The sural nerve supplies sensation to the skin of the lateral foot and lateral lower ankle. The formation and distribution of the sural nerve vary in different individuals. Anatomy of the sural nerve related to calcaneal tendon, intermalleolar line and small saphenous vein. The sural nerve supplies the lateral 5 dorsal digital nerves in 40% of cases. Sural nerve sn courses from the posterior aspect of leg to the lateral side of ankle and foot.
Sural nerve graft harvest iowa head and neck protocols. General sciences dorsal nerve dorsal cutaneous nerve pg. In this study, 17 cadaver specimens were dissected to clarify its course and branching patterns. Mr imaging of entrapment neuropathies of the lower extremity. There are some important characteristics of sural nerve damage related to the functioning and the anatomy of the involved structures. In some cases inflammatory or vasculitic diseases include the sural nerve selectively. Sural nerve entrapment explained chronic body pain. This pictorial essay illustrates the normal anatomy of the sural nerve, the technique for its examination by us, as well as the us appearance of its main pathologic changes. Sural nerve damage is a subtype of peripheral neuropathy.
Anatomy of the sural nerve and its relation to the achilles. Jun 20, 2014 sural nerve presents great topographic variability and it is responsible for sensory innervation of the posterolateral side of the distal third of the leg and lateral aspect of the foot. Understanding the variations of sural nerve in its formation, course and distribution may have an. The sural nerve is a pure sensory nerve, typically formed by the joining together of the medial sural nerve a branch of the tibial nerve and either the peroneal communicating nerve or the lateral sural cutaneous nerve branches of the cpn. It is a sensory nerve in the lower leg that lies close to the small saphenous vein, situated in the calf. Being variant in its origin, terminal branches of the sural nerve also supplied the adjacent sides of 5th and 4th toe instead of superficial peroneal nerve. 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. Posterior femoral cutaneous sensory nerve medial and intermediate dorsal cutaneous branches 228 saphenous nerve saphenous sensory nerve distal technique 232 saphenous sensory nerve proximal technique 236 sural nerve sural lateral dorsal cutaneous branch sensory nerve 240 sural sensory nerve 244.
The sural nerve complex snc consists of four named components. Each of these nerves gives off a branch, which together forms the sural nerve. Despite this, the use of ultrasound does improve the success rate of this nerve block at the ankle. As the bundle of fibers forms a branch of the femoral nerve, it is also known as short saphenous nerve. 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. Sural nerve location, function, anatomy and pictures. An anatomic study with clinical and surgical implications. Ac, coronal oblique sonograms obtained from proximal atodistalc. It provides sensation to the posterolateral lower third of the leg and lateral aspect of the foot and heel. Anatomic studies quantifying the course of this nerve are sparse. However, detailed anatomical studies focusing on the relationship of the sural nerve with the achilles tendon at various levels are scarce, even pending in two planes. The sural nerve passes between the heads of gastrocnemius and posterior. 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 sural nerve descends from the mid calf to the lateral side of the ankle, passes to.
A sural nerve block is used for making the effect of anesthesia on the foot as well as lower leg faster. Aug 08, 2018 a sural nerve block can be utilized for fast anesthetization to the foot and lower leg. Sural nerve injury associated with neglected tendo achilles. Itcanhavesomeanastomosis with the distal branches of the super. Ultrasound anatomy and rationale for investigation. The sural nerve is a peripheral nerve, meaning that it serves to communicate with the brain and spinal cord. Sometimes the two branches do not reconnect, when the medial sural cutaneous nerve is connected by the peroneal communicating nerve. The nerve is comprised of spinal nerve roots from s1 and s2. Bhanu prakash usmle, fmge and neet pg 146,116 views. The significant individual variation in the position of the sural nerve in relation to the achilles tendon should be borne in mind when placing sutures in the proximal part of the achilles tendon. Pdf anatomy of the sural nerve and its relation to the. The sural nerve emerges high in the leg in between the two heads of the gastrocnemius muscle. Aug 11, 2009 an defect on the posterior ankle exposing the tendoachilles and a fractured calcaneum covered with a sural artery flap.
The sural nerve is formed as a compilation of the median sural cutaneous and lateral sural cutaneous nerves, which arise from the tibial and peroneal nerves, respectively. Sural nerve biopsy has complications of pain, infection, sensory loss, and delayed wound healing and should only be undertaken in cases of peripheral neuropathy where there are good prospects of its significantly assisting in the diagnosis, as was the case in the study of gabriel et al, 4 which examined the value of biopsy in 50 consecutive. Anatomy of the sural nerve and its relation to the achilles tendon by ultrasound examination article pdf available in orthopedics 373. Pudendal nerve pathology pudendal neuralgia, entrapment or compression relevant anatomy sciatic nerve, sacrum, piriformis mm, gluteus maximus mm, sacrospinous and sacrotuberous ligaments positioningapp roach patient in sidelying position with hips flexed, operative side up. Variant formation of sural nerve and its distribution at the. The sural nerve passes between the heads of gastrocnemius and posterior to the peroneal tendons. Being superficial, this nerve is easily identifiable and accessible by surgeons. Sural nerve lipoma is a rare cause of sural nerve entrapment with an unknown etiology. The sural nerve is a cutaneous section of the tibial nerve that emerges high in the leg. The reverse sural artery flap is a reliable alternative for treating small to moderate size defects of the lower tibia, ankle, and heel regions. This study covers all information about the sural nerve anatomy published internationally. The sural nerve supplies the lateral inferior third of theleg,ankle,andfoot.
Nov 24, 2015 on this page you can read or download cpt code for sural nerve block in pdf format. Nov 23, 2015 on this page you can read or download neurolysis sural nerve in pdf format. Oct, 2017 the sural nerve is a small sensory nerve in the subcutaneous tissues of the calf that can be affected by a variety of disorders. Sural nerve injuries are an evident risk especially of minimalinvasive surgical achilles tendon repair. Fascial entrapment of the sural nerve and its clinical relevance. Sural nerve biopsy journal of neurology, neurosurgery.
Entrapment of the nerve could be caused by compression due to fascial. Jan 04, 2017 the sciatic nerve anatomy usmle step 1 origin, course, relations and branches. The sural nerve is somewhat superficial, that makes it more available to surgeons, hence it is somewhat simpler compared to other treatments. Merrilee zetaruk, jeff hyman, in clinical sports medicine, 2007. The sural nerve receives its innervation from the lumbosacral plexus l5, s1. Normal anatomy on cadaveric dissection and case series. 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. Surgical anatomy of the sural and superficial fibular. Rupture of the tendo achilles is a commonly seen injury, with an incidence of between 2 and 12 cases per 100 000 people per year. In a, the sural nerve white arrow runs close to the. Ultrasonography of the sural nerve wiley online library. Patients with diabetes mellitus and evidence of peripheral vascular disease have a 5 to 6time higher complication rate than patients without these comorbidities.
Sn is universally recognized by surgeons as a site for harvesting an autologous nerve graft. Introduction the sural nerve is a small and superficial nerve innervating the foot that can be difficult to visualize with ultrasound. Severe trauma can often result in sural neuropathy, a common neurological problem caused due to a damaged nerve. Studies to determine the course of the sural nerve. Anatomy of the sural nerve in a computerassisted model. If you dont see any interesting for you, use our search form on bottom v.
An defect on the posterior ankle exposing the tendoachilles and a fractured calcaneum covered with a sural artery flap. Pdf operative procedures and traumatic injuries of the lateral foot and ankle place the sural nerve and its branches at risk. Percutaneous sutures should not be placed in the lateral half of the ta. Management of sural nerve neuromas with targeted muscle. The sural nerve is a sensory nerve of the lower lateral leg and lateral aspect of the foot. To determine the position and course of the sural nerve in relation to the achilles tendon in two planes. Pdf sural nerve injury is a relatively common complication after surgery on the achilles tendon. Less commonly, the sural nerve may originate directly from. Anatomy of the sural nerve related to calcaneal tendon. 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. Surgical anatomy of the medial sural artery perforator flap. 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 sural nerve is a small sensory nerve in the subcutaneous tissues of the.
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