Topical diagnosis of lesions of the sacral plexus

Category Diagnostics | August 12, 2017 17:58

sacral plexus is formed from fibers of V lumbar and sacral spinal nerves of the two.Located sacral plexus in front of m.pyriformis on the inner surface of the sacrum.

Based on the topographic features of the sacral plexus, one can imagine that it is affected in any pathological foci in the pelvic area (inflammation, trauma, and others.).Sacral plexus may be involved in inflammation in the sacroiliac joint.The clinical picture of the sacral plexus injury is determined primarily by loss of peripheral nerve function, leaving the plexus.

These are the sciatic nerve with its main branches - large and peroneal nerves, as well as the upper and inferior gluteal nerve and posterior cutaneous nerve of the thigh.

sciatic nerve .Forming of the sacral plexus, the nerve lies under the m.pyriformis.Outside he goes through the foramen ischiadicus major, between trochanter major and the tuber ischii and hamstring sent down to the popliteal cavity, which in its upper right corner is divided into large and small tibial
nerves.

However, it should be said that the place of the division of the sciatic nerve in the branches is subject to large fluctuations.Sometimes fission occurs in the middle of the thigh, as well as when leaving the plexus, and then pierces the peroneal nerve m.pyriformis, and the tibial nerve exits the foramen ischiadicus major under m.pyriformis.

Knowledge of these topographical features relevant for the topical diagnosis.

High and complete defeat of the entire trunk of the sciatic nerve before its division into branches observed infrequently (for injuries, diseases of the pelvic organs).

painting full high lesion of the sciatic nerve trunk is determined by precipitation of the basic functions of its branches, as well as loss of function of the entire group, the flexor muscles of the lower leg.As a result, the patient is not able to bend the lower leg, completely paralyzed foot and fingers, atrophy of muscles posterior surface of the thigh, leg and foot.He suffers from the sensitivity of the back of the thigh, lower leg (with the exception of the innervation area).

If it affects the sciatic nerve often have severe pain, usually radiating to the back of the thigh and lower leg.When traumatic injuries of the sciatic nerve pain are particularly fierce, burning in nature and are known as kauzalgii (sciatic nerve is similar to the median nerve in the hand is rich in sympathetic fibers).

On palpation of the muscles in the nerve there is soreness, especially in places where the nerve trunk lies closest to the surface.These pressure points known as points Valle, located along the trunk of the sciatic nerve and its sequel - the tibia nerve - as follows: between the crest of the ilium and sacral articulation, in the middle of the crest of the ilium between the greater trochanter and ischial tuberosity, at the glutealfolds in the middle of the back of the thigh, in the popliteal cavity, the thickness of the calf muscles, the outer condyle on the rear of the foot.VMBekhterev also highlighted medioplantarnuyu pain point at the middle of the sole.Some tension characterizes the disease symptoms of the sciatic nerve.

Symptom Lasegue .In the supine patient straightened at the knee joint is bent leg at the hip joint.At the same time there is pain on the back of the thigh, lower back, lower leg (the first phase).If you feel pain right leg bent at the knee, the pain disappears as a result of the termination of the tension nerve (the second phase).Using the second phase Lassegue important for the differential diagnosis of the disease of the sciatic nerve and coxitis.At the last bend the legs at the hip joint also causes the pain does not disappear, however, when bent leg at the knee joint.The angle at which the pain occurs while bending the legs at the hip joint, is inversely proportional to the intensity of pain.As mentioned above, cross-Lasegue symptom (symptom spondylitis) is characteristic of the radicular lesions of the sciatic nerve.

Symptom Bonn.Flank Pain hips appear when activated or abduction straightened legs.

Symptom Sukkar .Vigorous dorsiflexion of the foot, while the foot to straighten the knee joint, causing pain along the sciatic nerve.The same dorsiflexion of the foot while bending the legs at the hip joint in the first phase Lassegue further intensifies the pain.

Symptom Turin.Pain along the sciatic nerve occurs with vigorous dorsiflexion thumb.

Symptom spondylitis .The pain along the sciatic nerve comes under strong pressure sensitive to the patient's knee the bed, lying on his back.

Symptom landing.When you try to get the patient in bed with straight legs felt pain along the sciatic nerve affected.

Symptom Minor .When getting up on his toes affected leg bent and the heel of the foot is higher than the other.

Symptom spondylitis .In a sitting position the patient can straighten the injured leg only if the bend healthy.In the sitting position the pain appears when zakidyvanii sore feet to a healthy.

One of the major symptoms of the disease when the sciatic nerve is antal'gicheskoń≠ scoliosis.On antal'gicheskoń≠ scoliosis at defeat ropes lumbosacral area most often occurs curvature of the spine in the opposite direction.At the same time expanding the intervertebral holes and reduced compression of damaged cords.This type of scoliosis is called antal'gicheskoń≠ heterologous (bulge in the affected side).

In cases stem diseases of the sciatic nerve or plexus homology observed scoliosis (a bulge in a healthy way).The spine is curved in the direction of the patient, and therefore decreases the tension and nerve plexus trunk.

At the phenomena of nerve irritation ankle reflex is usually increased.When the processes of violating its conductivity, ankle reflex disappears, and often there is an increase of the knee, and nizhnebryushnogo cremasteric reflexes.

The large number of sympathetic fibers in the composition of the trunk of the sciatic nerve causes the appearance of vasomotor-trophic disorders when it is damaged.The latter are expressed in lowering skin temperature, change in skin color, violation of sweating, the weakening of vascular pulsation.

In clinical practice, found failure of individual branches of the sciatic nerve.Therefore, from the standpoint of topical diagnosis should know symptomatology defeat them separately.

Small tibial nerve .Innervate the extensors of the foot, fingers and muscles, turning the foot outwards.Consequently, with the defeat of nerve patient loses the ability to produce dorsiflexion of the foot and toes, foot dangles downward and somewhat turned inward.The gait of the patient, who was forced to lift his leg high, so as not to hurt the foot dangling on the floor, acquires a peculiar character (peroneal, "cock" gait).Never stand on the heel or move them the patient can not.Atrophied muscles in the leg perednenaruzhnoy.Sensory disorders in lesions of the peroneal nerve insignificant.They are found only on the outer surface of the tibia and the rear foot and toes.

tibia nerve .Innervating the flexors of the foot, fingers and muscles, turning the foot inward.As a result, a patient with nerve damage may not produce plantar flexion of the foot and toes, standing on his toes.The foot and straighten somewhat turned outwards.Such a position of the foot in combination with atrophy of the muscles of the sole (high arch, retraction of the intercostals intervals) gives it a distinctive appearance.Atrophy and calf muscles.Disappears ankle reflex.N. tibialis is a direct continuation of the sciatic nerve, so when his involvement in the pathological process detected the same symptoms as in the defeat of the trunk of the sciatic nerve: the pain kauzalgichesky syndrome, vasomotor-trophic disorders.

sensory disorders in lesions n.tibialis found the back of the leg and on the sole and the plantar surface of the toes (plantar nerve cutaneous branches).Painful points Valle defined in the popliteal cavity, posterior surface of the tibia, soles.

directly from the sacral plexus, sciatic nerve in addition to its branches, depart following nerves.

superior gluteal nerve .It supplies the m.gluteus medius et minimus, and tensor fasciae latae.Isolated nerve damage - a rare phenomenon.Involving him in the pathological process is combined with the defeat, other nerves of the sacral plexus.Since the nerve is involved in the innervation of the muscles which are taking away a hip outwards, then the sole defeat of his abduction hampered thigh, and at the bilateral visibly upset gait ( "duck").

inferior gluteal nerve .Innervate m.gluteus maximus.The function of this nerve, as well as the upper breech, violated most often in conjunction with the defeat of all the sacral plexus.This mainly affects the hip extension function and limited the possibility of rectifying the trunk flexion position.

Such a patient with difficulty climbing stairs, stands up from a sitting position.

Posterior femoral cutaneous nerve n.cutaneus femoris posterior innervate the skin primarily hamstring and lower parts of the buttocks.Loss of function of the nerve in most cases occurs as a manifestation of the destruction of the sacral plexus.