SCIATIC NERVE

INTRODUCTION

Sciatic nerve is the thickest, largest and the longest nerve of the body. It is also known as ISCHIATIC NERVE. It begins in the pelvis and terminates at the superior angle of the popliteal fossa by dividing into the tibial and common peroneal nerves.
2

ORIGIN AND ROOT VALUE

Its the terminal branch or the continuation of the sacral plexus. Its root value is L4,L5,S1,S2,S3. Its is made up of 2 parts, tibial and the common peroneal parts. TIBIAL PART-Ventral divisions of the anterior primary rami of L4,L5,S1,S2,S3. COMMON PERONEAL PART-Dorsal divisions of the anterior primary rami of L4,L5,S1,S2,S3.
3

COURSE AND ITS DISTRIBUTION

IN PELVIS

IN GLUTEAL REGION
IN THIGH

IN PELVIS

Arises in the pelvis. Leaves the pelvis by passing through greater sciatic foramen below the piriformis to enter the gluteal region. No branches.

IN GLUTEAL REGION

Enters the gluteal region through greater sciatic foramen. Here its course is b/w ischial tuberosity and greater trochanter with slight lateral convexity. Lies deep to the gluteus maximus and superficial to obturator internus with two gamelli and quadratus femoris and then enter the back of the thigh. No branches.

BACK OF THIGH

Enters the back of the thigh at the lower border of gluteus maximus. Nerve is superficial to adductor magnus and deep to long head of biceps femoris. Here it gives muscular branches to semitendinosus, semimembranosus, biceps femoris and ischial head of adductor magnus.
7

TERMINATION

Terminates at the superior angle of the popliteal fossa i.e. at the junction of upper 2/3rd and lower 1/3rd of the thigh. Terminal branches are tibial and common peroneal nerves

BRANCHES

ARTICULAR-Branches to the hip joint arise in gluteal region. MUSCULAR-Branches given in the upper part of thigh. 1.Tibial part-supplies long head of the biceps femoris,semitendinosus, semimembranosus. 2.Common peroneal partsupplies short head of biceps femoris.
9

SEMITENDINOSUS

ORIGIN: From the inferomedial impression on the upper part of ischial tuberosity INSERTION: Upper part of the medial surface of the tibia behind sartorius and gracilis ACTION: Flexor of the knee

10

SEMIMEMBRANOSUS

ORIGIN: Superolateral impression on the upper part of the ischial tuberosity INSERTION: Into the groove on the posterior surface of the medial condyle of tibia ACTION: Flexor of the knee

11

BICEPS FEMORIS

ORIGIN: 1.LONG HEAD: From the inferomedial impression on the upper part of the ischial tuberosity 2.SHORT HEAD: From the lateral lip of linea aspera b/w add.magnus and vastus lat. INSERTION: Head of the fibula ACTION: Flexor of the knee.

12

ADDUCTOR MAGNUS
HAMSTRING PART: ORIGIN: Tuberosity of ischium. INSERTION: Linea aspera and adductor tubercle on medial cndyle of the femur. ACTION: Extension of hip joint.

13

SENSORY DISTRIBUTION

Innervates the skin of post. Aspect of thigh and gluteal regions Entire lower leg except for its medial aspect

14

APPLIED ANATOMY

15

Sciatica

Sciatica (or sciatic neuritis) is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five spinal nerve roots that give rise to each sciatic nerve, or by compression or irritation of the left or right or both sciatic nerves. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, pins and needles or tingling and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain.
16

17

Region of pain by compression of following roots of the sciatic nerve

18

Sypmtoms

Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. The result is leg pain. Sometimes the pain radiates around the hip or buttock to feel like hip pain. While sciatica is often associated with lower back pain (lumbago), it can be present without low back pain. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down.
19

Who is prone to developing symptoms of sciatica?

Sciatica can affect just about anyone, but it is extremely uncommon in young patients. Sciatica typically affects 30 to 50 year old patients. Often there is a sudden onset that may be attributed to over-exertion or a back injury.

20

Causes
Spinal disc herniation Spinal stenosis

Trigger points
Piriformis syndrome Pregnancy

Habits
21

Spinal disc herniation

Herniation of a disc occurs when the liquid center of the disc bulges outwards, tearing the external ring of fibers, extrudes into the spinal canal, and compresses a nerve root against the lamina or pedicle of a vertebra, thus causing sciatica. This extruded liquid from the nucleus pulposus may cause inflammation and swelling of surrounding tissue which may cause further compression of the nerve root in the confined space in the spinal canal. Sciatica caused by pressure from a disc herniation and swelling of surrounding tissue can spontaneously subside if the tear in the disc heals and pulposis extrusion and inflammation cease Sciatica can be caused by tumours impinging on the spinal cord or the nerve roots. Severe back pain extending to the hips and feet, loss of bladder or bowel control, or muscle weakness, may result from spinal tumours. Trauma to the spine, such as from a car accident, may also lead to sciatica.
22

Sciatica due to herniated spinal disc

23

Spinal stenosis

Spinal stenosis, a condition in which the spinal canal (the spaces through which the spinal cord runs) narrows and compresses the sciatic nerve roots. This narrowing can be caused by bone spurs, spondylolisthesis, inflammation, or herniated disc which decreases available space for the spinal cord, thus pinching and irritating nerves from the spinal cord that travel to the sciatic nerves.

24

Spinal stenosis

Pain shooting down the sciatic nerve

25

Piriformis syndrome

In 15% of the population, the sciatic nerve runs through the piriformis muscle rather than beneath it. When the muscle shortens or spasms due to trauma or overuse, it can compress or strangle the sciatic nerve beneath the muscle. Conditions of this type are generally referred to as entrapment neuropathies; in the particular case of sciatica and the piriformis muscle, this condition is known as piriformis syndrome. It has colloquially been referred to as "wallet sciatica" since a wallet carried in a rear hip pocket will compress the muscles of the buttocks and sciatic nerve when the bearer sits down. Piriformis syndrome may be a cause of sciatica when the nerve root is normal.
26

27

Trigger points

Another source of sciatic symptoms is active trigger points of the lower back and the gluteus muscles. In this case, the referred pain is not consequent to compression of the sciatic nerve, though the pain distribution down the buttocks and leg is similar. Trigger points occur when muscles become ischemic (having low blood flow) due to injury or chronic muscular contraction. The most commonly associated muscles with trigger points triggering sciatic symptoms are: the quadratus lumborum, the gluteus medius, the gluteus minimus, and the deep hip rotators.
28

Pregnancy

Results from the uterus pressing on the sciatic nerve, and, secondarily, from the muscular tension and/or vertebral compression consequent to carrying the extra weight of the fetus, and the postural changes inherent to pregnancy

29

Habits

Sitting on a wallet or standing for prolonged periods of time every day which can cause selfinflicted sciatica. Symptoms of numbness and/or pain behind the knee cap are associated with this form of sciatica. Work-related sciatica may be caused by the use of tool belts which hang around the hips and cause significant misalignment of the sacral vertebrae over long time periods.
30

There is a condition where the nerve becomes compressed as it passes under a muscle in the hip that results in the nerve sending pain messages to the brain that in many cases are phantom pains. Phantom pains from sciatica will give the impression that the only place where pain is occurring is in the heels of the feet and there is no pain in the knee or lower leg area. Sciatica is associated with a feeling of numbness in the heel and may be associated with a burning pain at night. Getting treatment for the Sciatica in many cases is the cure for the heel pain.
31

Reference

www.google.com www.wikipedia.com B.D Chaurasia

32

THANK YOU

33