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. The purpose of this study is to identify the course and variations in branching pattern of the sciatic nerve which may lead to various clinical manifestations.
Twenty-eight formalin fixed cadavers comprising of 56 lower limbs are used for this study, of which six specimens were female cadavers. Dissection of gluteal region and posterior compartment of the thigh was done to expose the sciatic nerve. Variations in the sciatic nerve anatomy; their relationship to Piriformis muscle and a point of bifurcation and trifurcation were noted and recorded.
Forty-two lower limbs (75 %) showed normal anatomy of sciatic nerve. Fourteen regions (25 %) showed variations in the sciatic nerve, of which six regions (11 %) showed a variation of the sciatic nerve in relation to Piriformis muscle, three regions (5 %) showed trifurcation of the sciatic nerve and five regions (9 %) showed variation in the origin of the sural nerve.
The knowledge regarding the level of division and distribution of the sciatic nerve and its location is of great importance. The sciatic nerve is frequently involved in daily medical practice of neurology, orthopedics, rehabilitation and anesthesia. Its long course makes it vulnerable to nerve injury. Even in this era the cadaver is the best means to study anatomy. It emphasizes proper clinical implications, for the surgeons to practice efficient surgical recombination and avoid errors.
Supercharge end-to-side (SETS) transfer, also referred to as reverse end-to-side transfer, distal to severe nerve compression neuropathy or in-continuity nerve injury is gaining clinical popularity ...despite questions about its effectiveness. Here, the authors examined SETS distal to experimental neuroma in-continuity (NIC) injuries for efficacy in enhancing neuronal regeneration and functional outcome, and, for the first time, they definitively evaluated the degree of contribution of the native and donor motor neuron pools.
This study was conducted in 2 phases. In phase I, rats (n = 35) were assigned to one of 5 groups for unilateral sciatic nerve surgeries: group 1, tibial NIC with distal peroneal-tibial SETS; group 2, tibial NIC without SETS; group 3, intact tibial and severed peroneal nerves; group 4, tibial transection with SETS; and group 5, severed tibial and peroneal nerves. Recovery was evaluated biweekly using electrophysiology and locomotion tasks. At the phase I end point, after retrograde labeling, the spinal cords were analyzed to assess the degree of neuronal regeneration. In phase II, 20 new animals underwent primary retrograde labeling of the tibial nerve, following which they were assigned to one of the following 3 groups: group 1, group 2, and group 4. Then, secondary retrograde labeling from the tibial nerve was performed at the study end point to quantify the native versus donor regenerated neuronal pool.
In phase I studies, a significantly increased neuronal regeneration in group 1 (SETS) compared with all other groups was observed, but with modest (nonsignificant) improvement in electrophysiological and behavioral outcomes. In phase II experiments, the authors discovered that secondary labeling in group 1 was predominantly contributed from the donor (peroneal) pool. Double-labeling counts were dramatically higher in group 2 than in group 1, suggestive of hampered regeneration from the native tibial motor neuron pool across the NIC segment in the presence of SETS.
SETS is indeed an effective strategy to enhance axonal regeneration, which is mainly contributed by the donor neuronal pool. Moreover, the presence of a distal SETS coaptation appears to negatively influence neuronal regeneration across the NIC segment. The clinical significance is that SETS should only employ synergistic donors, as the use of antagonistic donors can downgrade recovery.
The lateral exposure of the supracondylar femur includes the risk of damaging the neurovascular structures or tightening of the neurological structures within the popliteal fossa may occur as a ...complication of the osteotomy. Although different pathways of common peroneal nerve (CPN) have been reported throughout the literature, division of deep and superficial branches above the supracondylar femur level has not been reported. A 15-year-old boy with bilateral knee flexion contracture and spastic diplegic cerebral palsy underwent bilateral femoral distal extension osteotomy. The authors found an unusual higher division of CPN above the supracondylar femur level. This report is aimed at warning surgeons about the division of the CPN at a higher level and highlighting a need for a high-powered cadaveric research.
Background This was a retrospective review of published articles reporting acupuncture and moxibustion treatment of peroneal nerve palsy. Methods On-line database searches were carried out using; ...Cochrane Library, Pubmed, CNKI, NDSL and OASIS to find articles reporting acupuncture and moxibustion treatment for peroneal nerve palsy. Duplicate articles and studies that were not relevant to the topic were excluded, along with review articles and commentaries. Results 20 studies were selected, 18 clinical case studies (47 patients) and 2 randomized controlled trials (154 patients). Intervention treatments included acupuncture, moxibustion, bee-venom (BV), pharmacopuncture, electroacupuncture and acupotomy. Surprisingly, although peroneal nerve palsy is not a very rare disease, only 2 studies out of 20 carried out a randomized controlled trial. Conclusions Although studies to date report the efficacy of acupuncture and moxibustion treatment in peroneal nerve palsy patients, the absence of objective evaluation and the absence in the reporting of side-effects remains an issue.
Abstract Hyaluronan (HA) is known to inhibit neurons from regenerating in the central nervous system. However, hyaluronan tetrasaccharide (HA4) was found in in vitro experiments to promote outgrowth ...of neurons. To investigate the promotion by HA4 of nerve regeneration in vivo , we analyzed outgrowth of regenerating axons treated with HA4, using a film model method. After the common peroneal nerve in mice was transected, the proximal end of cut nerve was placed on a sheet of thin plastic film, immersed in several drops of HA4 solution, covered with another sheet of film, and then kept in vivo . Six hours after the procedure, terminal sprouts had grown out from ending bulbs formed at the cut end of parent nerve administered with HA4 solution 100 or 1000 μg/mL, while no sprouts were observed in groups treated with 10 μg/mL of HA4 or in controls. On the 2nd day after axotomy (day 2), many regenerating axons in the group treated with 100 μg/mL of HA4 extended onto the flat film for a longer distance than those treated with 1000 μg/mL of HA4 and controls. With the optimal dose of HA4 (100 μg/mL), axonal outgrowth was significantly ( p < 0.01) greater than that in controls at each time point. Schwann cells appeared migrating from parent nerve onto the film from day 3 as well as in controls. Thus, enhanced outgrowth of regenerating axons and normal behavior of migratory Schwann cells suggested that HA4 promoted regeneration of neurons without the mediation of Schwann cells.
•Ankle arthroscopy is growing in popularity and is generally regarded as a safe procedure.•Complications from this procedure do exist and this paper highlights the frequency of these as reported in ...the literature.•Damage to the superficial peroneal nerve is the most common complication following anterior ankle arthroscopy.•Temporary Achilles tendon tightness is the most common complication following posterior ankle arthroscopy.
There is a wealth of studies reporting the complications of anterior and posterior ankle arthroscopy. The aim of this study is to summarise and review the complication rate(s) associated with both anterior and posterior ankle arthroscopy, as described in the literature.
The authors carried out a comprehensive review of the literature up until March 2018. An extensive search of the MEDLINE, Cochrane library and EMBASE databases was undertaken using the following keywords: complications of ankle arthroscopy, anterior ankle arthroscopy, and posterior ankle arthroscopy.
A total of 107 papers were identified and 55 were deemed appropriate for analysis. The overall complication rate of ankle arthroscopy was found to be between 3.4– 9%.
No life threatening complications were identified in the literature with both anterior and posterior ankle arthroscopy. The commonest complication after anterior and posterior ankle arthroscopy is superficial peroneal nerve injury and temporary Achilles tendon tightness, respectively.
Anatomical landmarks for ankle block Nimana, K. V. H; Senevirathne, A. M. D. S. R. U; Pirannavan, R ...
Journal of orthopaedic surgery and research,
09/2023, Letnik:
18, Številka:
1
Journal Article
Recenzirano
Odprti dostop
We aimed to describe anatomical landmarks to accurately locate the five nerves that are infiltrated to accomplish anaesthesia of the foot in an ankle block. Twenty-four formaldehyde-fixed cadaveric ...ankles were studied. Photographs of cross sections of the frozen legs, cut at a horizontal plane across the most prominent points of the medial and lateral malleoli, were analysed. The curvilinear distance from the most prominent point of the closest malleolus to each of the five cutaneous nerves and their depth from the skin surface were measured. Sural, tibial, deep peroneal, saphenous and medial dorsal cutaneous nerves were located 5.2 ± 1.3, 9.2 ± 2.4, 7.4 ± 1.9, 2.8 ± 1.1, 2.1 ± 0.6 mm deep to the skin surface. The curvilinear distances from the medial malleolus to the tibial, deep peroneal and saphenous nerves were 32.5 ± 8.9, 62.8 ± 11.1 and 24.4 ± 7.9 mm, respectively. The curvilinear distances from the lateral malleolus to the sural and medial dorsal cutaneous branches of superficial peroneal nerves were 27.9 ± 6.3 and 52.7 ± 7.3 mm, respectively. The deep peroneal nerve was found between the tendons of the extensor hallucis longus and the extensor digitorum longus in the majority of specimens, while the medial dorsal cutaneous nerve was almost exclusively found on the extensor digitorum longus tendon. The sural and tibial nerves were located around halfway between the most prominent point of the relevant malleolus and the posterior border of the Achilles tendon. In conclusion, this study describes easily identifiable, palpable bony and soft tissue landmarks that could be used to locate the nerves around the ankle.
Melatonin attenuates muscle sympathetic nerve responses to sympathoexcitatory stimuli, but it is unknown whether melatonin similarly attenuates reflex changes in skin sympathetic nerve activity ...(SSNA). In this double-blind, placebo-controlled, crossover study, we tested the hypothesis that melatonin (3 mg) would attenuate the SSNA response to mental stress (mental arithmetic). Twelve healthy subjects underwent experimental testing on two separate days. Three minutes of mental stress occurred before and 45 min after ingestion of melatonin (3 mg) or placebo. Skin temperature was maintained at 34°C. Reflex increases in SSNA (peroneal nerve), mean arterial pressure, and heart rate (HR) to mental stress before and after melatonin were determined. Melatonin lowered HR (pre, 66 ± 3 beats/min; and post, 62 ± 3 beats/min, P = 0.046) and SSNA (pre, 14,282 ± 3,706 arbitrary units; and post, 9,571 ± 2,609 arbitrary units, P = 0.034) at rest. In response to mental stress, SSNA increases were significantly attenuated following melatonin ingestion (second minute, 114 ± 30 vs. 74 ± 14%; and third minute, 111 ± 29 vs. 54 ± 12%, both P < 0.05). The mean arterial pressure increase to mental stress was blunted in the third minute (20 ± 2 vs. 17 ± 2 mmHg, P = 0.032), and the HR increase was blunted in the first minute (33 ± 3 vs. 29 ± 3 beats/min, P = 0.034) after melatonin. In summary, exogenous melatonin attenuates the SSNA response to mental stress.
Soft tissue defects around the ankle are common and must be covered with thin and pliable flaps. A regional flap, particularly from the dorsum of the foot was considered ideal. A neurocutaneous flap, ...based on the superficial peroneal nerve (SPN) and its branches was designed as a proximally based flap via cadaveric dissection. This study aimed to demonstrate the vascularity and characteristics of the superficial peroneal neurocutaneous (SPNC) flap. The SPNC flap was created in 11 lower limbs (seven cadavers) using a proximally based design. The skin flap was dissected at the dorsum of the foot, followed by injection of diluted methylene blue through the anterior tibial artery, to visualize the vascularity. The flap pedicle above the anterior ankle joint line was dissected along the SPN for anatomical study of perforating branches, paraneural vessels, and flap territory. The mean distances of the most proximal perforating branches were 1.51 ± 1.48 cm from the anterior ankle joint line, and 5.12 ± 1.78 cm from the lateral malleolus. The mean distances of the most distal perforating branches were 2.75 ± 1.54 cm from the anterior ankle joint line, and 5.90 ± 1.81 cm from the lateral malleolus. The mean number of perforating branches was 3.73 ± 1.49. The mean flap territories were 5.51 ± 0.59 cm in length, and 7.15 ± 0.64 cm in width. The SPNC flap is an alternative method for soft tissue reconstruction around the ankle with a proximally based flap design. The antegrade flow has been shown to offer effective vascularity in flaps prepared via cadaveric dissection.
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