Ultrasound-guided diagnostic IPACK as a valuable tool in the management of a patient with soleal sling syndrome: a doubly rare case report

2021 ◽  
Author(s):  
Steven R Clendenen ◽  
Guilherme Ferreira-Dos-Santos ◽  
Mark Friedrich B Hurdle ◽  
John Tran ◽  
Anne MR Agur ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
Left Knee ◽  
Surgical Decompression ◽  
Popliteal Fossa ◽  
Ultrasound Guided ◽  
Posterior Compartment ◽  
Chronic Neuropathic Pain ◽  
Rare Case Report

This article describes the use of an infiltration between the popliteal artery and capsule of the knee joint (IPACK) to diagnose an entrapment neuropathy of the tibial nerve (TN) in a patient presenting with chronic neuropathic pain in the medial posterior compartment of the left knee, with a previous electromyography showing no evidence of tibial or common peroneal nerve neuropathy. After a positive sciatic nerve block, the patient was evaluated for a TN block, cancelled due to the presence of an abnormal leash of vessels wrapping around the nerve. For this reason, the patient was submitted to a diagnostic IPACK. A negative IPACK suggested that a compression of the TN at the popliteal fossa was the most likely source of the symptoms. After surgical decompression of the TN nerve at the popliteal fossa, the patient’s symptoms decreased substantially.

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

2005 ◽  
Vol 62 (1) ◽  
pp. 45-49 ◽  
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.

scholarly journals Cadaveric Study of the Mode of Termination of the Sciatic Nerve in a Malian Population: Cases of Trifurcation and Hexafurcation

2021 ◽  
Author(s):  
Tata Touré ◽  
Babou Ba ◽  
Adoul Kader Moussa ◽  
Abdoulaye Kanté ◽  
Falé Traoré ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Artery Aneurysm ◽  
Common Peroneal Nerve ◽  
Anatomical Variations ◽  
Popliteal Fossa ◽  
Terminal Branch ◽  
Cross Sectional ◽  
Significant Difference

Abstract Background: The sciatic nerve is the largest nerve in body. It is the only terminal branch of the sacral plexus. It emerges under the piriformis muscle, descends into the gluteal region, then into the posterior compartment of the thigh. It ends in the popliteal fossa by dividing into the tibial and common peroneal nerve. It is the most frequently injured nerve. The aim of this work was to study the mode of termination of the sciatic nerve by cadaveric dissection in a Malian population.Materials and methods: This was a cross-sectional study, carried out at the anatomy laboratory of the Faculty of Medicine and Odontostomatology of Bamako, ranging from December 2019 to April 2021. The sciatic nerve was dissected 74 times in 37 cadaveric subjects (29 men and 8 women).Results: The classic termination mode (the sciatic nerve terminates giving the tibial nerve and common peroneal nerve) was most frequently encountered with a prevalence of 82.43%. Anatomical variations were noted in 17.57%. Among these variations, trifurcation (termination in three branches) of the sciatic nerve was observed in 16.22%. Hexafurcation (six-branch termination) of the sciatic nerve was observed in 1.35%. The termination mode showed a significant difference being more frequently bilateral than unilateral (P˂0.05)Conclusion: Anatomical variations in the mode of termination of the sciatic nerve are not uncommon. The most common of these variations is the trifurcation in which the sciatic nerve ends up giving the tibial nerve, the common peroneal nerve and a third branch which is variable. Knowledge of these variations is important for surgeons when treating popliteal artery aneurysm, popliteal vessel fistula and popliteal fossa cysts.

scholarly journals The Anatomic Relationship of the Tibial Nerve to the Common Peroneal Nerve in the Popliteal Fossa: Implications for Selective Tibial Nerve Block in Total Knee Arthroplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Eric R. Silverman ◽  
Amaresh Vydyanathan ◽  
Karina Gritsenko ◽  
Naum Shaparin ◽  
Nair Singh ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Sciatic Nerve ◽  
Nerve Block ◽  
Knee Arthroplasty ◽  
Local Anesthetic ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
Ultrasound Guided ◽  
Total Knee

Background. A recently described selective tibial nerve block at the popliteal crease presents a viable alternative to sciatic nerve block for patients undergoing total knee arthroplasty. In this two-part investigation, we describe the effects of a tibial nerve block at the popliteal crease. Methods. In embalmed cadavers, after the ultrasound-guided dye injection the dissection revealed proximal spread of dye within the paraneural sheath. Consequentially, in the clinical study twenty patients scheduled for total knee arthroplasty received the ultrasound-guided selective tibial nerve block at the popliteal crease, which also resulted in proximal spread of local anesthetic. A sensorimotor exam was performed to monitor the effect on the peroneal nerve. Results. In the cadaver study, dye was observed to spread proximal in the paraneural sheath to reach the sciatic nerve. In the clinical observational study, local anesthetic was observed to spread a mean of 4.7+1.9 (SD) cm proximal to popliteal crease. A negative correlation was found between the excess spread of local anesthetic and bifurcation distance. Conclusions. There is significant proximal spread of local anesthetic following tibial nerve block at the popliteal crease with possibility of the undesirable motor blocks of the peroneal nerve.

scholarly journals VARIANT RELATION OF THE SCIATIC NERVE TO THE PIRIFORMIS MUSCLE: A CADAVERIC STUDY FROM NORTH INDIA. Variaciones en la relación del nervio ciático con el músculo piriforme: Un estudio cadavérico en India del Norte

2016 ◽  
Vol 8 (1) ◽  
pp. 38-42
Author(s):  
Virendra Budhiraja ◽  
Rakhi Rastogi ◽  
Sanjeev K Jain ◽  
Nidhi Sharma ◽  
Rohin Garg ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Clinical Outcomes ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
North India ◽  
Piriformis Muscle ◽  
The Common ◽  
Long Course ◽  
Relationship Of

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

scholarly journals Nerve Blocks around the Knee in Children

1984 ◽  
Vol 12 (1) ◽  
pp. 14-17 ◽  
Author(s):  
P. M. Kempthorne ◽  
T. C. K. Brown
Keyword(s):  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
Saphenous Nerve ◽  
Popliteal Fossa ◽  
Nerve Stimulator ◽  
Nerve Blocks ◽  
Peripheral Nerve Stimulator ◽  
Below The Knee ◽  
The Common ◽  
Equinus Deformity

Analgesia below the knee can be achieved by blocking the tibial nerve and the common peroneal nerve in the popliteal fossa, and the saphenous nerve adjacent to the knee. The anatomy and technique of nerve block in the popliteal fossa is described, the nerve being located prior to blockade using a peripheral nerve stimulator. The block as described has been used in children for postoperative analgesia, as a diagnostic block, and as an adjunct to the physiotherapy management of severe equinus deformity after brain injury.

scholarly journals COMBINED INTEROSSEOUS TIBIAL NERVE AND COMMON PERONEAL NERVE BLOCKS FOR FOOT SURGERY

1987 ◽  
Vol 67 (3) ◽  
pp. A288-A288
Author(s):  
S. M. Shulman ◽  
A. T. C. Peng ◽  
K. Nyunt ◽  
I. J. Kepes ◽  
L. S. Blancato
Keyword(s):  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Common Peroneal Nerve ◽  
Foot Surgery ◽  
Nerve Blocks

scholarly journals The blood supply of the common peroneal nerve in the popliteal fossa

2005 ◽  
Vol 87-B (3) ◽  
pp. 337-342 ◽  
Author(s):  
R. K. Kadiyala ◽  
A. Ramirez ◽  
A.E. Taylor ◽  
C. L. Saltzman ◽  
M. D. Cassell
Keyword(s):  
Blood Supply ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Popliteal Fossa ◽  
The Common
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