Neuroscience Research Letter 09/2011;

ABSTRACT The sciatic nerve begins in pelvis and normally leaves the pelvis by passing through the greater sciatic foramen below the piriformis muscle. Normally it terminates at the superior angle of the popliteal fossa by dividing into the tibial and common peroneal nerve. However, it may rarely be terminated within the pelvis. In such cases, the tibial nerve and the common peroneal nerve may leave the pelvis through different routes. These variations may cause nerve compressions under other anatomic structures, resulting in non-discogenic sciatica. The aim of present study was to define the relationship between the sciatic nerve and the piriformis muscle. 100 gluteal regions were examined in 50 properly embalmed adult male cadavers. In 96%of the cases, the exit of sciatic nerve from the pelvis was observed as a whole nerve without any division, whereas in 4% of the cases, the tibial branch of the sciatic nerve left the pelvis through the infra piriform foramen and common peroneal branch through the piriformis muscle. The differences in the exit routes of these two nerves are important in clarifying the clinical etiology of non discogenic sciatica. INTRODUCTION The sciatic nerve is thickest nerve in the body. It is almost 2 cm wide at its origin near the sacral plexus. The sciatic nerve is formed in the pelvis by joining anterior divisions of L4, L5, S1, S2, S3 spinal nerve roots. It has two separate nerve trunks, the tibial nerve and the common peroneal nerve enveloped by a common fascial sheath (epineural sheath). These two trunks leave the pelvis through the greater sciatic foramen below the piriformis muscle (infra piriform foramen). The nerve passes along the back of the thigh, and divides into the tibial and common peroneal nerves, at the superior angle of the popliteal fossa. The tibial nerve is formed by the ventral division of the anterior primary rami of L4, L5, S1, S2, S3 and common peroneal nerve is formed by the dorsal division of the anterior primary rami of L4, L5, S1, and S2. Previous studies reported a variety of different anatomic relations between the sciatic nerve and the piriformis 1 . The undivided nerve may emerge above, below or through the piriformis muscle. The major divisions of the nerve may lie either side of the muscle, or (the most common variant) one division either above or below. The evidence of each variation may cause different clinical presentation. It is known that each anatomical variation may reflect a different and a case specific clinical presentation 2 . This requires a detailed description of anatomical variations. The aim of this study was to find out the anatomical variation between the sciatic nerve and the piriformis muscle if any.

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    ABSTRACT: A less common but important cause of buttock and leg pain known as "Piriformis Syndrome". Piriformis syndrome is all intrinsic pathology of the piriformis itself, such as myofascial pain, anatomical variations, hypertrophy, and myositis ossificans or it is caused by trauma to the pelvis or buttock. In this case report we are going to present a rare cause of piriformis syndrome. Our first case was a 32 year old woman. She was referred to our pain clinic for leg pain that radiates from buttock to backside of the knee for 5 years. She did not have any problems in her history or laboratory findings. But in her lower extremity ortho roentgenogram, her leg was 2 cm short at the effected side. Second case was a 23 year old woman who had pain radiating from gluteal region to backside of the knee. In her history she had a car accident two years ago. In this accident, she had a fracture of collum femoris, and her leg was 1 cm short at the effected side. We conclude that "short leg" is one of the rare causes of piriformis syndrome and can be seen alone or with the other causes. The injection on piriformis muscle could be more effective for the patients who have PS after the "short leg" treated.
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May 23, 2014