruction of vessel walls, with S118-S130. variants as nonsystemic skin/nerve secondary ischemic injury to the in- © CopyrightCopyright CLINICAL AND vasculitis and diabetic/non-diabetic volved tissues (1). They are generally EXPERIMENTAL RHEUMATOLOGY 2008.2008. lumbosacral radiculoplexus neuropa- classifi ed based on sizes of involved thy. Most patients present with pain- vessels and histopathologic and clini- Key words: Vasculitis, peripheral ful, stepwise progressive, distal-pre- cal features. -
Vascular Entrapment of the Sciatic Plexus Causing Catamenial Sciatica and Urinary Symptoms
683 Lemos N1, Marques R1, Kamergorodsky G1, Plöger C1, Schor E1, Girão M1 1. Universidade Federal de São Paulo VASCULAR ENTRAPMENT OF THE SCIATIC PLEXUS CAUSING CATAMENIAL SCIATICA AND URINARY SYMPTOMS. Introduction Pelvic congestion syndrome is a well-known cause of cyclic pelvic pain. Patients commonly present with pelvic pain without evidence of inflammatory disease. The pain is worse during the premenstrual period and pregnancy, and is exacerbated by fatigue and standing[1]. However, what is much less known is that dilated or malformed branches of the internal or external iliac vessels can entrap the nerves of the sacral plexus against the pelvic sidewalls, producing symptoms that are not usual in the gynecological practice, such as sciatica, or refractory urinary and anorectal dysfunction[2]. The objective of this video is to explain and describe the symptoms suggestive of vascular entrapment of the sacral plexus, as well as the technique for the laparoscopic decompression of those nerves. Design To illustrate those concepts, we report two clinical cases. The first is that of a 36 year-old woman with complaint of burning pain on left S2 dermatome which worsened during the perimenstrual period. She had already been submitted to one laparoscopy for fulguration of endometriotic foci and medical treatment with desogestrel, being both unsuccessful. At examination, hyperesthesia on the left sciatic nerve dermatome was observed and vaginal examination revealed hypertonic pelvic floor muscles and pain on uterine mobilization. MRI revealed dilated vessels over the sciatic nerve region. Laparoscopy was indicated under the hypothesis of vascular entrapment of the sciatic nerve. No endometriotic nodules were found in the pelvis. -
Differential Movement of the Sciatic Nerve and Hamstrings During The
Musculoskeletal Science and Practice 43 (2019) 91–95 Contents lists available at ScienceDirect Musculoskeletal Science and Practice journal homepage: www.elsevier.com/locate/msksp Original article Differential movement of the sciatic nerve and hamstrings during the straight leg raise with ankle dorsiflexion: Implications for diagnosis of T neural aspect to hamstring disorders Elena Bueno-Graciaa,*,1, Albert Pérez-Bellmuntb,1, Elena Estébanez-de-Miguela, Carlos López-de-Celisb, Michael Shacklockc, Santos Caudevilla-Poloa, Vanesa González-Ruedab a Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain b Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain c Neurodynamic Solutions, Adelaide, Australia ARTICLE INFO ABSTRACT Keywords: Introduction: In hamstrings injuries, sciatic nerve and muscle disorders can coexist. Therefore, differential di- Biomechanics: diagnosis agnosis to include or exclude nerve involvement is an important aspect of evaluation. The objective of this paper Hamstrings is to investigate the mechanical behaviour of the sciatic nerve and biceps femoris muscle in the proximal thigh Sciatic nerve with the ankle dorsiflexion manoeuvre at different degrees of hip flexion during the straight leg raise in cadavers. Material and methods: A cross-sectional study was carried out. Linear displacement transducers were inserted into the sciatic nerve and the biceps femoris muscle of 11 lower extremities from 6 fresh cadavers to measure potential strain of both structures during ankle dorsiflexion at 0°, 30°, 60° and 90° of hip flexion during the straight leg raise. Excursion was also measured with a digital calliper. Results: Ankle dorsiflexion resulted in significant strain and distal excursion of the sciatic nerve at all ranges of hip flexion during the straight leg raise (p < 0.05).