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Lumbosacral Plexus

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Sciatic Nerve

Lumbosacral trunk arises from the lower part of the lumbar plexus and fuses with sacral plexus to form the sciatic nerve ( exit through greater sciatic foramen) Nerve courses in posterior aspect of the hip joint and then enters the thigh. In its course through the thigh it 7/13/12 innervates the hamstring muscles,

The peroneal and tibial divisions run together in a common sheath, forming the sciatic nerve At the lower end of knee it divides into 2 The only portion of the hamstring muscle mass innervated by the peroneal division is the short head of the biceps femoris; all other
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hamstring muscles are innervated

After the bifurcation in the popliteal fossa, the peroneal nerve moves laterally and winds around the fibular head , and then descends toward the foot. Common peroneal nerve pierces the peroneus longus msucle and divide into Superfical and deep part Deep part supply anterior 7/13/12 compatement ( TA, EDL,EHL,PL)

Common Peroneal N entrapment

MC injured nerve in lower extremity Traumatic , Habitual leg crossing

Also called as slimmer palsy Seen in profession who squat for long time

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Mangement

Conservative Surgery

GA /LA Patient in lateral position with knee flexed Curvilinear oblique incison taken over the fibular neck Lateral sural cutneous N , posteriro femoral cutaneous n are preserved Deep fascia is incised above he nerve CPN is note with surrounding adipose tissue

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Tarsal Tunnel Syndrome

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Anatomy

Counterpart of carpal tunnel Present in the posterior and inferior part of medial malleolus Flexor Retinaculam form the roof extends from medial malleolus above to medial tubercle of calcaneum Floor is formed by the medial aspect of calcaneus and posterior aspect of medial malleolus

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Contents of tarsal tunnel

From anterior to posterior

Tendon of Tibialis Posterior Tendon of Flexor Digitorum Longus Posterior Tibial vessels Tibial N Tendon of Flexor Hallucis Longus

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Posterior Tibial N is terminal branch of sciatic nerve descends vertically in the posterior part of leg deep to soleus Distal to the tunnel divide into 3 branches
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Calcaneal purely sensory Medial plantar Lateral Plantar

Clinical features

Burning sensaton in lateral part of foot with sparing of heel Pain is severe in the night Signs atrophy of intrinsic muscles of foot

Sensory impairement

Tinel sign may be +

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Treatment

Posterior tibial N block proximal to flexor retinaculam Surgery

Curvlinear incision made 1.5 cm behind and below the medial malleolus Flexor retinaculam is divided Deep fibrous septal prolongations from retinaculam is released Distal branches also to be traced and released

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Meralgia Paraesthesia Lateral femoral cutaneous n of thigh

Meros Thigh ,algos- pain Sigmund Freud suffered from this disease Seen mainly in middle aged men who are overweight Preganacy , COPD, Belts , binders , corsets causes this Purely sensory n Arises from L2 , L3 nerve

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The nerve passes between the 2 roots of attachments of inguinal ligament It later on pierces medial neurotic expansion of sartorius muscle ( attached to the inferior part of inguinal ligament) It descends downward and pierces fascia lata and becomes 7/13/12 subcutaneous

Possible sites of compression

Anterior /posterior root of attachment of inguinal ligament Aponeurotic expansio of sartorius muscle Fascial interconnecting bands between fascia lata and illiac fascia

Any factor which will pull the inguinal ligament down causes symptoms like obese, pendulous 7/13/12 abdominal wall, prolonged standing ,

Clinical features

Burning sensation in in lateral part of thigh Anterior branch is involved more than the posterior Sensation of pin prick , touch blunted Trophic changes like loss of hair

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Diagnosis

Clinical History Demonstration of of sensory loss To rule out other areas of sensory loss, muscle atropy Mri /Ct abdomen/Electromyography 5ml of 1% lignocaine infiltrated medial to ASIS observe for relief of symptoms
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Treatment

Weight reduction Removal of tight binders Local Anaesthesia

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Surgery

Curvilinear vertical incision or horizontal incision just medial to ASIS is taken Deep fascia of thigh is divided along the anteroir border of sartorius Nerve is traced upwards upto inguinal ligament Inguinal ligament superficial to the nerve is divided Nerve is retracted and deeper part of inguinal ligament , aponeurotic margin of sartorius are divided

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Saphenous Nerve

Longest and largest cutaneous nerv

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