This document discusses the bowstring test for assessing sciatic nerve pathology. It begins with objectives about describing the sciatic nerve, identifying lesions, and outlining the bowstring test. It then describes the sciatic nerve's course and supply. It discusses common sciatic nerve pathologies like sciatica. The document concludes by detailing the steps of the bowstring test, which involves straight leg raises and popliteal compression, and explains that a positive test implies sciatic nerve pathology.

1. BOWSTRING
TEST
BY
 PHILANS COSMOS ANKRAH

3. OBJECTIVES
By the end of this presentation, students should be able to;
 Describe the sciatic nerve and its course of supply
 Identify lesions of the sciatic nerve
 Identify the bowstring test as one of the tests of sciatic nerve
pathology
 Outline the steps in conducting the bowstring test
 Give the implications of the results obtained

4. THE SCIATIC NERVE
(LUMBOSACRAL PLEXUS)
 also known as the ischiadic nerve and the ischiatic
nerve
 It begins in the lower back and runs through the
buttock and down the lower limb.
 The sciatic nerve supplies nearly the whole of the skin
of the leg, the muscles of the back of the thigh, and
those of the leg and foot.
 It is derived from spinal nerves L4 through S3.

5. COURSE
 Exits the sciatic notch and runs anterior (deep) to piriformis.
 It then lies posterior (superficial) to the short external rotators
(superior gemellus, inferior gemellus and obturator internus).
 It then runs down the posterior leg where it breaks into its three
main divisions at the level of the mid thigh.
 The terminal branches are the common peroneal and tibial
nerve.

6. SUPPLY
 Articular branches supply the hip-joint
 Muscular branches supply posterior thigh muscles and
muscles of the leg.
 Sensor supply; innervates the skin on the posterior aspect of
the thigh and gluteal regions, as well as the entire lower leg
(except for its medial aspect).

7. PATHOLOGY
 Pain caused by a compression or irritation of the sciatic nerve by
a problem in the lower back is called sciatica.
 Common causes of sciatica include the following lower back and
hip conditions: spinal disc herniation, degenerative disc disease,
lumbar spinal stenosis, spondylolisthesis, and piriformis
syndrome
 Sciatic nerve palsy is a complication of total hip arthroplasty
 Sciatic nerve palsy can also result from severe spinal stenosis

8. SCIATICA

10. THE BOWSTRING TEST
Steps
 Subject begins supine with legs extended With a little
abduction of the hip and internal rotation
 Examiner performs a passive straight leg raise on the
involved side
 If radiating pain is reported, the examiner then flexes
the subjects knee until symptoms are reduced
 The examiner then applies pressure to the popliteal
area in attempt to reproduce the radicular pain

11. BOWSTRING TEST (RESULTS)
Positive Test
 Reproduction of radicular pain with popliteal
compression
Positive Test Implications
 Sciatic nerve pathology

12. STEPS AGAIN

14. THANK YOU…