| Sural nerve |
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The small saphenous vein (sural nerve visible running vertically)
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| Details |
| From |
Medial sural cutaneous nerve, communicating branch with the common fibular nerve (S1, S2) |
| Identifiers |
| Latin |
nervus suralis |
| MeSH |
A08.800.800.720.450.760.820.820 |
| TA |
A14.2.07.062 |
| FMA |
44688 |
| Anatomical terms of neuroanatomy
[edit on Wikidata]
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The sural nerve is a sensory nerve in the calf region (sura) of the leg. It is made up of collateral branches of the tibial nerve and common fibular nerve. Two cutaneous branches, the medial and lateral, form the sural nerve. The medial cutaneous branch arises from the tibial nerve, and the lateral branch arises from the common fibular nerve. The tibial nerve and the common fibular nerve arise as the sciatic nerve divides into two branches in the popliteal fossa. As the tibial nerve travels down the popliteal fossa, and before it goes beneath the gastrocnemius, it gives off a cutaneous branch which is the medial sural cutaneous nerve. This nerve courses laterally over the lateral head of the gastrocnemius. The common fibular nerve also gives off a small cutaneous branch which is the lateral sural cutaneous nerve. When the common fibular nerve is divided from the sciatic nerve, it travels parallel to the distal portion of the biceps femoris muscle and towards the fibular head. The small cutaneous branch arises as the common fibular nerve travels towards the fibular head. The nerve then continues down the leg on the posterior-lateral side, then posterior to the lateral malleolus where it runs deep to the fibularis tendon sheath and reaches the lateral tuberosity of the fifth toe, where it ramifies.[1]
Contents
- 1 Anatomy
- 2 Function
- 3 Clinical relevance
- 3.1 Sural Nerve Block
- 3.2 Sural Neuropathy
- 4 Additional images
- 5 References
- 6 External links
Anatomy
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 cutaneous nerve (LSCN) which is one of the terminal branches of the common fibular nerve. These two branches, MSCN and LSCN, are connected by the sural communicating branch and form the sural nerve. How the two branches fuse, the contribution of the fibular and tibial branch, the location of the connection, and differences between the two lower extremities contribute to variability of this nerve.
From the mid calf down to the ankle the nerve courses subcutaneously along a line drawn from the mid-posterior popliteal fossa to just posterior to the lateral malleolus and thence under the malleolus and forward along the lateral aspect of the foot. It supplies sensation to the skin of the lateral foot and lateral lower ankle.[2]
Function
The nerve transmits sensory signals from the posterior lateral corner of the leg and the lateral foot and 5th toe towards the spinal cord and brain.[1]
Clinical relevance
The sural nerve subserves a purely sensory function, and therefore its removal results in only a relatively trivial deficit. For this reason, it is often used for nerve biopsy, as well as the donor nerve when a nerve graft is performed.
Sural Nerve Block
A sural nerve block can be used for quick anesthetization to the foot and lower leg. Because this technique requires few injections to reach adequate anesthesia, a smaller volume of anesthetic is needed.[3] The sural nerve is rather superficial, which makes it more accessible to surgeons, therefore it is relatively easier than other procedures. Also, due to its superficial properties, the sural nerve is also easily blocked at multiple levels at or above the ankle. In one study, regional anesthesia of the foot and ankle, when performed by surgeons, was completely successful 95% of the time.[4] Sural nerve block is not advised if a patient is allergic to the anesthetic solution, has infected tissue at the injection site, has severe bleeding disorder, or has preexisting neurological damage.[5]
Sural Neuropathy
Sural mononeuropathy is uncommon. It can be due to a mass lesion such as a ganglion or to trauma, which is the most common cause.[6] Sometimes inflammatory or vasculitic diseases will selectively involve the sural nerve. In addition, the sural nerve will be involved in any kind of generalized peripheral sensory or sensorimotor neuropathy. Sensory changes from sural neuropathy are variable but usually occur in the postero-lateral aspect of the leg and the dorso-lateral foot. These can sometimes be painful with paresthesias and dysesthesias. [7] Nerve conduction studies can be used to delineate sural nerve lesions.[8] Treatment will depend on the cause of the neuropathy. For example, ganglions are usually resected. Traumatic neuropathy is usually treated non-surgically.[6]Sural nerve damage is, in fact, a subclass of peripheral neuropathy.[9]
Additional images
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Cutaneous nerves of the right lower extremity. Front and posterior views.
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Diagram of the segmental distribution of the cutaneous nerves of the sole of the foot.
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Deep nerves of the front of the leg.
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Nerves of the dorsum of the foot.
References
This article incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918)
- ^ a b "The Sural Nerve, Anatomy and entrapment". Functional Anatomy. November 26, 2009. [self-published source?]
- ^ Medical Research Council Memorandum 45. Aids to the examination of the peripheral nervous system. 1975 London: Her Majesty's Stationery Office. p 54.
- ^ Crystal, Chad S.; Blankenship, Robert B. (2005). "Local Anesthetics and Peripheral Nerve Blocks in the Emergency Department". Emergency Medicine Clinics of North America. 23 (2): 477–502. doi:10.1016/j.emc.2004.12.012. PMID 15829393.
- ^ Myerson, M. S.; Ruland, C. M.; Allon, S. M. (1992). "Regional Anesthesia for Foot and Ankle Surgery". Foot & Ankle International. 13 (5): 282–8. doi:10.1177/107110079201300510. PMID 1624194.
- ^ Sural Nerve Block at eMedicine
- ^ a b Stickler DE, Morley KN, Massey EW. Sural neuropathy: etiologies and predisposing factors. Muscle Nerve. 4:482-484, 2006.
- ^ Yuebing L, Lederman RJ. Sural mononeuropathy: A report of 36 cases. Muscle Nerve 49:443-445, 2014.
- ^ Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 1983 Philadelphia, FA Davis, p 502.
- ^ "Sural Nerve Pain - Causes, Symptoms & Treatment of Neuritis". Pain Care - Comprehensive Guide For Treatment Of Pain. Retrieved 1 October 2016.
External links
- Anatomy photo:11:07-0202 at the SUNY Downstate Medical Center
- Sural_nerve at the Duke University Health System's Orthopedics program
- Cutaneous field
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Nerves of the lumbosacral plexus
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| Lumbar plexus |
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iliohypogastric
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- lateral cutaneous branch
- anterior cutaneous branch
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ilioinguinal
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- anterior scrotal ♂/labial ♀
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genitofemoral
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- femoral branch
- genital branch
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Lateral cutaneous
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|
|
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obturator
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- anterior
- posterior
- accessory
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femoral
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- anterior cutaneous branches
- saphenous
- (infrapatellar
- medial crural cutaneous
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|
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| sacral plexus |
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sciatic
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common peroneal
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- lateral sural cutaneous
- deep peroneal
- lateral terminal branch
- medial terminal branch
- dorsal digital
- superficial peroneal
- medial dorsal cutaneous
- intermediate dorsal cutaneous
- dorsal digital
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tibial
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- medial sural cutaneous
- medial calcaneal
- medial plantar (common plantar digital nerves
- proper plantar digital)
- lateral plantar (deep branch
- superficial branch
- common plantar digital
- proper plantar digital)
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sural
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- lateral dorsal cutaneous
- lateral calcaneal
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other
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- Muscular
- superior gluteal
- inferior gluteal
- lateral rotator group (to quadratus femoris
- to obturator internus
- to the piriformis)
cutaneous: posterior cutaneous of thigh (inferior cluneal
- perineal branches)
- perforating cutaneous
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|
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| coccygeal plexus |
- pudendal
- perineal
- deep
- posterior scrotal ♂/labial ♀)
- dorsal of the penis ♂/clitoris ♀
- anococcygeal
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- cutaneous innervation of the lower limbs
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