Dr. Ebraheim’s educational animated video describes the anatomy of the sural nerve in a very easy and simple animation.
The sural nerve is composed of two branches. One branch comes from the tibial nerve and the other branch comes from the common peroneal nerve. The lateral sural cutaneous nerve arises from the common peroneal nerve. The tibial branch is called the medial sural cutaneous nerve and its distal continuation is the sural nerve proper.
The sural nerve is a guide to the parent trunk which is the tibial nerve. The tibial nerve can be located by tracking the sural nerve proximally. The sural nerve passes down to the posterolateral side of the leg and onto the dorsal aspect of the lateral side of the foot. The sural nerve maintains a close relationship with the small saphenous vein.
The sural nerve is purely sensory and it supplies sensation to the lower lateral leg, lateral heel, ankle and dorsal lateral foot.
Damage to the sural nerve due to injury, biopsy, trauma, or surgery may not cause significant disability or deficit due to overlap of other nerves. These deficits decrease with time.
The sural nerve can be used as a nerve graft and up to 25 mm of the nerve can be used. Some alternatives to sural nerve graft are available. The sural nerve can be injured by percutaneous postero-lateral ankle screws. Start fixation closer to the fibula to minimize the risk of injury to the nerve. Injury to the sural nerve can also occur in calcaneal fractures from either trauma, surgery or adhesions.
A sural nerve block is usually performed as a field block. A nerve block is done 2 cm proximal to the tip of the lateral malleolus and halfway between the lateral malleolus and the Achilles tendon.
The sural nerve can also be biopsies and a 3-5 cm section of the nerve is usually taken. The biopsy is helpful in diagnosing peripheral neuropathy.
Sural nerve landmarks for injection
•The position of the patient: the patient should be positioned supine with the leg internally rotated.
•The sural nerve runs subcutaneously through the midpoint between the lateral malleolus and the Achilles tendon.
Ultrasound guided injection of the sural nerve
•Use betadine to clean the injection site
•The position of the probe: Place the probe over the lateral aspect of the leg just posterior to the lateral malleolus.
•The position of the needle: injection can be performed along either the long or short axis.
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11 июл 2024
