- Anatomy:
- arises from
lumbrosacral plexus:
L4,
L5,
S1,
S2,
S3;
- nerve emerges from pelvis below
piriformis & enters thigh between ischial tuberosity & greater trochanter;
- in 10% of patients, the sciatic nerve is separated in
greater sciatic foramen by all or part of the piriformis;
- sciatic nerve is accompanied by
PFCN & by
inferior gluteal artery and its special branch to nerve;
- nerve enters thigh beneath lower border of
maximus;
- descends near middle of thigh, lying on
adductor magnus muscle & being crossed obliquely by long head of
biceps femoris ;
- nerve usually separates in upper part of popliteal space;
- Tibal Nerve Branch:
- from anterion branches of
LS plexus:
L4,
L5,
S1,
S2,
S3;
- 2 branches from
tibial division: below
quadratus femoris:
- upper branch passes to long head of
biceps femoris & upper portion of
semitendinosus;
- lower branch: innervates lower portion of
semitendinosus &
semimembranous & ischiocondylar portion of
adductor magnus ;
- Common Peroneal Nerve:
- from posterior branches:
L4,
L5,
S1,
S2;
- nerve to short head of
biceps femoris arises from lateral side of sciatic nerve (common
peroneal portion)
in middle of thigh & enters superficial surface of the muscle;
- Sciatic Nerve in THR: (see:
nerve injuries from THR)
- in THR the sciatic nerve may be injured by excessive tension when extremity has been lengthened significantly, especially in pts w/ DDH ;
- sciatic nerve is at risk during leg lengthening;
-
peroneal division is most often affected;
- w/ sciatic nerve injury following THR, keep pts leg flexed over side of bed;
- if injury was due to traction, the nerve may recover in the relaxed position;
- Sciatic Nerver Injury from Kocher Langenbock Approach;
- sciatic nerve palsy from Kocher Langenbock Approach;
- can be prevented by intraop monitoring of amount of tension applied by assistants retracting the nerve;
- early treatment consists of AFO
- sciatic nerve recovery may occur over a 3 yr period;
- tendon transfers are usually not performed unitl 3 yr post op;
Sciatic nerve palsy after total hip arthroplasty: treatment by modular neck shortening.
Nerve palsy associated with total hip replacement. Risk factors and prognosis.
Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty.
Somatosensory-evoked potential monitored during total hip arthroplasty.
Treatment of sciatic denervation disuse osteoporosis in the rat tibia with capacitively coupled electrical stimulation. Dose response and duty cycle.
Sciatic paralysis. A complication of bleeding following hip surgery.
Spontaneous gluteal artery rupture resulting in compartment syndrome and sciatic neuropathy. Report of a case in Ehlers-Danlos syndrome.
Paralytic drop foot and gluteal fibrosis after intramuscular injections.
Extrapelvic compression of the sciatic nerve. An unusual cause of pain about the hip: report of five cases.
Hughes SS. et al. JBJS Am 1993 Oct;75(10):1576 Journal of Bone & Joint Surgery - American Volume. 74(10):1553-9, 1992 Dec
Sciatic Nerve Resection. Is That Truly an Indication for Amputation? Jacob Bickels, MD et al CORR 2002;2002:201-204
Sciatic Nerve Release Following Fracture or Reconstructive Surgery of the Acetabulum
