Sciatic nerve and its variations: is it possible to associate them with piriformis syndrome?

Barbosa, Ana Beatriz Marques; Santos, Priscele Viana dos; Targino, Vanessa Apolonio; Silva, Nathalie de Almeida; Silva, Yanka Costa de Melo; Gomes, Felippe Barbosa; Assis, Thiago de Oliveira

doi:10.1590/0004-282x20190093

Cited by 13 publications

(6 citation statements)

References 20 publications

(44 reference statements)

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“…This suggests the possibility of a yet to be observed variation pattern. Interestingly, Barbosa et al in their review article mentioned the occurrence of a rare variant where the sciatic nerve emerges divided, and the common peroneal nerve passes between the heads of a double piriformis, while the tibial nerve passes beneath the muscle (29). From this present study, we opined that knowledge of these anatomical variations might be useful in choosing the correct treatment for patients with piriformis syndrome or sciatica, as previously suggested (28,30).…”

Section: Discussionsupporting

confidence: 74%

“…Although this variant was not anticipated by Beaton and Anson, they hypothesised the possibility of two other types: one in which the nerve passes between and above the heads, and in the other, an undivided nerve passes above the undivided muscle (12). However, a more recent review article identified twelve variants, that is, seven additional variants to the Beaton and Anson variants (29). This suggests the possibility of a yet to be observed variation pattern.…”

Section: Discussionmentioning

confidence: 92%

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Anatomic Variation of the Sciatic Nerve: A Study on the Prevalence, and Bifurcation Loci in Relation to the Piriformis and Popliteal Fossa

Atoni

Oyinbo

Francis

et al. 2022

ama

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Objective. To examine and identify sciatic nerve variations in relation to the piriformis muscle, its prevalence, pattern and the course of its bifurcation loci.Materials and Methods. Twenty-eight formalin fixed male cadavers comprising 56 lower limbs were used for this study. Dissection of the gluteal region and posterior compartment of the thigh was conducted to expose the sciatic nerve. Variations in the sciatic nerve anatomy, their relationship to the piriformis muscle and points of bifurcation, and other observable features were noted and recorded.Results. Fifty-two lower limbs (93%) showed normal anatomy of the sciatic nerve. Four regions (7.1%) showed variations in the morphology of the sciatic nerve. Of these, one (1.8%) showed a variation of the sciatic nerve with the piriformis muscle. This single case showed a common peroneal nerve emerging on the left between the heads of a double piriformis muscle - a variant not described in the original Beaton and Anson classification, with the tibial nerve deep to the muscle. In two other limbs, the sciatic nerves showed a normal relationship with the piriformis, but had variations in the bifurcation loci (bilateral). The divisions were in upper third and middle third of the right and left thighs respectively.Conclusion. Knowledge of the level of bifurcation and distribution of the sciatic nerve and its location is important. This nerve is commonly encountered by neurologists, orthopaedics, and anaesthesiologists. The uncommon anatomical findings described are relevant to surgeons to enable them to perform efficient surgical procedures and avoid errors.Sciatic Nerve; Bifurcation Loci; Piriformis; Sciatica

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 92%

Anatomic Variation of the Sciatic Nerve: A Study on the Prevalence, and Bifurcation Loci in Relation to the Piriformis and Popliteal Fossa

Atoni

Oyinbo

Francis

et al. 2022

ama

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“…Barbosa et al [ 23 ] conducted a systematic review and showed that the most prevalent anatomical variation was that the common fibular nerve passed through the piriformis muscle fibers (33.3%) and pointed to a possible association of this condition with piriformis syndrome. Similarly, Poutoglidou and colleagues [ 24 ] wrote a comprehensive systematic review with a meta-analysis of the SN variants relative to the PM and compared those variants’ prevalence among different geographical populations with respect to gender and laterality, reporting that SN variants were more common among East Asians (with a 31% pooled prevalence of total variants), and no statistically significant differences with respect to gender and laterality.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Variations of the Sciatic Nerve Exit from the Pelvis and Its Relationship with the Piriformis Muscle: A Cadaveric Study

Reynoso

Ramirez

Nurmukhametov

et al. 2022

Neurology International

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Background: The sciatic nerve (SN) is the widest nerve of the human body that exits the pelvis through the greater sciatic foramen, usually below the piriformis muscle (PM), and descends between the greater trochanter of the femur and ischial tuberosity of the pelvis to the knee. The aim of this paper is to examine and identify the SN variations in relation to the PM, its prevalence, pattern, and course. Methods: A prospective-descriptive cross-sectional study was carried out to determine the frequency of anatomical variations in the exit of the SN in relation with the PM in 20 anatomical bodies (corpses) of both genders, in equal numbers. Results: The dissection of 40 SNs in corpses of both sexes in equal numbers showed that the SN exited inferior to the PM in 37 lower limbs (92.5%); between the fascicles of the PM and inferior to the PM in two lower limbs (5%); and in one thigh, between the fascicles of the PM and superior to the PM (2.5%). Our study reported that the SN divides in its terminal branches more commonly in the proximal part of the popliteal fossa in 55% of cases, in the gluteal region in 35% of cases, and in the middle third of the thigh in 10% of cases. Conclusions: Anatomical variations of the SN in relation to the PM are challenging for the diagnostic and therapeutic procedure in many clinical and surgical cases. Rapid recognition of the SN changes makes surgical approaches more accurate and effective. Our study confirmed that the SN exits the pelvis most commonly below the PM, although some anatomical variations may occur.

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“…108 A third specific explanation for the influence of compression garments on HRV may lie in the effects of the physical stimulation of the sciatic nerve fibers which cover most of the skin areas of the lower limb. 109 The compression of the lower limb intuitively stimulates the distal components (e.g. common peroneal nerve and tibial nerve) of this nerve, which leads to the release of neurotransmitters locally, as well as it leads to the activation of the neural reflex of the efferent pathways of the same sciatic nerve.…”

Section: Discussionmentioning

confidence: 99%

Compression therapy, autonomic nervous system, and heart rate variability: A narrative review and our preliminary personal experience

Cavezzi

Colucci

Barsotti³

et al. 2022

Phlebology

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Aims To highlight the relationship among compression therapy (CT), the autonomic nervous system (ANS) (parasympathetic and sympathetic system), and the heart rate variability (HRV) analysis. Background Beyond the typical analgesic and anti-inflammatory effects of CT in patients affected by venous and/or lymphatic diseases, some literature about CT influence on wellbeing has been published as well. More specifically, CT influence on the ANS has been elucidated mostly through HRV application, providing useful quali-quantitative data for scientific and clinical purposes. Material and Methods A literature search was performed through several web-based search engines to investigate the available evidence concerning the possible influence of CT on the ANS and on psychoneuroendocrineimmunology. Moreover, we examined literature data regarding HRV use in the assessment of CT. Lastly, a preliminary cross-over study was performed on 10 patients affected by phlebolymphedema of the lower limbs, undergoing CT with 18–21 mmHg stockings for 10 h and investigated by means of HRV. Results A CT-based increase of the anti-inflammatory activity of the parasympathetic (vagal) system has been elucidated in most scientific literature. Similarly, CT application has generally resulted in an improvement of HRV, which indicates a beneficial influence on the ANS. In our preliminary experience with compression stockings and HRV, two parasympathetic-based parameters improved by 22.8% and 68.0% after 10 h, whereas they decreased in the same subjects without stockings by 2.7% and 8.2%, during normal breathing. The remaining HRV parameters did not show relevant variations, especially during diaphragmatic breathing. Conclusions From literature data and based on our very preliminary experience, it is possible to deduce that CT exerts different effects on the psychobiological parameters of the individual, overall improving HRV and parasympathetic activity. Incorporating both HRV/ANS assessment in phlebolymphology and the beneficial neural action of CT in health care may represent viable options in the future biomedical science.

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Sciatic nerve and its variations: is it possible to associate them with piriformis syndrome?

Cited by 13 publications

References 20 publications

Anatomic Variation of the Sciatic Nerve: A Study on the Prevalence, and Bifurcation Loci in Relation to the Piriformis and Popliteal Fossa

Anatomic Variation of the Sciatic Nerve: A Study on the Prevalence, and Bifurcation Loci in Relation to the Piriformis and Popliteal Fossa

Anatomical Variations of the Sciatic Nerve Exit from the Pelvis and Its Relationship with the Piriformis Muscle: A Cadaveric Study

Compression therapy, autonomic nervous system, and heart rate variability: A narrative review and our preliminary personal experience

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