Normal anatomy of the peripheral sural nerve neupsy key. Severe trauma can often result in sural neuropathy, a common neurological problem caused due to a damaged nerve. The report of reisin et al 1 of three cases of sural neuropathy caused by external pressure without penetrating injury provokes me to add a case of my own and append some brief comments. Sural nerve biopsy has been a well established diagnostic procedure for the investigation of peripheral neuropathies for over 30 years and the techniques and indications were described by dyck and loufgren at the mayo clinic1 and thomas. The sural nerve supplies the lateral 5 dorsal digital nerves in 40% of cases. As aforesaid, it is purely a sensory nerve and does not consist of motor fibers. The purpose of this crosssectional study was to use ultrasound to determine the relations of the sural nerve in a healthy population. Hence the study of sural nerve complex was taken up. It runs downwards through the popliteal fossa and closely follows the medial border of the biceps muscle. An anatomical study of the formation of the sn was carried out on 100 limbs from 50 embalmed foetuses. Department of anatomy, melaka manipal medical college manipal campus, international centre for health sciences, manipal. Our study indicates that during the approach to the lateral malleolus there is a high risk of laceration of malleolar branches from both the sural and the superficial fibular nerves.
A,b the sural nerve white arrow head ran parallel to the short saphenous vein ssv, blue rubber. Snc was observed by dissecting 100 lower limbs in the department of anatomy at three different. We hope this picture sural nerve innervation anatomy can help you study and research. Malleolar nerve branches were identified in 76% of the cases in 28% from both sources. It is a branch from tibial nerve tn in the popliteal fossa, descends between the two heads of the gastrocnemius muscle, and pierces the deep fascia in the middle third of the posterior surface of the leg. Specific neuropathies common peroneal nerve normal anatomy and imaging. 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 lateral malleolus. Pdf anatomical and histological morphometry of the sural. The sural nerve from sura, latin for calf is a sensory nerve that typically derives from both peroneal lateral and tibial.
A 24yearold man was in a vehicular collision without apparent injury beyond soreness and minor bruising. Normal anatomy and compression areas of nerves of the foot. The results showed that the sn was formed by the union of the medial sural. Research article study of sural nerve complex in human cadavers s.
Oct 14, 2010 the sural nerve is the most commonly nerve used in nerve transplantation, and so the aim of this study was to determine the variations of the sural nerve in the back of the leg, its relations to the calcaneal tendon and lateral malleolus, and determine the patterns of its distribution on the dorsum of the foot. In the thigh, the peroneal division of the sciatic nerve supplies the short. 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. Pdf the sural nerve is the most commonly nerve used in nerve transplantation, and so the aim of this study was to determine the variations of. Research article study of sural nerve complex in human. Modern texts are in agreement about which areas of the skin are served by which nerves, but there are minor variations in some of the details.
Pdf anatomical and histological morphometry of the sural nerve. Sural nerve graft harvest iowa head and neck protocols. Normal anatomy of the peripheral sural nerve springerlink. Operative procedures and traumatic injuries of the lateral foot and ankle place the sural nerve and its branches at risk. Medialsuralcutaneousnervecontinuingassuralnerve mscn. In 7 cases 10% the sural nerve overlapped or was tangent to the tip of the malleolus. This pictorial essay illustrates the normal anatomy of the sural nerve, the technique for its examination by us, as well asthe us appearance of its main pathologic changes. 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. Anatomic studies quantifying the course of this nerve are sparse.
Anatomical and histological morphometry of the sural nerve in human fetuses. A proportion of the intraneural capillaries were fenestrated. Us and mr imaging with anatomic correlation1 the anatomy of the nerves of the foot and ankle is complex, and familiarity with the normal anatomy and course of these nerves as well as common anatomic variants is essential for correct identification at imaging. The sural nerve is a cutaneous nerve of the lower limb that innervates the posterolateral aspect of the lower leg, ankle, and foot. The absolute distances between the ssv and the sural nerve sn closestnearest branch were measured over the complete length of the leg 120 data points per leg, and the presence of the interlaying deep fascia was mapped. Your doctor will ask about your symptoms and take a closer look at your foot. The sciatic nerve anatomy usmle step 1 origin, course, relations and branches. Pdf anatomical variations of the human sural nerve and its role. Jan 04, 2017 the sciatic nerve anatomy usmle step 1 origin, course, relations and branches. Variant formation of sural nerve and its distribution at the. Diagnosing and treating sural nerve problems your sural nerve runs down the back of your leg, behind the outside edge of your ankle and down the outside of your foot. Being superficial, this nerve is easily identifiable and accessible by surgeons. Anatomy of the spinal cord cylinder of nerve tissue within the vertebral canal thick as a finger vertebral column grows faster so in an adult the spinal cord only extends to l1 31 pairs of spinal nerves arise from cervical, thoracic, lumbar and sacral regions of the cord each cord segment gives rise to a pair of spinal nerves. The borders designated by the diagrams in the 1918 edition of grays anatomy, provided below, are similar but.
Mr imaging of entrapment neuropathies of the lower extremity. 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 small. Local anatomy the sural nerve receives its innervation from the lumbosacral plexus l5, s1. The sheaths of the intracardiac nerves therefore become progressively attenuated during their course in the heart. In its proximal course, the sural nerve is located between the two heads of the gastrocnemius muscle. Study of sural nerve complex in human cadavers europe pmc. As the sural nerve is of significant diagnostic and therapeutic importance, detailed knowledge of the sural nerves anatomy and its contributing nerves is also of great importance.
Surgical anatomy of the sural and superficial fibular nerves. Sural nerve damage is a subtype of peripheral neuropathy. The medial cutaneous nerve was absent in only one case. Study of sural nerve complex in human cadavers hindawi. Request pdf the surgical anatomy of the sural nerve. The electrophysiologic responses of the sural nerve were determined at different temperatures in 22 healthy adults. The effect of a perturbation will be minimized by accommodation of the limb to uneven terrain during stance and avoidance of an obstacle during swing. Furthermore, the sacrifice of the sural nerve results in hyposensitivity of the lateral border of the foot. The sural nerve is a purely cutaneous nerve formed by variable contributions from the tibial and peroneal nerve in the popliteal fossa. The sural nerve, with the contributions from the tibial medial sural and peroneal lateral sural or peroneal communicating branch nerve, is outlined, along with the relationships of the nerve to the lesser saphenous vein and lateral malleolus. This innovative atlas focuses on peripheral nerves and provides a brand new approach compared to regular anatomy books. The sural nerve itself is formed from the medial and lateral sural cutaneous nerves, from the tibial and the common peroneal fibular nerves respectively. We think this is the most useful anatomy picture that you need.
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. Anatomy the femoral nerve, formed by the dorsal divisions of the anterior rami of l2l4, is the largest terminal branch of the lumbar plexus. Sural nerve biopsy journal of neurology, neurosurgery. Dd williamsa study of the human fibular communicating nerve. 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.
Gross anatomy brain anatomy human body anatomy medical anatomy muscle anatomy anatomy and physiology anatomy of the neck body diagram medical illustration for my character, i want veins running up the neck and face, i want some to be protruding and others to be subtle, i want these to look realistic and run along with the natural muscles and veins. Sural nerve entrapment may cause pain and paraesthesia along the posterolateral aspect of the lower leg, extending behind the lateral malleolus and along the lateral border of the foot fig. Article pdf available in journal of the anatomical society of. There are some important characteristics of sural nerve damage related to the functioning and the anatomy of the involved structures. Sural nerve entrapment explained chronic body pain. The reverse sural artery flap is a reliable alternative for treating small to moderate size defects of the lower tibia, ankle, and heel regions. Merrilee zetaruk, jeff hyman, in clinical sports medicine, 2007. Huelke 1958 reported that the peroneal communicating nerve arose directly from the common peroneal nerve in 54. Anatomy of the sural nerve related to calcaneal tendon. The short saphenous nerve initially courses posterior between the heads of the gastrocnemius muscle. Such origin and distribution of sural nerve may lead to misinterpretation of common or superficial peroneal nerves in sural nerve.
His lower left leg struck the car door without evident. In 12 cases without any anastomoses, the route of the sural nerve was followed by the medial cutaneous nerve of the leg in 9 cases and by the lateral cutaneous nerve in 3 cases. 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. In the leg it is covered in the upper part of its course by the muscles of the calf. Research article study of sural nerve complex in human cadavers. Anatomy of the sural nerve and its relation to the achilles tendon by ultrasound examination article pdf available in orthopedics 373. Clinically, sural nerve is largely used in biopsy and as a graft in nerve transplantations. However, the implications of sensory loss following sural nerve injury have yet to be thoroughly investigated. Jul, 2019 we hope this picture sural nerve innervation anatomy can help you study and research. Sleep music for quarantine 247, lucid dreams, sleeping music, meditation, study music, sleep yellow brick cinema relaxing music 3,582 watching live now. Ultrasonography of the sural nerve wiley online library. The formation and distribution of the sural nerve vary in different individuals. Normal anatomy on cadaveric dissection and case series.
A study of sural nerve relationship with tendoachilles in human cadavers m shilpa 1, k r dakshayani 2. Grasso department of biomedical sciences, section of anatomy and histology, university of siena, italy abstract lymphatics were detected in the epineurium of the human sural nerve by. Sural nerve injury is a relatively common complication after surgery on the achilles tendon. The sural nerve receives its innervation from the lumbosacral plexus l5, s1. In the posterior thigh, the sciatic nerve divides into its two main branches. The common peroneal nerve is the smaller of the terminal branches of the sciatic nerve, the other being the tibial nerve. Anatomy sciatic nerve, sacrum, piriformis mm, gluteus maximus mm. According to huelke, the frequency of variation 1 was 19. The peroneal communicating nerve gave rise to the lateral sural cutaneous branches in.
Romanes, cunninghams manual of practical anatomy, vol. Common peroneal anatomy anatomy atlas human anatomy. 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. Snc was observed by dissecting 100 lower limbs in the department of anatomy at three different medical colleges, over a period of 10 years. The intraneural capillaries of the human heart differ from those in animals in possessing an increased number of endothelial cells. The importance of sural nerve in relation to tendoachilles is worth to know,as it is frequently injured during tendoachilles rupture repair. The surgical anatomy of the small saphenous vein and. The nerve is widely used for electrophysiological studies. It travels within subcutaneous tissue adjacent to the small saphenous vein in the lower posterolateral calf. Cutaneous innervation refers to the area of the skin which is supplied by a specific nerve. The identification of motor fibers in the sural nerve before nerve biopsy has important implications for the. 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. Introduction sural nerve sn courses from the posterior aspect of leg to the lateral side of ankle and foot.
Jul 22, 2019 the surgical anatomy of sural nerve sural n. Areas of skin supplied by nerves of the leg the sural nerve supplies the lateral ankle. Surgical anatomy of the ovine sural nerve for facial nerve. The sural nerve complex snc consists of four named components. The sural artery flap is insensate and is not an option in cases in which sensitivity is an issue. The peroneal and tibial divisions of the sciatic nerve physically split at or above the popliteal fossa to form the cpn and tibial nerve. The medial sural cutaneous nerve terminates as cutaneous branches to the heel with the lateral sural cutaneous nerve passing onto the foot. Researcharticle study of sural nerve complex in human. 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 lateral malleolus and then under the malleolus and forward along the lateral aspect of the foot.
Contribution of the sural nerve to postural stability and. Pdf formation of the sural nerve in foetal cadavers. Anatomical variations of the human sural nerve and its role. The sural nerve is formed by the union of two branches. Primals 3d atlas of human anatomy of the leg, ankle and foot. The anatomy of the ssv and adjacent nerves was studied in 20 embalmed human specimens. The sural nerve is frequently used as a donor nerve for human facial nerve reconstruction because it is a sensory nerve, can be easily harvested, and is associated with relatively low donor site.
Sural nerve, small saphenous vein, achilles tendon, calcaneal tuberosity. Pdf anatomy of the sural nerve and its relation to the. Neurologic diseases caused by human immunodeficiency virus type 1 and opportunistic infections. Entrapment of the sural nerve on gastrocnemius muscle. In this study, 17 cadaver specimens were dissected to clarify its course and branching patterns. Also we aimed to reveal histological features of the sn components. Jun 23, 2014 jacobs jm, love s 1985 qualitative and quantitative morphology of human sural nerve at different ages. Therefore, knowing about the course, formation pattern and variations of sural nerve are important for the abovementioned. The sural nerve is a sensory nerve in the calf region of the leg. A sural nerve block is used for making the effect of anesthesia on the foot as well as lower leg faster. Feb 15, 1998 to summarize, our data on the sural nerve indicate that nonnoxious reflexes function to stabilize human gait, both during stance and swing, so that unimpeded locomotion can continue. Anatomy of the heel and ankle 8 10 1 vote in this image, you will find the sural nerve, short saphenous v. Limb temperature was monitored with a thermistor probe placed subcutaneously near the sural nerve. Distal sensory latency and amplitude of the sural snap was determined at 1c intervals over a limb temperature range of 23 to 40c.
Because the sural nerve is almost universally the nerve chosen for biopsy, certain elements of the discussion are specific to this site. On the other hand, in 11 cases the lateral cutaneous nerve or its communicating branch was missing. Bhanu prakash usmle, fmge and neet pg 146,116 views. So during any repair of achilles tendon the knowledge exact proximity of sural nerve discussion m shilpa, k r dakshayani. It provides sensation to those areas and to your two outside toes, and problems can occur if the nerve is irritated or damaged. Aug 30, 2016 figure 452 schematic of sural nerve anatomy. During routine cadaver dissection two different sural nerve formations were observed in the 64yearold male cadaver. Motor fibers in the sural nerve of humans neurology. Function of sural nerve reflexes during human walking. Electrophysiologic responses of human sural nerve to. M shilpa, assistant professor, department of anatomy, adichunchanagiri institute of medical sciences, mandya.
The sural nerve is located somewhat lateral to the achilles tendon and in proximity to the lesser saphenous vein. The sural nerve is a small sensory nerve in the subcutaneous tissues of the calf that can be affected by a variety of disorders. While you should have an overall knowledge of human anatomy, cosmetology is primarily limited to the skin, muscles, nerves, circulatory system, and bones of the head, face, neck. Patients with diabetes mellitus and evidence of peripheral vascular disease have a 5 to 6time higher complication rate than patients without these comorbidities. Bilateral variations in the formation of sural nerve. Its anatomy is of clinical importance since the sn is frequently used for biopsy and nerve graft to diagnose neuropathies and repair nerve injuries, respectively matsuyama et al, 2000. Anatomical and histological morphometry of the sural nerve in human fetuses article pdf available in journal of the anatomical society of india 661 may 2017 with 98 reads how we measure reads. Sural nerve is one of the cutaneous nerves of the lower limb. Although motor fibers in the sural nerve were already described in three individuals, this nerve is considered purely sensory. Treating sural nerve issues begins with an accurate diagnosis, and this is best achieved through a physical exam with an orthopedic specialist. Study of sural nerve complex in human cadavers europe. The nerve is comprised of spinal nerve roots from s1 and s2. Sural nerve and short saphenous vein entrapmenta case report. Studies to determine the course of the sural nerve have been performed on cadaveric specimens.
Each of these nerves gives off a branch, which together forms the sural nerve. Considering this pattern, it is plausible that it contributes to the maintenance of postural stability. Abstract the dissection of 37 cadavers has shown that in only a third of cases, the sural nerve comes. The anatomy of the sural nerve complex in 20 cadaveric limbs was determined by dissection. Normal anatomy and compression areas of nerves of the foot and ankle.
Using a modern 3d approach, it offers an alternative to conventional anatomical structures. However, the sural nerve has also been found to arise from the medial sural cutaneous nerve and the peroneal communicating branch, or simply a continuation from the medial sural cutaneous nerve. This pictorial essay illustrates the normal anatomy of the sural nerve, the technique for its examination by us, as well as. Branch of the sciatic nerve extending through the posterior tibial nerve and providing nerve sensation to certain muscles of the leg and the sole of the foot.
This study covers all information about the sural nerve anatomy published internationally. The sural nerve is a sensory nerve of the lower lateral leg and lateral aspect of the foot. It innervates the muscles of the lateral and posterior third of leg as well as the lateral aspect of foot and heel. Sural nerve sn courses from the posterior aspect of leg to the.
1126 1252 1478 1434 1521 1502 317 557 746 744 1048 105 278 893 55 316 771 212 498 852 187 880 993 792 824 665 991 296 1455 78 1317 552 941 1411 1335 922 933 545