The coexistence of different and confusing terminologies is pinpointed and adjusted to allow comparison of previous reports and to gain a coordinated data pool of more than 2500 investigated sural nerves. The short saphenous nerve initially courses posterior between the heads of the gastrocnemius muscle. We discuss the epineurial, perineurial, and endoneurial compartments of nerve, followed by a description of the changes that occur with aging. A sural nerve yellow arrowhead neuroma in a male following achilles tendon repair c. Normal anatomy and compression areas of nerves of the foot. A thorough knowledge of the trajectory of the nerve is essential for establishing a diagnosis, as well as for treatment. High in the popliteal fossa, the sciatic nerve divides into its two main branches on route to serve the leg, namely the tibial nerve, and the common fibular nerve. Sometimes the two branches do not reconnect, when the medial sural cutaneous nerve is connected by the peroneal communicating nerve. These two branches, mscn and lscn, are connected by the sural communicating branch and form the sural nerve. Considering this pattern, it is plausible that it contributes to the maintenance of postural stability. It is subdivided into gross anatomy and microscopic anatomy.
The sural nerve complex snc consists of four named components. The sural nerve is a delicate structure, easily damaged during removal. The sciatic nerve anatomy usmle step 1 origin, course, relations and branches. Anatomy of the sural nerve and its relation to the achilles tendon by ultrasound examination article pdf available in orthopedics 373.
The goal of sural nerve treatment is to free the nerve from the underlying issue that is causing the irritation. The sural nerve descends between the two heads of the gastrocnemius, deep to the investing fascia figure 192. The sural nerve coursed toward the ps in the lower leg, and the median distance at level 21 was 5. Studies reporting the anatomy of the sural nerve and injury rates have been performed on cadaveric specimens or patients following nerve rupture. Preoperatively, the medial calf was examined with the handheld doppler. Anatomy any of the cordlike bundles of fibres that conduct sensory or motor impulses between the brain or spinal cord and another part of the body. Once formed, the nerves runs down the mid calf to the ankle and along the skin from the midposterior popliteal fossa to just behind to the.
The sural nerve is a sensory nerve of the lower lateral leg and lateral aspect of the foot. Severe trauma can often result in sural neuropathy, a common neurological problem caused due to a damaged nerve. Sural nerve lipoma is a rare cause of sural nerve entrapment with an unknown etiology. Although entrapment of the sural nerve is a rare condition, the resultant pain can be debilitating for patients. The following outline is provided as an overview of and topical guide to human anatomy. Anatomical variations of the sensory nerves to the fibular. Gross anatomy also called topographical anatomy, regional anatomy, or anthropotomy is the study of anatomical structures that can be seen by unaided vision. Pdf anatomy of the sural nerve and its relation to the. The sural nerve is a purely cutaneous nerve formed by variable contributions from the tibial and peroneal nerve in the popliteal fossa. I have damage to my sural, tibal, and peroneal nerve in my left leg and sural and peroneal in my right leg. Contrary to its constant retromalleolar position, formation and course of the proximal sural nerve show great variability. The nerve initially courses posterior between the heads of the gastrocnemius muscle. Sural nerve is formed by communication of medial sural cutaneous nerve mscn, that arise from tibial nerve in popliteal fossa and peroneal communicating nerve pcn, a branch directly from common peroneal nerve or from lateral sural. Sural nerve injury is a complication of achilles tendon ta rupture.
The sural nerve descends from the mid calf to the lateral side of the ankle, passes to. The sural nerve is a cutaneous nerve of the lower limb that innervates the posterolateral aspect of the lower leg, ankle, and foot. Ultrasonography us is widely considered to be an effective, accurate, dynamic, and noninvasive technique for assessment of peripheral nerves of the extremities. Sural nerve definition of sural nerve by medical dictionary. Surgical anatomy of the ovine sural nerve for facial nerve. The sural nerve is somewhat superficial, that makes it more available to surgeons, hence it is somewhat simpler compared to other treatments. Mar 01, 2014 studies reporting the anatomy of the sural nerve and injury rates have been performed on cadaveric specimens or patients following nerve rupture. The branching of the tibial and peroneal components and the main nerve is variable. Oct, 2017 ultrasonography us is widely considered to be an effective, accurate, dynamic, and noninvasive technique for assessment of peripheral nerves of the extremities. Treating sural nerve issues begins with an accurate diagnosis, and this is best achieved through a physical exam with an orthopedic specialist. Sn is universally recognized by surgeons as a site for harvesting an autologous nerve graft. Manual of nerve conduction studies second edition ralph m. Sural nerve article about sural nerve by the free dictionary. It emerges anterolateral to the achilles tendon and passes around the posterior lateral malleolus.
The formation and distribution of the sural nerve vary in different individuals. A swollen segment white arrowhead and a relatively normal portion smaller white arrowhead of the saphenous nerve adjacent to a hematoma white arrow of the distal femur e. The original technique is performed by an oblique based full thickness lateral incision on the calcaneus in line of the osteotomy 4,5 posterior to the peroneal tendons and the sural nerve. Sural nerve location, function, anatomy and pictures. Your doctor will ask about your symptoms and take a closer look at your foot.
However, the implications of sensory loss following sural nerve injury have yet to be thoroughly investigated. Areas of skin supplied by nerves of the leg the sural nerve supplies the lateral ankle. The sural nerve is a unique sensory nerve in that it often though not always forms distally from a combination of 2 peripheral sensory nervesthe medial and lateral sural nerves. The superficial peroneal nerve emerged subcutaneously very low in the leg median, 25 cm. It provides sensation to the posterolateral lower third of the leg and lateral aspect of the foot and heel. As aforesaid, it is purely a sensory nerve and does not consist of motor fibers. Figure 6 a a 22yearold male presented with a left foot degloving injury with. Pdf formation of the sural nerve in foetal cadavers. Sural nerve graft harvest iowa head and neck protocols. Medial sural artery perforator flap plastic surgery key. Request pdf the surgical anatomy of the sural nerve. I am considered idiopathic at this time, all my blood work has come back normal so far. Stretching, angulation or compression by the forceps can cause artefactual changes suf. The purpose of this study was to provide a morphologic description and assessment on the formation level of the sural nerve sn and its components.
Sural nerve medical definition merriamwebster medical. Human anatomy scientific study of the morphology of the adult human. As the bundle of fibers forms a branch of the femoral nerve, it is also known as short saphenous nerve. We hope this picture sural nerve innervation anatomy can help you study and research.
Aug 11, 2009 an defect on the posterior ankle exposing the tendoachilles and a fractured calcaneum covered with a sural artery flap. Also we aimed to reveal histological features of the sn components. This article incorporates text in the public domain from page 963 of the 20th edition of grays anatomy 1918 a b medical research council memorandum 45. The results showed that the sn was formed by the union of the medial sural. A,b the sural nerve white arrow head ran parallel to the short saphenous vein ssv, blue rubber. Anatomical variations in formation of sural nerve in adult. It emerges anterolateral to the achilles tendon and passes around the posterior. The sural nerve passes between the heads of gastrocnemius and posterior. We dissected 30 cadaveric lower limbs to describe the course of the sural nerve in relation to the ta. The sural nerve is a cutaneous section of the tibial nerve that emerges high in the leg. We are pleased to provide you with the picture named sural nerve innervation anatomy. It is a sensory nerve in the lower leg that lies close to the small saphenous vein, situated in the calf. It is made up of branches of the tibial nerve and common fibular nerve, the medial cutaneous branch from the tibial nerve, and the lateral cutaneous branch from the common fibular nerve. A sural nerve schwannoma in a female with chronic calf pain d.
Normal anatomy of the peripheral sural nerve springerlink. Merrilee zetaruk, jeff hyman, in clinical sports medicine, 2007. The medial sural perforator flap was described in a very similar fashion in cadaver dissections by taylor and daniel as a potential free flap donor site as early as 1975. Surgical anatomy of the medial sural artery perforator flap. The tibial nerve gives a single cutaneous branchthe sural nerveat about the midline of the popliteal fossa. At the level of insertion of the ta into the calcaneum, the sural nerve was a mean 18. Contribution of the sural nerve to postural stability and. It runs down and passes near the lateral margin of the achilles tendon, which is present in the tendon of the posterior leg and lies with the. The sural cutaneous nerve consists of the fusion of the medial sural cutaneous nerve mscn which is a terminal branch of the tibial nerve and the lateral sural cutaneous nerve lscn which is one of the terminal branches of the common fibular nerve.
The sural nerve is a sensory nerve of the lower limb formed by the union of sural branch of the tibial nerve and the communicating sural branch of the common fibular nerve supplying sensation to the lower lateral aspect of the calf and foot gross anatomy. The nerve is comprised of spinal nerve roots from s1 and s2. The sural nerve sn is a sensory nerve of lower limb that supplies lower posterolateral part of leg and lateral part of dorsum of foot. Virtually all members of the animal kingdom have at least a rudimentary nervous system. Sural nerve sural lateral dorsal cutaneous branch sensory nerve 240 sural sensory nerve 244 tibial mixed nerve medial and lateral plantar branches 248. In its proximal course, the sural nerve is located between the two heads of the gastrocnemius muscle.
An anatomical study of the formation of the sn was carried out on 100 limbs from 50 embalmed foetuses. Nerve the cordlike association of nerve tissues that links the. In most cases, sural nerve problems can be managed with nonsurgical treatment techniques. Anatomy of the sural nerve and its relation to the. Baek 2 was the first to report its clinical applications along with anatomical observations regarding medial and lateral femoral free flaps. The flap was distally based, islanded and covered the area with vascularised. In some cases inflammatory or vasculitic diseases include the sural nerve selectively. The sural nerve is a sensory nerve that runs along the calve and into the outer part of the foot. It travels within subcutaneous tissue adjacent to the small saphenous vein in the lower posterolateral calf. The sural nerve is a formed of branches of the common peroneal nerve and the tibial nerve.
A sural nerve block is used for making the effect of anesthesia on the foot as well as lower leg faster. Saphenous sensory nerve proximal technique 236 sural nerve sural lateral dorsal cutaneous branch sensory nerve 240 sural sensory nerve 244 tibial mixed nerve medial and lateral plantar branches 248 contents ix. Anatomy of the sural nerve and its relation to the achilles. The sural nerve is a sensory nerve derived from the s1 and s2 nerve root. This study covers all information about the sural nerve anatomy published internationally. Jan 04, 2017 the sciatic nerve anatomy usmle step 1 origin, course, relations and branches. The sural nerve is formed by the union of two branches. The sural nerve is a pure sensory nerve and can be entrapped in several different locations causing pain in the calf as well as the lateral ankle and foot. Any thoughts about sural nerve neurotalk support groups. Sural nerve definition of sural nerve by the free dictionary. In the posterior calf, the sural nerve emerges from between the two heads of the gastrocnemius muscle and runs with the small saphenous vein inferiorly to curve under the lateral malleolus. Bhanu prakash usmle, fmge and neet pg 146,116 views.
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