Proximity of the Common Peroneal Nerve to the Tibial Nerve Entering the Gastrocnemius Muscle: The Implications for Calf Reduction

El nervio ciático sale de la pelvis y entra en la región glútea debajo del músculo piriforme como un único tronco. Tiene dos componentes: el nervio peroneo común y el nervio tibial. La relación variable del nervio ciático con el músculo piriforme y su longitud hace que el nervio sea vulnerable a las lesiones. Estudiamos la relación variable del nervio ciático en sesenta extremidades inferiores de treinta cadáveres y encontramos el nervio ciático emergiendo indiviso por debajo del músculo piriforme en el 68,33% de los casos, pero en el 31,66% el nervio ciático estaba dividido arriba en la pelvis. En el 18,33% de los casos el componente peroneo común emergió arriba y en el 13,33% de los casos emergió a través del músculo piriforme. Pensamos que tener un conocimiento adecuado sobre la anatomía del nervio ciático es bueno para los resultados clínicos. Sciatic nerve leaves the pelvis and enters the gluteal region below the piriformis muscle as single trunk. It has two components common peroneal nerve and the tibial nerve. The variable relationship of sciatic nerve with the piriformis muscle and its long course makes the nerve vulnerable to injury. We studied sciatic nerve variable relation in sixty lower extremities of thirty cadavers and found the sciatic nerve emerging undivided below the piriformis muscle in 68.33% of cases but in 31.66% the sciatic nerve divided high in the pelvis. In 18.33% cases the common peroneal component emerged above and in 13.33% of cases it emerged through the piriformis muscle. We think proper knowledge of the anatomy of the sciatic nerve is good for clinical outcomes

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Persistent traumatic peroneal nerve palsy - surgical treatment by neuromusculotendinous gastrocnemius muscle transfer

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00228 ◽

2019 ◽

Vol 7 (6_suppl4) ◽

pp. 2325967119S0022

Author(s):

Matthias Hoppert ◽

Ulf Dornseifer

Keyword(s):

Surgical Technique ◽

Peroneal Nerve ◽

Nerve Palsy ◽

Gastrocnemius Muscle ◽

Tibial Nerve ◽

Common Peroneal Nerve ◽

Clinical Results ◽

Peroneal Nerve Palsy ◽

Muscle Transfer ◽

Common Peroneal Nerve Palsy

Aims and Objectives: Common peroneal nerve palsy is a relatively frequent complication in trauma of the knee and lower extremity. Persistent traumatic peroneal nerve palsy is usually treated by tendon transfer. A surgical concept for the treatment by neurotized lateral gastrocnemius muscle transfer is demonstrated with the aim of restoring active voluntary dorsiflexion. The indication, the surgical technique and the results obtained in two own cases with review of the literature are presented. Materials and Methods: Surgical technique: The lateral head of the gastrocnemius muscle is transferred to the tendons of the anterior tibial muscle group. The intact proximal end of the deep peroneal nerve is transpositioned to the tibial nerve of the gastrocnemius muscle by microsurgical technique. The transferred muscle is reinnervated by nerve coaptation between the undamaged proximal part of the deep peroneal nerve and the motor branch of the tibial nerve supplying the gastrocnemius muscle. The key steps of the surgical technique are described. Results: Short term results of the own cases appeared excellent. In both patients the transferred gastrocnemius muscle showed signs of reinnervation within 6 months after the operation. The patients achieved stable functional gait, voluntary movement of the transferred muscle and active range of motion of about 40 degrees. The early clinical results are compared with the clinical series in the literature since 1994. Conclusion: Early clinical results after the neuromusculotendinous gastrocnemius muscle transfer appear highly successful. They still need to be compared with conventional tendon transfer procedures. The described operative approach offers some advantages compared with other methods in the reconstruction of a drop foot secondary to traumatic common peroneal nerve palsy in a well-selected group of patients. In contrast to the commonly used treatment of tibialis posterior muscle transfer no reeducation of the transferred muscle is needed. We review the indications and limitations of this technique.

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Common Peroneal Nerve Grafting to Repair the Tibial Nerve as a Salvage Procedure in the Treatment of Sciatic Nerve Injury with Long-Segment Defects

Journal of Reconstructive Microsurgery Open ◽

10.1055/s-0038-1653951 ◽

2018 ◽

Vol 03 (01) ◽

pp. e41-e45

Author(s):

Haodong Lin ◽

Desong Chen ◽

Chunlin Hou

Keyword(s):

Sciatic Nerve ◽

Nerve Injury ◽

Peroneal Nerve ◽

Tibial Nerve ◽

Plantar Flexion ◽

Common Peroneal Nerve ◽

Sciatic Nerve Injury ◽

Salvage Procedure ◽

Nerve Grafting ◽

The Common

Background In sciatic nerve neuropathies, when direct nerve repair is impossible due to a large gap, nerve grafting can be performed. However, the diameters of traditional autologous nerve grafts are too small to cover the whole cross-sectional area of the sciatic nerve. The aim of this study is to present the outcome of common peroneal nerve grafting to repair the tibial nerve in eight patients with sciatic nerve injuries, showing long defects of more than 10 cm. Methods Between 2007 and 2013, the common peroneal nerve was used as an autograft to repair the tibial nerve in eight patients with complete high sciatic nerve injury with long defects. There were 6 men and 2 women with an average age of 31 years (range: 17–44 years). Muscle strength was evaluated using the British Medical Research Council scale. The Semmes–Weinstein monofilament test was used for sensory evaluation. Results The follow-up time for patients ranged from 36 to 60 months, with an average of 48.75 months. Tibial nerve motor function was “good” or “very good” (M3–M4) in five out of eight patients (55.6%). Plantar flexion was not adequate in the rest of the patients. Sensory recovery was “good” or “very good” (S2–S3) in six patients and “inadequate” (S4) in two patients. Conclusion In cases where there were extensive gaps in the sciatic nerve, using the common peroneal nerve as an autograft to repair the tibial nerve provides an alternative to traditional nerve graft repair.

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Position of the fabella relative to the path of the common peroneal nerve across the lateral head of the gastrocnemius muscle

Clinical Anatomy ◽

10.1002/ca.980060306 ◽

1993 ◽

Vol 6 (3) ◽

pp. 163-166 ◽

Cited By ~ 2

Author(s):

Christopher N. Chihlas ◽

Lewis T. Ladocsi ◽

Milton M. Sholley ◽

Thomas P. Loughran ◽

Richard J. Krieg

Keyword(s):

Peroneal Nerve ◽

Gastrocnemius Muscle ◽

Common Peroneal Nerve ◽

The Common ◽

Lateral Head

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Bilateral eventration of sciatic nerve

Journal of Nepal Medical Association ◽

10.31729/jnma.66 ◽

2010 ◽

Vol 50 (180) ◽

Author(s):

T Sharma ◽

RK Singla ◽

M Lalit

Keyword(s):

Sciatic Nerve ◽

Peroneal Nerve ◽

Tibial Nerve ◽

Common Peroneal Nerve ◽

Leg Pain ◽

Piriformis Syndrome ◽

Piriformis Muscle ◽

Male Cadaver ◽

The Common ◽

Popliteal Block

During routine dissection of a 60 years male cadaver, it was observed that the two divisions of sciatic nerve were separate in the gluteal region on both the sides with the tibial nerve passing below the piriformis and the common peroneal nerve piercing the piriformis muscle. The abnormal passage of the sciatic nerve (SN), the common peroneal nerve (CPN), and the tibial nerve (TN), either through the piriformis or below the superior gemellus may facilitate compression of these nerves. Knowledge of such patterns is also important for surgeons dealing with piriformis syndrome which affects 5-6% of patients referred for the treatment of back and leg pain. A high division may also account for frequent failures reported with the popliteal block. Keywords: eventration, piriformis muscle, piriformis syndrome, sciatic nerve

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A Comparative Electrophysiological Study on Neurotisation in Rats

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(91)90104-v ◽

1991 ◽

Vol 16 (5) ◽

pp. 505-510 ◽

Cited By ~ 3

Author(s):

D. T. W. CHIU ◽

L. CHEN ◽

N. SPIELHOLTZ ◽

R. W. BEASLEY

Keyword(s):

Peroneal Nerve ◽

Detrimental Effect ◽

Tibial Nerve ◽

Electrophysiological Study ◽

Common Peroneal Nerve ◽

Nerve Suture ◽

Nerve Grafts ◽

Different Types ◽

The Common ◽

Gastrocnemius Muscles

A comparative experimental study has been carried out in rats with denervated gastrocnemius muscles. Three groups of five rats were treated by three different types of implantation of nerve directly into muscle (neurotisation). In the fourth group, the common peroneal nerve was sutured to the transected tibial nerve. The fifth group was left denervated as a control. The muscles were studied by serial electrodiagnostic studies and later histologically. The results showed little difference between nerve suture and implantation of nerve directly into muscle. Extension of the common peroneal nerve with a pair of sural nerve grafts did not produce a detrimental effect.

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A Cadaveric Study of the Distal Biceps Femoris Muscle in relation to the Normal and Variant Course of the Common Peroneal Nerve: A Possible Cause of Common Peroneal Entrapment Neuropathy

BioMed Research International ◽

10.1155/2020/3093874 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Jeong-Hyun Park ◽

Jinseo Yang ◽

Kwang-Rak Park ◽

Tae Woo Kim ◽

Taeyeong Kim ◽

...

Keyword(s):

Peroneal Nerve ◽

Gastrocnemius Muscle ◽

Common Peroneal Nerve ◽

Biceps Femoris ◽

Biceps Femoris Muscle ◽

Distal Biceps ◽

The Common ◽

The Relationship ◽

Femoris Muscle ◽

Lateral Head

The most frequent mononeuropathy in the lower extremity has been reported as the common peroneal nerve entrapment neuropathy (CPNe) around the head and neck of the fibula, although the mechanism of the neuropathy in this area cannot be fully explained. Therefore, the aim of this cadaveric study was to evaluate the relationship between morphologic variations of the distal biceps femoris muscle (BFM) and the course of the common peroneal nerve (CPN) and to investigate the incidence and morphological characteristics of anatomical variations in the BFM associated with CPNe. The popliteal region and the thigh were dissected in 115 formalin-fixed lower limbs. We evaluated consensus for (1) normal anatomy of the distal BFM, (2) anatomic variations of this muscle, and (3) the relationship of the muscle to the CPN. Measurements of the distal extents of the short and long heads of the BFM from insertion (fibular head) were performed. Two anatomic patterns were seen. First, in 93 knees (80.8%), the CPN ran obliquely along the lateral side of the BFM and then superficial to the lateral head of the gastrocnemius muscle. Second, in 22 cases (19.2%), the CPN coursed within a tunnel between the biceps femoris and lateral head of the gastrocnemius muscle (LGCM). There was a positive correlation between the distal extents of the short heads of the biceps femoris muscle (SHBFM) and the presence of the tunnel. The “popliteal intermuscular tunnel” in which the CPN travels can be produced between the more distal extension variant of the SHBFM and the LGCM. This anatomical variation of BFM may have a clinical significance as an entrapment area of the CPN in the patients in which the mechanism of CPNe around the fibula head and neck is not understood.

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Neuronal application of capsaicin modulates somatic pressor reflexes

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.2001.281.3.r868 ◽

2001 ◽

Vol 281 (3) ◽

pp. R868-R877 ◽

Cited By ~ 4

Author(s):

J. F. LeDoux ◽

L. B. Wilson

Keyword(s):

Dorsal Horn ◽

Peroneal Nerve ◽

Tibial Nerve ◽

Cardiovascular Function ◽

Cardiovascular Responses ◽

Common Peroneal Nerve ◽

Saphenous Nerve ◽

Static Contraction ◽

The Common ◽

Stimulation Of

Static contraction of skeletal muscle elicits a reflex increase in cardiovascular function. Likewise, noxious stimuli activate somatic nociceptors eliciting a reflex increase in cardiovascular function. On the basis of recent work involving spinothalamic cells in the dorsal horn, we hypothesized that the dorsal horn cells involved in the aforementioned reflexes would be sensitized by applying capsaicin (Cap) to a peripheral nerve. If correct, then Cap would enhance the cardiovascular increases that occur when these reflexes are evoked. Cats were anesthetized, and the popliteal fossa was exposed. Static contraction was induced by electrical stimulation of the tibial nerve at an intensity that did not directly activate small-diameter muscle afferent fibers, whereas nociceptors were stimulated by high-intensity stimulation (after muscle paralysis) of either the saphenous nerve (cutaneous nociceptors) or a muscular branch of the tibial nerve (muscle nociceptors). The reflex cardiovascular responses to these perturbations (contraction or nociceptor stimulation) were determined before and after direct application of Cap (3%) onto the common peroneal nerve, using a separate group of cats for each reflex. Compared with control, application of Cap attenuated the peak change in mean arterial pressure (MAP) evoked by static contraction (ΔMAP in mmHg: 38 ± 10 before and 24 ± 8 after ipsilateral Cap; 47 ± 10 before and 33 ± 10 after contralateral Cap). On the other hand, Cap increased the peak change in MAP evoked by stimulation of the saphenous nerve from 57 ± 8 to 77 ± 9 mmHg, as well as the peak change in MAP elicited by activation of muscle nociceptors (36 ± 9 vs. 56 ± 14 mmHg). These results show that the reflex cardiovascular increases evoked by static muscle contraction and noxious input are differentially affected by Cap application to the common peroneal nerve. We hypothesize that a Cap-induced alteration in dorsal horn processing is the locus for this divergent effect on these reflexes.

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The level of the sciatic nerve division and its relations to the piriform muscle

Vojnosanitetski pregled ◽

10.2298/vsp0501045u ◽

2005 ◽

Vol 62 (1) ◽

pp. 45-49 ◽

Cited By ~ 28

Author(s):

Sladjana Ugrenovic ◽

Ivan Jovanovic ◽

Vladislav Krstic ◽

Vesna Stojanovic ◽

Ljiljana Vasovic ◽

...

Keyword(s):

Sciatic Nerve ◽

Peroneal Nerve ◽

Tibial Nerve ◽

Lower Extremities ◽

Common Peroneal Nerve ◽

Popliteal Fossa ◽

Terminal Branch ◽

Sacral Plexus ◽

The Common ◽

Popliteal Block

Background. The sciatic nerve, as the terminal branch of the sacral plexus, leaves the pelvis through the greater sciatic foramen beneath the piriform muscle. Afterwards, it separates into the tibial and the common peroneal nerve, most frequently at the level of the upper angle of the popliteal fossa. Higher level of the sciatic nerve division is a relatively frequent phenomenom and it may be the cause of an incomplete block of the sciatic nerve during the popliteal block anesthesia. There is a possibility of different anatomic relations between the sciatic nerve or its terminal branches and the piriform muscle (piriformis syndrome). The aim of this research was to investigate the level of the sciatic nerve division and its relations to the piriform muscle. It was performed on 100 human fetuses (200 lower extremities) which were in various gestational periods and of various sex, using microdissection method. Characteristic cases were photographed. Results. Sciatic nerve separated into the tibial and common peroneal nerve in popliteal fossa in 72.5% of the cases (bilaterally in the 66% of the cases). In the remainder of the cases the sciatic nerve division was high (27.5% of the cases) in the posteror femoral or in the gluteal region. Sciatic nerve left the pelvis through the infrapiriform foramen in 192 lower extremities (96% of the cases), while in 8 lower extremities (4% of the cases) the variable relations between sciatic nerve and piriform muscle were detected. The common peroneal nerve penetrated the piriform muscle and left the pelvis in 5 lower extremities (2.5% of the cases) and the tibial nerve in those cases left the pelvis through the infrapiriform foramen. In 3 lower extremities (1.5% of the cases) common peroneal nerve left the pelvis through suprapiriform, and the tibial nerve through the infrapiriform foramen. The high terminal division of sciatic nerve (detected in 1/3 of the cases), must be kept in mind during the performing of popliteal block anesthesia. Conclusion. Although very rare, anatomical abnormalities of common peroneal nerve in regard to piriform muscle are still possible.

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