orthopedics. sciatic n. injury.(baxtyar rasul)

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orthopedics. sciatic n. injury.(baxtyar rasul)

  1. 1. Sciatic nerve
  2. 2. Anatomy Supplies: Hamstrings (posterior of thigh) Above knee divided into : (1)Common peroneal: Superficial peroneal : The two peronei Skin of lateral of leg and dorsum of foot except 1st cleft Deep peroneal: Muscles of anterior compartment of the leg Skin of 1st cleft (2)Tibial nerve : muscles of the calf Skin of the sole
  3. 3. Causes of injury of the main trunk Gunshot Operative accidents Trauma following hip dislocation or fractures of the acetabulum
  4. 4. Symptoms and signs Paralysis of (1) Hamstrings (2) All muscles below the knee Foot drop Absent sensation in most of the leg Trophic ulcers ±
  5. 5. Treatment Urgent reduction of hip dislocation Proper treatment of fractures Open wounds: Repair While recovery is awaited a drop-foot splint is fitted
  6. 6. <ul><li>Prognosis </li></ul><ul><li>Poor </li></ul><ul><li>At best it will be delayed and incomplete </li></ul><ul><li>If there is no recovery whatever, amputation may be preferable to a </li></ul><ul><li>flail, deformed, insensitive limb </li></ul>
  7. 7. Common peroneal nerve injury
  8. 8. Causes Varus force in the knee Pressure from a splint or plaster cast Lying with the leg externally rotated Anterior compartment syndrome (pressure on deep peroneal nerve)
  9. 9. Symptoms and signs Wasting of dorsiflexor and peronei muscles Drop foot Loss of sensation of dorsum of foot
  10. 10. Nerve entrapment syndromes Whenever peripheral nerves traverse fibro-osseous tunnels , they are at risk of entrapment or compression
  11. 11. Causes ↑ in soft tissue bulk( pregnancy, myxoedema, RA) Local obstruction (ganglion, osteophyte,old #) Idiopathic
  12. 12. Sites Carpal tunnel at the wrist (Median nerve)
  13. 13. Cubital tunnel at the elbow( ulnar nerve)
  14. 14. Tarsal tunnel below the ankle( Posterior tibial nerve)
  15. 15. Lateral part of inguinal ligament (lateral cutaneous of the thigh )
  16. 16. Thoracic outlet( C8+ T1)
  17. 17. Clinical features Intermittent tingling OR pain OR numbness These symptoms are related to specific postures which compromise the nerve. e.g. CTS : flexion or hyperextension of the wrist Ulnar neuropathy : flexion of the elbow for a long time(driving, using telephone) Areas of altered sensation Motor weakness Muscle wasting
  18. 18. Treatment Avoiding compromising postures Light splints Local steroid injection If all above failed : Surgical decompression

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