Type of Article : Case Report
Year: 2015 | Volume 3 | Issue 3 | Page No. 1341-1344
Date of Publication: 30-09-2015
VARIATIONS OF SCIATIC NERVE BIFURCATION IN DISSECTED CADAVERES FROM ETHIOPIA AND THEIR CLINICAL IMPLICATION: A CASE REPORT
Peter Etim Ekanem *, Sunday Abba, Kidan Mariam, Hafte Assefa.
*Anatomy Unit, Biomedical Institute, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Address: Dr. Peter Etim Ekanem, Anatomy Unit, Biomedical Institute, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. Phone: +251-925327490
Background: The tibial and common peroneal nerves are dorsal and ventral divisions of the ventral rami of L4 to S3 of the lumbosacral plexus that join to form the sciatic nerve. The two nerves are structurally separate and supply the posterior compartment of the thigh, the leg and the foot. The point of bifurcation or separation of the sciatic nerve into tibial and common peroneal nerve varies. The common site is at the junction of the middle and lower third of the back of the thigh, near the apex of the popliteal fossa, but division may occur at any point above this. It may also rarely occur below it. The variations in the bifurcation of the sciatic nerve have clinical implications. They may result in nerve injury during deep intramuscular injections in the gluteal region, sciatica, piriformis syndrome etc. This study is to report the variations of the bifurcation in the sciatic nerve found in the cadaveres from Ethiopia, and discuss the clinical implications of such variations.
Conclusion: We conclude from this study that the bifurcation of the sciatic nerve could occur high up in the gluteal region in relation to the piriformis muscle and may present clinical challenges in patient management
KEY WORDS: Sciatic Nerve, Piriformis, Bifurcation, Tibial nerve, Common Peroneal nerves.
- Standring S, Gray’s Anatomy 39th Edition: The Anatomical Basis of Clinical Practice. AJNR 2005;26:2703-2704.
- Paval J, Nayak S. A Case of bilateral high division of sciatic nerve with a variant inferior gluteal nerve. Neuroanatomy. 2006;5:33–34.
- Saritha S, Praveen KM, Supriya G. Anatomical Variations in the Bifurcation of the Sciatic Nerve, A Cadaveric Study and its Clinical Implications. Anatomy & Physiology 2014; 2(5):2-4.
- Sabnis AS. Anatomical Variations of Sciatic Nerve Bifurcation in Human Cadaveres. Journal of Clinical Research Letters 2012;3(2):46-48.
- Vloka JD, Hadzic A, April EW, Thys DM. The division of the sciatic nerve in the popliteal fossa: anatomical implications for popliteal nerve blockade. Anesth Analg 2001;92:215-217.
- Babinski M. A., Machado FA, Costa WS. A rare variation in the high division of the sciatic nerve surrounding the superior gemellus muscle. Eur J Morphol 2003;41:41–42.
- Machado FA, Babinski MA, Brasil FB, Favorito LA, Abidu- Figureiedo M, Costa MG. Anatomical variations between sciatic nerve and piriformis muscle during fetal period in human. Int J Morphol 2003;21:29-35.
- Smoll NR. Variations of the piriformis muscle and sciatic nerve with clinical consequence: a review. Clin Anat 2010;23:8-17.
- Muthu Kumar .T, Shrimathi, Ananda Rani, Sumathi Latha. A Cadaveric Study of Sciatic Nerve and It’s Level of Bifurcation. Journal of Clinical and Diagnostic Research 2011;5(8):1502-04.
- Khan YS, Khan TK. A rare case of bilateral high division of sciatic nerve (of different types) with unilateral divided piriformis and unusual high origin of genicular branch of common fibular nerve. International Journal of Anatomical Variations (IJAV) 2011;4:63-66.
- Standring S, Mahadevan V, Collins P, Healy JC, Lee J, Niranjan NS. From Gray’s Anatomy, The Anatomical Basis of Clinical Practice. Pelvic Girdle and Lower Limb: Overview and Surface Anatomy; Pelvic girdle, gluteal region and thigh. 40th Edition. Spain, Philadelphia; Churchill Livingstone Elsevier. 1337-1338, 1371, 1384.
- Ugrenović S, Jovanović I, Krstić V, Stojanović V, Vasović L, et al. The level of the sciatic nerve division and its relations to the piriform muscle. Vojnosanit Pregl 2005; 62:45-49.
- Ronald AB, Adel KA, Ryosuke M. Sciatic Nerve, Illustrated Encyclopedia of Human Anatomic Variation: Opus III: Nervous System: Plexuses, Anatomy Atlases; 2015 www.anatomyatlases.org/AnatomicVariants/NercousSystem/Text/SciaticNerve.shtml
- Sharma T, Singla RK, Lalit M. Bilateral eventration of sciatic nerve. JNMA J Nepal Med Assoc 2010;50:309-312.
- Güvençer M, Iyem C, Akyer P, Tetik S, Naderi S. Variations in the high division of the sciatic nerve and relationship between the sciatic nerve and the piriformis. Turkish Neurosurg 2009; 19:139–144.
- Borgeat, A, Blumenthal S, Lambert M, Theodorou P, Vienne P. The feasibility and complications of the continuous popliteal nerve block: a 1001-case survey. Anesth Analg. 2006;103(1):229-33.
- Parziale JR, Hudgins TH, Fishman LM. The piriformis syndrome. Am. J. Orthop. 1996;25:819-823.
- Selda B, Mehmet A, Ümmühan BL , Metin K, Adile ZGN , Ayşe RÇ. Sciatic nerve injury due to intramuscular injection: electrophysiological findings and one-year follow-up. Turk J Med Sci 2012;42 (5):913-917.
Peter Etim Ekanem, Sunday Abba, Kidan Mariam, Hafte Assefa. VARIATIONS OF SCIATIC NERVE BIFURCATION IN DISSECTED CADAVERES FROM ETHIOPIA AND THEIR CLINICAL IMPLICATION: A CASE REPORT. Int J Anat Res 2015;3(3):1341-1344. DOI: 10.16965/ijar.2015.219