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The sciatic nerve (also known as the ischiatic nerve) is a large nerve that starts in the lower back and runs through the buttock and down the lower limb. It is the longest and largest single nerve in the body. The sciatic 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.
The nerve enters the lower limb by exiting the pelvis through the greater sciatic foramen, below the Piriformis muscle. It descends midway in the greater trochanter of the femur and the tuberosity of the ischium, and along the back of the thigh to about its lower third, where it divides into two large branches, the tibial and common peroneal nerves. This division may take place at any point between the sacral plexus and the lower third of the thigh. When it occurs at the plexus, the common peroneal nerve usually pierces the Piriformis muscles. In the upper part of its course, the nerve rests upon the posterior surface of the ischium, the nerve to the Quadratus femoris, the Obturator internus and Gemelli; it is accompanied by the posterior femoral cutaneous nerve and the inferior gluteal artery, and is covered by the Gluteus maximus. Lower down, it lies upon the Adductor magnus, and is crossed obliquely by the long head of the Biceps femoris.
The nerve gives off articular and muscular branches. The articular branches (rami articulares) arise from the upper part of the nerve and supply the hip-joint, perforating the posterior part of its capsule; they are sometimes derived from the sacral plexus. The muscular branches (rami musculares) are distributed to the following muscles of the lower limb: Biceps femoris, Semitendinosus, Semimembranosus, and Adductor magnus. The nerve to the short head of the Biceps femoris comes from the common peroneal part of the sciatic, while the other muscular branches arise from the tibial portion, as may be seen in those cases where there is a high division of the sciatic nerve. The muscular branch eventually gives off the tibial nerve and common peroneal nerve, which innervates the muscles of the (lower) leg. The tibial nerve goes on to innervate all muscles of the foot except the extensor digitorum brevis (peroneal nerve).
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 low back conditions: spinal disc herniation, degenerative disc disease, spinal stenosis, and spondylolisthesis.
Sciatica is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve, or by compression or irritation of the sciatic nerve itself. 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, and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body. Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.
Causes of sciatica
o1.1 Spinal disc herniation o1.2 Spinal stenosis o1.3 Piriformis syndrome o1.4 Sacroiliac joint dysfunction o1.5 Trigger points o1.6 Pregnancy
2 Diagnosis and treatment
2.1 Medication therapies o 2.2 Invasive therapies o 2.3 Minimally invasive procedures o 2.3.1 Intradiscal Electrothermoplasty (IDET) o 2.3.2 Radiofrequency Discal Nucleoplasty (Coblation Nucleoplasty) 2.4 Alternative therapies
The tibial nerve is a branch of the sciatic nerve. The tibial nerve passes through the popliteal fossa to pass below the arch of soleus. In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris muscles, an articular branch to the knee joint, and a cutaneous branch that will become the sural nerve. The sural nerve is joined by fibers from the common peroneal nerve and runs down the calf to supply the lateral side of the foot. Below the soleus muscle the nerve lies close to the tibia and supplies the tibialis posterior, the flexor digitorum longus and the flexor hallucis longus. The nerve passes into the foot below the medial malleolus. Here it is bound down by the flexor retinaculum in company with the posterior tibial artery.
In the foot, the nerve divides into medial and lateral plantar branches.
Medial plantar nerve The medial plantar nerve supplies: the abductor hallucis, the flexor digitorum brevis, the flexor hallucis brevis and the first lumbrical. Cutaneous distribution of the medial planter nerve is to the medial sole and medial three and one half toes, including the nail beds on the dorsum (like the median nerve in the hand). Lateral plantar nerve The lateral plantar nerve supplies quadratus plantae, flexor digiti minimi, adductor hallucis, the interossei, three lumbricals. and abductor digiti minimi. Cutaneous innervation is to the lateral sole and lateral one and one half toes (like the ulnar nerve).
Common fibular nerve
The common peroneal nerve (common fibular nerve; external popliteal nerve; peroneal nerve), about one-half the size of the tibial nerve, is derived from the dorsal branches of the fourth and fifth lumbar and the first and second sacral nerves. It descends obliquely along the lateral side of the popliteal fossa to the head of the fibula, close to the medial margin of the Biceps femoris muscle. It lies between the tendon of the Biceps femoris and lateral head of the Gastrocnemius muscle, winds around the neck of the fibula, between the Peronæus longus and the bone, and divides beneath the muscle into the superficial peroneal nerve (superficial fibular nerve) and deep peroneal nerve (deep fibular nerve).
Previous to its division it gives off articular and lateral sural cutaneous nerves. The articular branches (rami articulares) are three in number: oTwo of these accompany the superior and inferior lateral genicular arteries to the knee; the upper one occasionally arises from the trunk of the sciatic nerve. oThe third (recurrent) articular nerve is given off at the point of division of the common peroneal nerve; it ascends with the anterior recurrent tibial artery through the Tibialis anterior to the front of the knee. The lateral sural cutaneous nerve (n. cutaneus suræ lateralis; lateral cutaneous branch) supplies the skin on the posterior and lateral surfaces of the leg.
Trauma to the nerve can result in a condition called foot drop, where dorsiflexion of the foot is compromised and the foot drags during walking, and sensory loss to the dorsal surface of the foot and portions of the anterior, lower-lateral leg.
Peroneal nerve decompression: oIn the surgical treatment of peroneal nerve compression, an incision is made over the neck of the fibula. Fascia surrounding the nerves to the lateral side of the leg is released. Deep peroneal nerve decompression: oIn the surgical treatment of deep peroneal n. entrapment in the foot, a ligament from the extensor digitorum brevis m. that crosses over the deep peroneal nerve, putting pressure on it and causing pain, is released.
VESSELS IN THE BACK OF LEG
*POSTERIOR TIBIAL ARTERY *POSTERIOR TIBIAL VEIN
Posterior tibial vein
In anatomy, the posterior tibial vein of the lower limb carries blood from the posterior compartment and plantar surface of the foot to the popliteal vein which it forms when it joins with the anterior tibial vein. Like most deep veins, the posterior tibial vein is accompanied by an artery of the same name, the posterior tibial artery, along its course.