High Division Of Sciatic Nerve Research Articles

A study of high division of sciatic nerve in human cadavers and its clinical significance

Background: Sciatic nerve is a mixed nerve which provide sensory and motor supply for skin and muscles of the lower limb by tibial and common peroneal nerve. Anatomical variations of sciatic nerve at high division have been reported by various authors. The path of the sciatic nerve is important while administration of intramuscular injection to prevent nerve injury and nerve blockage failure during anesthesia. This knowledge of high division helps in different surgical approach for sciatic nerve injury or hip dislocation. Aims and Objectives: The aim of the study was to describe incidences of high division variation of Sciatic nerve and different types in cadavers during routine dissection schedule. Materials and Methods: The study was conducted during routine dissection schedule in anatomy department for first MBBS students to observe sciatic nerve course in 30 gluteal regions from 15 adult cadavers fixed by formalin. Location of sciatic nerve in relation to piriformis muscle and its division whether in single nerve sheath or separate sheath and types was recorded. Results: In 12 cadavers (80%), sciatic nerve course found normal which leaves pelvis at inferior border of piriformis muscle and bifurcate in terminal branches tibial nerve and common peroneal nerve as it approaches at the apex of popliteal fossa. In 3 cadavers (20%), two male and one female, we found high division of sciatic nerve where terminal branches, tibial nerve, and common peroneal nerve leave the pelvis below piriformis separately in different sheaths. Conclusion: Knowledge of variations-related high division of sciatic nerve would help surgeons during different interventions related to sciatic nerve and for preventing further complications.

Variations in the gluteal region and its clinical significance – A cadaveric study

Anatomical structures involving muscles and nerves in the gluteal region are important as any variations of Sciatic nerve (SN) and its surrounding muscles like piriformis muscle (PM) can lead to entrapment or compression of this nerve causing sciatica and piriformis syndrome. To find out variations in the gluteal region related to piriformis muscle and the nerves surrounding it. The study was done on 20 embalmed cadavers (total 40 gluteal regions) during routine cadaveric dissection. The anatomical relations of the piriformis and surrounding nerves i.e. sciatic nerve, its divisions and gluteal nerves were studied. The dissection was done on 40 gluteal regions. In 36 gluteal regions (90%) the sciatic nerve emerged below the piriformis as a single trunk. While in 4 gluteal regions (10%) there was a higher division of sciatic nerve. In one cadaver we observed an accessory piriformis muscle just inferior to the main piriformis muscle. The sciatic nerve was also dividing higher up into common peroneal nerve and tibial nerve in the gluteal region. The common peroneal nerve (CPN) was observed emerging between the main and the accessory piriformis muscle. Along with it the inferior gluteal nerves were also seen traversing between the main and the accessory piriformis muscle.Knowledge of anatomical variations in the gluteal region is important to explain the myalgia and neuropathies in this region. This knowledge is also important in performing hip surgeries and giving intramuscular injections in the gluteal region.

Anatomically high division of sciatic nerve and its clinical significance

Background / Aim. The sciatic nerve (SN) is a mixed nerve formed in pelvis by joining of L4 - S3 anterior spinal nerve roots. SN can be under the pressure in different regions throughout its course. However, the most frequent site of impingement is under the piriformis muscle which causes the occurrence of piriformis syndrome. High division of SN has its relevance considering the fact that it leads to the compression of nerve resulting in piriformis syndrome. The aim of this study was to determine the connection be-tween anatomical parameters of pelvis and high division of SN, which is considered to be one of the most common causes of piriformis syndrome in both genders. Methods. This study was conducted on 28 formalin fixed cadavers of both genders at the Institute of Anatomy, Faculty of Medicine, University of Belgrade (Belgrade, Serbia) and the Department of Anatomy, School of Medicine, University of St Andrews (St Andrews, United Kingdom). For the measuring of required dimensions, we used a ruler and a caliper. Results. A statistically significant difference in the values of bispinal and bituberal lines was observed. A high division of SN was found on 58.33% of the male cadavers and 80% of the female cadavers. A statistically significant difference in the mean value of the bituberal line between the male and female sex was also recognised. Conclusion. The connection between the anatomical parameters of the pelvis and the level of division of the SN is confirmed. Although on the basis of the results it could be assumed that people with smaller pelvic dimensions would have greater likelihood of developing a piriformis syndrome, the other factors, such as biomechanics related to a wider ?Q angle? in women that could result in a higher incidence of piriformis syndrome, should also be considered.

High division of sciatic nerve associated with a double superior gemellus muscle

Abstract Introduction: The superior gemellus muscle is a lateral rotator of the thigh, functioning together with other muscles of the region such as the piriformis muscle. The sciatic nerve is the largest nerve of the human body. It arises from the lumbosacral plexus and divides into two nerves: the tibial and common fibular nerves, which normally appear near the apex of the popliteal fossa. It is responsible for the innervation of the muscles of the posterior compartment of the lower limb. Case report: We report a doubled superior gemellus muscle associated with a high division of the sciatic nerve on the left side of a cadaveric specimen. The other muscles of the region showed no abnormality. Conclusion: This variation may offer information to piriformis muscle syndrome and be of importance in radiology and surgery of the region.

The sciatic nerve in human cadavers - high division or low formation?

Variations of the sciatic nerve have been extensively studied in the past including its relationship with the piriformis muscle and associated clinical conditions like piriformis syndrome and sciatica. In the present study we noticed some interesting variations of the sciatic nerve, which were slightly different from the cases described earlier. In the previous studies most of the authors described the higher division of sciatic nerve and none of them discussed its formation. In this study we tried to look its formation from the sacral plexus and its divisions in the thigh. We noticed that in one cadaver the two components of the sciatic nerve originated directly from the sacral plexus and coursed down without merging in the thigh. Should this be called a higher division or non formation of the sciatic nerve? On the other hand in two other cadavers, the two divisions after emerging separately from the sacral plexus, united in the gluteal region and in the thigh respectively. Should we call this as higher division or low formation of the sciatic nerve? In two other cadavers the sciatic nerve emerged from the greater sciatic foramen below the piriformis and divided in the gluteal region itself. Ideally this should be called as higher division of sciatic nerve.

Common peroneal nerve entrapment with the communication between inferior gluteal nerve and common peroneal nerve

Sciatic nerve divides into tibial nerve and common peroneal nerve at the level of superior angle of popliteal fossa and variations in its branching pattern are common. The most common nerve entrapment syndrome in the lower limbs is common peroneal nerve entrapment at fibular head. Invariably it can also be trapped in gluteal region due to split piriformis muscle which compresses sciatic nerve as whole or its division such as common peroneal nerve. In this case report, we describe a case of high division of sciatic nerve along with duplicated piriformis associated with a communicating branch between inferior gluteal nerve and common peroneal nerve. Such an anatomical variation of common peroneal nerve with the communicating nerve is discussed with its embryological basis.

UNILATERAL HIGH DIVISION OF SCIATIC NERVE AND ITS RELATION TO BIFID PIRIFORMIS

Address for Correspondence: Dr. Rashmi C. Goshi, C\O P C Goshi; Ashirwad building; Kangoori Galli; BetgeriGadag 582102, Karnataka, India. E-Mail: rashmigoshi@gmail.com Junior Resident, Department of Anatomy, Gadag Institute Of Medical Sciences, Gadag, Karnataka, India. Background: The sciatic Nerve can rarely be separated into tibial and common fibular Nerve within the Pelvis. In such cases the tibial nerve and common fibular nerve leave the pelvis through different routes. Materials and Method: The variation found during routine dissection for MBBS students in a 30 yr old male cadaver in the department of Anatomy, JJM Medical college Davangere, Karnataka, India. Results: The variation is High division of sciatic Nerve unilaterally on right side in 30yrs old male cadaver. Common peroneal Nerve is found passing between the two divisions of bifid piriformis while tibial Nerve passed below the inferior piriformis Conclusion: Knowledge of this variation is important clinically in sciatic nerve entrapment resulting in nondiscogenic sciatica and also requires reviewing of the piriformis syndrome

Arterial Supply of Sciatic Nerve and Its Impact on Clinical Practice

Sciatic nerve is the nerve of the posterior compartment of thigh; it is formed in the pelvis from the ventral rami of L4 to S3 spinal nerves. It leaves the pelvis via the greater sciatic foramen below piriformis and divides into common peroneal nerve and tibial nerve at the level of the upper angle of the popliteal fossa. The vasculature of peripheral nerves is adapted specifically to their structure and function. Arterial vessels that reach main nerve trunks originate from the adjacent main arteries or their muscular or cutaneous branches. Although variability in arterial supply of sciatic nerve was discussed by some authors it is still deficient. To minimize sciatic nerve ischemia and its concomitant problems, an understanding of the origin and course of the arteries supplying it in the gluteal region and the posterior compartment of thigh is important. The present study aimed to detect the different arteries supplying the sciatic nerve in the gluteal and posterior thigh regions and to study the importance of this in clinical practice. Three cases subjected to vascular surgery and twenty lower limbs of ten formalin preserved male cadavers were used. Higher division of sciatic nerve was observed in all specimens. In 6 specimens (30%), arterial supply of sciatic nerve originated from the inferior gluteal artery, 6 specimens (30%)from first, second and third perforating arteries, 5 specimens (25%)from the lateral circumflex femoral artery and 3 specimens (15%)from internal pudendal artery. Anastomosis between internal iliac artery through its internal pudendal branch and external iliac artery through perforating arteries was observed. It was concluded that there is a good anastomosis between internal iliac and profunda femoris artery on the same side but cross pelvic anastomosis is absent or deficient and in case of profunda femoris occlusion we should preserve internal pudendal artery and the reverse.

Study on variant anatomy of sciatic nerve.

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. Knowledge regarding such variation and differences in the course of SN is important for the surgeons to plan for various surgical interventions pertaining to the gluteal region. The variant anatomy of SN may cause piriformis syndrome and failure of SN block. Hence present study is undertaken to know the level of division, exit, course, relationship to piriformis and variations in the branching pattern of SN.

Higher division of sciatic nerve and its clinical importance

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.