Cutaneous femoris posterior nerve

Genetic testing

NCV/EMG

Laboratory

Imaging

Biopsy

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Fibers come from the lower part of the lumbosacral plexus, roots S1-3. The fibers descend together with the inferior gluteal nerve through the greater sciatic notch, below the piriformis muscle. A branch leaves to the perineum and scrotum. The sensory area includes the lower buttock, parts of the labia or scrotum, dorsal side of the thigh and proximal third of the calf. The autonomic field is a small area above the popliteal fossa.

Anatomy

Paresthesias and numbness over the lower part of the buttock and posterior Symptoms thigh.

Sensory deficit

Bicycle riding Colorectal tumors Fall on the buttocks Gymnastic exercises on buttocks Hemangiopericytoma Iatrogenic injection in buttock Ischemia of lower extremity Sedentary occupation Venous malformation Wounds of the dorsal thigh

NCV - difficult technique

EMG: may distinguish from sacral lesion

Need to differentiate from sacral plexus lesions

Sciatic nerve lesion

Sacral plexus or radicular lesion S2, S3

Arnoldussen WJ, Korten JJ (1980) Pressure neuropathy of the posterior femoral cutaneous nerve. Clin Neuro Neurosurg 82: 57-60

Laban MM, Meerschaert JR, Taylor RS (1982) Electromyographic evidence of inferior gluteal nerve compromise; an early representation of recurrent colorectal carcinoma. Arch Phys Med Rehabil 63: 33-35

Müller-Vahl H (1986) Mononeuropathien durch ärztliche Maßnahmen. Dtsch Ärztebl 83: 179-182

Wilbourn AJ, Furlan AJ, Hulley W, et al (1983) Ischemic monomyelic neuropathy. Neurology 33:447-451

Signs

Pathogenesis

Diagnosis

Differential diagnosis

References

Sciatic nerve

Genetic testing

Surgical revision

Fig. 42. Sciatic nerve anatomy. Greater sciatic nerve. 1 Great sciatic nerve. 2 Gluteal superior nerve. 3 Infrapiriform foramen. 4 Peroneal nerve. 5Tibial nerve. 6 Semitendinosus muscle. 7 Semimembranosus muscle

Infrapiriform Foramen

Fig. 43. Neurofibromatosis. Bilateral enlargement of the sciatic nerve in transverse a and longitudinal section b

Fibers from L3 to S3 und S4 leave the pelvis through the sciatic foramen. The Anatomy nerve passes below the piriform muscle (or pierces it), into the gluteal region and moves first laterally, then caudally. It continues between the greater trochanter and the ischial tuberosity through the inferior buttock, where it is embedded in fatty tissue in the subgluteal space.

It is positioned on the dorsal side of the femoral bone, between the flexor muscles of the knee. The location of the division into the tibial and peroneal nerves varies, but usually occurs in the upper thigh. Fibers from the lateral and medial divisions of the sciatic nerve become the peroneal and tibial nerves. Fibers from the lateral division (peroneal nerve) are more prone to compression. The peroneal and tibial nerves include motor, sensory and autonomic fibers.

The nerve provides motor innervation to the following muscles: the semiten-dinosus, the long head of the biceps femoris, the semimembranosus, part of the adductor magnus (medial trunk), the short head of the biceps femoris (lateral trunk) and all muscles innervated by the peroneal and tibial nerves (see Fig. 42).

Complete proximal transsection produces a paralysis of hamstring muscles and Symptoms all the muscles innervated by the peroneal and tibial nerves. Sensory loss occurs in all cutaneous areas supplied by both nerves, with the exception of a small medial zone that is innervated by the saphenous nerve.

Many sciatic lesions are partial and tend to resemble peroneal nerve lesions, due to the increased susceptibility of the peroneal nerve fibers.

Painful neuropathic syndromes can result from sciatic nerve lesions.

Inspection and palpation along the sciatic nerve (the sciatic notch in the thigh). Signs Tenderness in the notch is a non-specific sign. Muscle testing should include hip muscles (gluteal), which should be spared. Hamstring muscles and knee flexors will be weak. Complete lesions will lead to involvement of all muscles in the lower leg, as well as loss of sensation in all regions except the region supplied by the saphenous nerve. Severe trophic changes may be present in the tibial nerve distribution. Absent (or at least diminished) ankle jerk and gait difficulties will also occur.

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