different modalities of sciatic nerve injuries and protocol of management.

1. Sciatic nerve injuries:
Different Pathologies
Dr. Mohamed ElSayed ElSebaey
Neurosurgery Department
Benha Teaching Hospital
2023

9. Piriformis syndrome
• Cardinal features:
1. History of trauma.
2. Pain in the region of the sacro-iliac joint causing
difficulty walking.
3. Acute exacerbating of pain with lifting and
moderately relieved by traction.
4. Palpable sausage shaped mass over the
piriformis muscle.
5. Positive lasegue sign.
6. Gluteal muscle atrophy .

15. Innervation:
Superior gluteal nerve (L5 S1)

16. Innervation:
Inferior gluteal nerve L5 S1 S2

17. Innervation:
Piriformis: Sacral Plexus S1 S2
Gemellus Inferior: N to Quadratus femoris (L5 S1)
Gemellus Superior: N to Obturator internus (L5 S1)
Obturator internus: N to obturator internus (L5 S1)

18. Innervation:
Semimembranous: Sciatic N , Tibial division (L5 S1 S2)
Semitendinosus : Sciatic N , Tibial division (L5 S1 S2)
Long head of Biceps femoris: Sciatic N, tibial division (L5 S1 S2)
Short head of Biceps femoris: Sciatic N, Peroneal division (L5 S1 S2)

19. Innervation:
Peroneus Longus M: Superficial peroneal N (L5 S1 S2)
Peroneus Brevis M : Superficial peroneal N (L5 S1 S2

20. Innervation:
Tibialis Anterior M: Deep Peroneal N (L4 L5)

21. Innervation:
Extensor digitorum Longus M:
Deep Peroneal N (L5 S1)

22. Innervation:
Extensor Hallucis Longus M:
Deep Peroneal N (L5 S1)

23. Innervation:
Extensor Digitorum Brevis M:
Deep Peroneal N (L5 S1)

24. Innervation:
Soleus M: Tibial N (S1 S2)
Gastrocnemius M: Tibial N (S1 S2)

25. Innervation:
Tibialis Posterior M:
Tibial N (L4 L5)

26. Innervation:
Flexor Digitorum Longus M:
Tibial N (S2 S3)

27. Flexor Hallucis Longus M:
Tibial N (S2 S3)
Flexor Hallucis Brevis M: ( Medial and lateral heads)
Medial planter N (S2 S3)
Lateral planter N (S2 S3)

28. Abductor Hallucis M:
Medial Planter N (S2 S3)

29. Flexor digitorum brevis M:
Medial Planter N (S2 S3)

30. Lumbricals muscles:
Medial and lateral planter Ns (S2 S3)

31. Dorsal Interossei Muscles:
lateral planter N (S2 S3)

32. Planter Interossei M:
Lateral planter N (S2 S3)

33. Adductor Hallucis M:
lateral Planter N ( S2 S3)

35. Possible causes for Sciatic N injury
• Hip arthroplasty
• Injection injury
• Direct injury (stap, GSW, kiking)
• RTA
• Positional like (mainly in prone position)
• Adhesions post orthopedic instruments ( Ex. Fix., plate and
screws)
• Knee joint dislocation
• After splint or plaster cast
• After sleeping with leg outside bed compressing the

56. • Length of the needle
• Angle of the needle
• Position of the patient during injection (lateral decubitus, upright or leaning
forward)
• Agitated child  injection injury

57. Ischemia

58. Nature of the injected agents

60. Evaluation of neurotoxicity

62. Time of the surgical intervention after injection injury