Variations of Sciatic Nerve Bifurcation: A Study (original) (raw)
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Study on variant anatomy of sciatic nerve
Journal of clinical and diagnostic research : JCDR, 2014
Sciatic Nerve (SN) is the nerve of the posterior compartment of thigh formed in the pelvis from the ventral rami of the L4 to S3 spinal nerves. It leaves the pelvis via the greater sciatic foramen below piriformis and divides into Common Peroneal Nerve (CPN) and Tibial Nerve (TN) at the level of the upper angle of the popliteal fossa. Higher division of the sciatic nerve is the most common variation where the TN and CPN may leave the pelvis through different routes. Such variation may lead to compression of the nerve and lead to Non-discogenic sciatica. Fifty lower limbs were used for the study from Department of Anatomy, J.J.M.M.C Davangere, Karnataka, India. In our study on 25 cadavers (50 lower limbs), we have observed 4 (8 %) lower limbs high division of sciatic nerve was noted. High division of sciatic nerve in the back of thigh was noted in one specimen (2%), while high division within the pelvis was noted in 3 specimens (6%), while in 46 (92%) it occurred outside the pelvis. ...
Higher division of sciatic nerve and its clinical importance
International Journal of Basic and Applied Sciences, 2013
The Sciatic Nerve after originating from sacral plexus leaves the pelvis through the lower part of greater sciatic foramen into the gluteal region and divides into two components at any level from its origin to its usual division inside the upper part of popliteal fossa. The Present study was conducted in the Department of Anatomy Government Medical College Srinagar to study the variations in the level of division of the sciatic nerve during usual dissection for academic purposes. Both lower limbs of a middle aged formalin preserved Indian male cadaver were dissected out for routine teaching and simultaneously recording observations. It was observed that the left sided sciatic nerve divided into its two components inside the pelvis. The tibial and common peroneal nerves after leaving through greater sciatic foramen sandwiched piriformis muscle in the gluteal region. The common peroneal nerve passed above the piriformis where as the tibial nerve passed inferior to this muscle. The sciatic nerve on the other side of this cadaver followed the normal anatomical course. The higher division of sciatic nerve inside the pelvis though rare is of great academic and clinical significance in Neurology, General Surgery, Orthopaedics, Anaesthesiology, Sports medicine and physiotherapy. The knowledge of this variation is also important for paramedics who frequently give intramuscular injections into the gluteal region.
Sciatic Nerve Bifurcation in the Gluteal Region
EC clinical and experimental anatomy, 2020
Sciatic nerve is the longest and widest nerve in the human body. It originates from the sacral plexus from L4S3 spinal nerves in the form of two nerve trunks. Commonly sciatic nerve bifurcates at the apex of the popliteal fossa into Tibial nerve and Common peroneal nerve. In the cadaver, we present a rare variation of bifurcation of the sciatic nerve into Tibial nerve and Common peroneal nerve in the gluteal region passing above the piriformis muscle. This type of human has a great chance of piriformis syndrome, which can cause compression of sciatic nerve by the piriformis muscle leading to non-discogenic sciatica.
2019
Original Research Article Background: The Sciatic nerve is the widest nerve of the body. It consists of two components, namely: the tibia and the common peroneal components derived from the ventral rami of L4 to S3 spinal nerves of the lumbosacral plexus. It exits the pelvis through the greater sciatic foramen below the Piriformis muscle and descends between the greater trochanter of the femur and ischial tuberosity of the pelvis to the knee. Higher division of the sciatic nerve is the most common variation where the TN and CPN may leave the pelvis through different routes which may lead to various clinical manifestations Likewise, their adequate knowledge will help in increasing surgical precision and decreasing morbidity. Material and methods: The study is a descriptive cross-sectional study conducted at the department of anatomy of several medical faculties in Sudan from May 2016 to June 2017. In which 50 male cadaver (100 lower extremities) age ranges from 50 to 70 years were di...
International Journal of Anatomy and Research, 2015
Background: The tibial and common peroneal nerves are dorsal and ventral divisions of the ventral rami of L4 to S3 of the lumbosacral plexus that join to form the sciatic nerve. The two nerves are structurally separate and supply the posterior compartment of the thigh, the leg and the foot. The point of bifurcation or separation of the sciatic nerve into tibial and common peroneal nerve varies. The common site is at the junction of the middle and lower third of the back of the thigh, near the apex of the popliteal fossa, but division may occur at any point above this. It may also rarely occur below it. The variations in the bifurcation of the sciatic nerve have clinical implications. They may result in nerve injury during deep intramuscular injections in the gluteal region, sciatica, piriformis syndrome etc. This study is to report the variations of the bifurcation in the sciatic nerve found in the cadaveres from Ethiopia, and discuss the clinical implications of such variations. Conclusion: We conclude from this study that the bifurcation of the sciatic nerve could occur high up in the gluteal region in relation to the piriformis muscle and may present clinical challenges in patient management
2016
Introduction: Commonly encountered peripheral nerve in emergency, trauma, routine surgical medical practice and neurology is Sciatic Nerve (SN). Its vulnerability to injury is because of its thickness and long course. Its vast clinical involvement warrants a more definitive study. So the study was planned with the following aims and objectives. Aim: To study the anatomical variations in the division and innervation of the sciatic nerve and to correlate these variations with the clinical consequences of the nerve. Materials and Methods: This study was carried out on 30 lower limbs of human cadavers of Indian origin. The sciatic nerves of these cadavers were dissected, photographed, observed, analysed and interpreted in the Department of Anatomy. Results: It was found that in 43% of cases division of sciatic nerve was just below the lower border of piriformis, in 36%, between the piriformis and the mid of the thigh, in 14% near the mid of the thigh, in 7%, between midway of thigh and joint line of the knee and not even in a single case, the division was found to be, in the pelvis and below the knee joint line. Conclusion: Most common site of exit and bifurcation of SN were found to be just below the piriformis which is in contradiction to the earlier reports which state apex of the popliteal fossa to be the most common site of SN bifurcation. So we emphasize that this fact should also be there in the mind of concerned surgeons, orthopedicians, anaesthesiologists and neurophysicians while dealing with and planning for the pathologies involving SN, not only for better diagnosis and treatment but also for avoidance of iatrogenic complications.
Kathmandu University Medical Journal, 2020
Background Sciatic nerve block used for various surgeries below knee and for maintenance of analgesia demonstrates wide variability regarding its bifurcation into tibial and common peroneal nerves, frequently accounting for incomplete nerve blocks. Objective To determine the variation of sciatic nerve bifurcation among Nepalese volunteers. Method This cross sectional study was conducted in the Department of Anesthesiology of Kathmandu Medical College Teaching Hospital from March to May 2019, where 110 healthy volunteers underwent ultrasonography of sciatic nerve starting from popliteal fossa to its bifurcation. The distance between the bifurcation of sciatic nerve from popliteal crease and depth of the nerve at that point from the skin were measured. Result The mean distance at which sciatic nerve bifurcated from the popliteal crease was 5.42 ± 1.37 cm. Most commonly, the sciatic nerve bifurcated at a distance of 5-7 cm from the popliteal crease in 110 limbs (50.45%). However, in 80...
Report of a Novel Bilateral Variation of Sciatic and Inferior Gluteal Nerve: A Case Study
The sciatic nerve is the thickest nerve of the sacral plexus which innervates many muscles and vast areas of the skin of the lower limb. It leaves the pelvis via the greater sciatic foramen, emerges into the gluteal region by passing under the piriformis muscle, and descends beneath the gluteus maximus to divide into its terminal branches; the tibial and common peroneal nerve at the superior angle of the popliteal fossa. In some cases, the sciatic nerve divides into the tibial and common peroneal nerves at a higher level and one of them or both passes through or over the piriformis muscle. Case Presentation: We find an interesting bilateral variation of sciatic nerve accompanying a very thick inferior gluteal nerve on the right side and unusual route and branching of tibial and common peroneal nerves on the left side. Conclusion: As in conditions like intramuscular injections, gluteal surgeries, and piriformis syndrome such variations may increase the risk of injury, it is important for the medical team to be aware of them. In this paper, by reporting many variations in a cadaver, we emphasize the importance of anatomical variations, especially for surgeons and nurses.
Sciatic nerve high division: two different anatomical variants
Acta médica portuguesa
Sciatic nerve variations are relatively common. These variations are often very significant in several fields of Medicine. The purpose of this paper is to present two such variants and discuss their clinical implications. Three Caucasian cadavers with no prior history of lower limb trauma or surgery were dissected and found to present anatomical variants of the sciatic nerve. In all cases the sciatic nerve divided above the popliteal fossa. In two cases (cadavers 1 and 2) it divided on both sides in the inferior portion of the gluteal region in its two terminal branches: the common fibular and the tibial nerves. In another case (cadaver 3) the sciatic nerve was found to divide inside the pelvis just before coursing the greater sciatic notch. The common fibular nerve exited the pelvis above the pyriformis muscle and then passed along its posterior aspect, while the tibial nerve coursed deep to the pyriformis muscle. According to the literature, the anatomical variant described in cad...
CADAVERIC STUDY OF THE EXIT OF SCIATIC NERVE
Aims: To study the exit of sciatic nerve in 100 cadavers. Materials & Methods: In the department of Anatomy of K.J.Somaiya Medical College, Sion, Mumbai, India, the study on exit of sciatic nerve was performed on 100 (200 specimens of Inferior Extremities) embalmed donated cadavers (80 males & 20 females). The specimens were classified into six groups. Observations: In Type I, 106 (103 males & 3 female) of the 200 (53%) specimens, the exit of the sciatic nerve below piriformis muscle. In Type II, 44 (all males) out of 200 (22%) specimens, the exit of common peroneal nerve through piriformis muscle and the tibial nerve below piriformis muscle. In Type III, 24 (22 males and 2 female) out of 200 (12%) specimens, the exit of common peroneal nerve above piriformis muscle and the tibial nerve below piriformis muscle. In Type IV, 16 (all males) out of 200 (8%) specimens, the exit of sciatic nerve through piriformis muscle. In Type V, 6 (4 males and 2 females) out of 200 (3%) specimens, the exit of tibial nerve above piriformis muscle and common peroneal nerve through piriformis muscle. In Type VI, 4 (all males) out of 200 (2%) specimens, the exit of sciatic nerve above piriformis muscle. Conclusion: Sciatic nerve division into the tibial and common peroneal components at a higher level can result in the involvement of only one out of the two divisions in sciatic neuropathy. It can also result in a failure of the sciatic nerve block while performing popliteal block anaesthesia. These anatomical variations may contribute to clinical conditions such as piriformis syndrome, sciatica and coccygodynia.