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. 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. Aug 11, 2009 an defect on the posterior ankle exposing the tendoachilles and a fractured calcaneum covered with a sural artery flap. Bhanu prakash usmle, fmge and neet pg 146,116 views. Mr imaging of entrapment neuropathies of the lower extremity. Aug 08, 2018 a sural nerve block can be utilized for fast anesthetization to the foot and lower leg. 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 is a purely cutaneous nerve formed by variable contributions from the tibial and peroneal nerve in the popliteal fossa. The sural nerve descends from the mid calf to the lateral side of the ankle, passes to. Variant formation of sural nerve and its distribution at the. As the bundle of fibers forms a branch of the femoral nerve, it is also known as short saphenous nerve. 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.
The sural nerve is somewhat superficial, that makes it more available to surgeons, hence it is somewhat simpler compared to other treatments. To determine the position and course of the sural nerve in relation to the achilles tendon in two planes. 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 is a cutaneous section of the tibial nerve that emerges high in the leg. The sural nerve passes between the heads of gastrocnemius and posterior.
Introduction the sural nerve is a small and superficial nerve innervating the foot that can be difficult to visualize with ultrasound. The sural nerve is a peripheral nerve, meaning that it serves to communicate with the brain and spinal cord. An defect on the posterior ankle exposing the tendoachilles and a fractured calcaneum covered with a sural artery flap. It provides sensation to the posterolateral lower third of the leg and lateral aspect of the foot and heel. Itcanhavesomeanastomosis with the distal branches of the super. Sural nerve entrapment explained chronic body pain. This study covers all information about the sural nerve anatomy published internationally. The sural nerve is a small sensory nerve in the subcutaneous tissues of the. Anatomy of the sural nerve and its relation to the. Ultrasound anatomy and rationale for investigation. 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.
Pdf sural nerve injury is a relatively common complication after surgery on the achilles tendon. The sural nerve passes between the heads of gastrocnemius and posterior to the peroneal tendons. Sn is universally recognized by surgeons as a site for harvesting an autologous nerve graft. 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. Sural nerve injuries are an evident risk especially of minimalinvasive surgical achilles tendon repair. 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. Merrilee zetaruk, jeff hyman, in clinical sports medicine, 2007. Management of sural nerve neuromas with targeted muscle. In a, the sural nerve white arrow runs close to the. 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. The sural nerve supplies the lateral 5 dorsal digital nerves in 40% of cases.
Anatomy of the sural nerve and its relation to the achilles tendon by ultrasound examination article pdf available in orthopedics 373. Sural nerve biopsy journal of neurology, neurosurgery. Nov 24, 2015 on this page you can read or download cpt code for sural nerve block in pdf format. Sural nerve damage is a subtype of peripheral neuropathy. Patients with diabetes mellitus and evidence of peripheral vascular disease have a 5 to 6time higher complication rate than patients without these comorbidities. Anatomy of the sural nerve related to calcaneal tendon, intermalleolar line and small saphenous vein. The sural nerve complex snc consists of four named components.
Jan 04, 2017 the sciatic nerve anatomy usmle step 1 origin, course, relations and branches. Normal anatomy on cadaveric dissection and case series. Entrapment of the nerve could be caused by compression due to fascial. 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. Surgical anatomy of the medial sural artery perforator flap. An anatomic study with clinical and surgical implications. 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. 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.
Severe trauma can often result in sural neuropathy, a common neurological problem caused due to a damaged nerve. In the posterior thigh, the sciatic nerve divides into its two main branches. Anatomy of the sural nerve and its relation to the achilles. Sural nerve location, function, anatomy and pictures. Ac, coronal oblique sonograms obtained from proximal atodistalc. Pdf operative procedures and traumatic injuries of the lateral foot and ankle place the sural nerve and its branches at risk. Sural nerve graft harvest iowa head and neck protocols. Ultrasonography of the sural nerve wiley online library. The reverse sural artery flap is a reliable alternative for treating small to moderate size defects of the lower tibia, ankle, and heel regions. It is a sensory nerve in the lower leg that lies close to the small saphenous vein, situated in the calf. Studies to determine the course of the sural nerve. Sural nerve injury associated with neglected tendo achilles.
Percutaneous sutures should not be placed in the lateral half of the ta. Surgical anatomy of the medial sural artery perforator flap wong et al. A sural nerve block is used for making the effect of anesthesia on the foot as well as lower leg faster. Anatomy of the sural nerve related to calcaneal tendon. 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. In this study, 17 cadaver specimens were dissected to clarify its course and branching patterns. The sural nerve supplies sensation to the skin of the lateral foot and lateral lower ankle.
Being superficial, this nerve is easily identifiable and accessible by surgeons. The sural nerve is a sensory nerve of the lower lateral leg and lateral aspect of the foot. 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. In some cases inflammatory or vasculitic diseases include the sural nerve selectively. The nerve is comprised of spinal nerve roots from s1 and s2. Operative procedures and traumatic injuries of the lateral foot and ankle place the sural nerve and its branches at risk. The sural nerve emerges high in the leg in between the two heads of the gastrocnemius muscle. 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. There are some important characteristics of sural nerve damage related to the functioning and the anatomy of the involved structures. 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.
Reverse sural fasciocutaneous flap da vinci foot and ankle. Anatomy of the sural nerve in a computerassisted model. Less commonly, the sural nerve may originate directly from. The sural nerve courses from medial to lateral part, and at a point 7 cm proximal to the tip of the lateral malleolus, the nerve is on an average 26 mm posterior to the edge of the fibula. 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. 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. The sural nerve supplies the lateral inferior third of theleg,ankle,andfoot. Surgical anatomy of the sural and superficial fibular. Anatomic studies quantifying the course of this nerve are sparse. Sural nerve sn courses from the posterior aspect of leg to the lateral side of ankle and foot.
Nov 23, 2015 on this page you can read or download neurolysis sural nerve in pdf format. The sural nerve receives its innervation from the lumbosacral plexus l5, s1. General sciences dorsal nerve dorsal cutaneous nerve pg. If you dont see any interesting for you, use our search form on bottom v. The formation and distribution of the sural nerve vary in different individuals. Despite this, the use of ultrasound does improve the success rate of this nerve block at the ankle. Sural nerve lipoma is a rare cause of sural nerve entrapment with an unknown etiology. Each of these nerves gives off a branch, which together forms the sural nerve.
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