Sciatic Nerve Injury different Pathologies.pptx

different modalities of sciatic nerve injuries and protocol of management.

1. Sciatic nerve injuries: Different Pathologies Dr. Mohamed ElSayed ElSebaey Neurosurgery Department Benha Teaching Hospital 2023

2. Anatomy

3. Piriformis syndrome Cardinal features: History of trauma. Pain in the region of the sacro -iliac joint causing difficulty walking. Acute exacerbating of pain with lifting and moderately relieved by traction. Palpable sausage shaped mass over the piriformis muscle. Positive lasegue sign. Gluteal muscle atrophy .

4. Innervation : Superior gluteal nerve (L5 S1)

5. Innervation : Inferior gluteal nerve L5 S1 S2

6. Innervation: Piriformis : Sacral Plexus S1 S2 Gemellus Inferior: N to Quadratus femoris (L5 S1) Gemellus Superior: N to Obturator internus (L5 S1) Obturator internus : N to obturator internus (L5 S1)

7. Innervation: Semimembranous : Sciatic N , Tibial division (L5 S1 S2) Semitendinosus : Sciatic N , Tibial division (L5 S1 S2) Long head of Biceps femoris : Sciatic N, tibial division (L5 S1 S2) Short head of Biceps femoris : Sciatic N, Peroneal division (L5 S1 S2)

8. Innervation: Peroneus Longus M: Superficial peroneal N (L5 S1 S2) Peroneus Brevis M : Superficial peroneal N (L5 S1 S2 Planter flexion Ankle Eversion

9. Dorsi flexion Innervation: Tibialis Anterior M: Deep Peroneal N ( L4 L5 )

10. Dorsiflexion Extension of phalang . Innervation: Extensor digitorum Longus M: Deep Peroneal N ( L5 S1 )

11. Innervation: Extensor Hallucis Longus M: Deep Peroneal N (L5 S1) Dorsi flexion Extension big toe

12. Innervation: Extensor Digitorum Brevis M: Deep Peroneal N ( L5 S1 ) Dorsi flexion

13. Planter flexion Innervation: Soleus M: Tibial N ( S1 S2 ) Gastrocnemius M: Tibial N ( S1 S2 )

14. Planter flexion Inversion Innervation: Tibialis Posterior M: Tibial N ( L4 L5 )

15. Planter flexion Phalang . Innervation: Flexor Digitorum Longus M: Tibial N ( S2 S3 )

16. Flexor Hallucis Longus M: Tibial N ( S2 S3) Flexor Hallucis Brevis M: ( Medial and lateral heads) Medial planter N (S2 S3) Lateral planter N (S2 S3)

17. Abductor Hallucis M: Medial Planter N (S2 S3)

18. Flexor digitorum brevis M: Medial Planter N ( S2 S3 )

19. Lumbricals muscles: Medial and lateral planter Ns ( S2 S3 )

20. Dorsal Interossei Muscles: lateral planter N ( S2 S3 )

21. Planter Interossei M: Lateral planter N ( S2 S3 )

22. Adductor Hallucis M: lateral Planter N ( S2 S3)

23. Causes

24. Possible causes for Sciatic N injury Hip arthroplasty Injection injury Direct injury (stap, GSW, kiking ) RTA Positional like (mainly in prone position) Adhesions post orthopedic instruments ( Ex. Fix., plate and screws) Knee joint dislocation After splint or plaster cast After sleeping with leg outside bed compressing the

25. Length of the needle Angle of the needle Position of the patient during injection (lateral decubitus, upright or leaning forward) Agitated child  injection injury

26. Ischemia

27. Nature of the injected agents

28. Evaluation of neurotoxicity

29. Time of the surgical intervention after injection injury

30. pathology

31. investigations

32. Cases