WordNet

any bundle of nerve fibers running to various organs and tissues of the body (同)nervus
one of the sections (or chapters) in the Koran; "the Quran is divided in 114 suras"
control of your emotions; "this kind of tension is not good for my nerves"

PrepTutorEJDIC

〈C〉『神経』 / 〈C〉《複数形で》『神経過敏』,いらだち / 〈U〉『勇気』,度胸(courage) / 〈U〉《時にa ~》厚かましさ,ずぶとさ;無礼 / 〈C〉葉脈;(昆虫の)翅脈(しみゃく) / 〈人,特に自分〉‘に'力を与える,‘を'元気づける

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/05/27 14:55:28」(JST)

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The sural nerve is a sensory nerve in the leg made up of collateral branches off 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]

Structure

Variation

The sural cutaneous nerve as we report in the previews page, created by the communication between medial sural cutaneous nerve which is a terminal branch of tibial nerve and lateral sural cutaneous nerve which is one of the termianal branch of common fibular nerve. These two branches, MSCN and LSCN are connected by sural communicating branch and form the sural nerve. The way and how the two branches approach together, the exact location of the connection, as also if the connection is identical in both legs give a vast range of variability onto this nerve.

The variations of sural nerve divided mainly into three categories:

I. According to the way of union of sural nerve. Which may be connected from LSCN or MSCN or both, so that’s why divided into three varieties, type A, type B and type C. II. The rest two categories essentially are subdivisions of type A. In this category differentiated into symmetrical and asymmetrical groups, according to identical type of structure in the both legs or not. III. In the last category subdivided into other fives groups, which are the five possible regions for sural nerve union.

Function

The nerve transmits signal from the posterior lateral corner of the leg, and the lateral foot and 5th toe.^[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.^[2] 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.^[3] 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.^[4]

Sural Neuropathy

Radiofrequency can be a successful use in treatment of chronic pain conditions. However, continuous radiofrequency ablation can have a neurodestructive effect. Due to this fact, pulsed radiofrequency is a better treatment for peripheral sensory nerves. Radiofrequency is an alternating current with an oscillating frequency of 500,000 Hz.^[5] Pulsed radiofrequency uses radiofrequency currents in short, high-voltage bursts. Each burst lasts about 20 milliseconds, which is then followed by 480 milliseconds of rest to allow the heat to dissipate. Allowing the heat to dissipate avoids temperature increases. The advantage of pulsed radiofrequency over the continuous radiofrequency is that its effect does not rely on the thermal destruction of nerve tissue. Since the sural nerve is a sensory nerve, if applying continuous radiofrequency to a sensory nerve can cause a neuroma formation and could cause pain to worsen.^[6] Pulsed radiofrequency is a much better option because it does not affect the structural integrity of the nerve and may cause only transient mild edema. Pulsed radiofrequency produces a very weak magnetic field without any significant biologic effects and it has a much stronger electric field than continuous radiofrequency. The electric field can induce changes on tissue and distort and dislocate charged molecular structures, which disrupts cell functioning without substantial elevations in temperature.^[7] Pulsed radiofrequency causes transient inhibition of evoke excitatory transmission with full recovery of synaptic activity within a few minutes, whereas continuous radiofrequency produces a long-lasting blockade.^[8] It is concluded that continuous radiofrequency results in neurodestructive effects, whereas pulsed radiofrequency produces neuromodulation. One case study implies that pulsed radiofrequency may provide long-term pain relief in cases of sural nerve injury.^[9]

Additional images

Cutaneous nerves of the right lower extremity. Front and posterior views.
Cutaneous nerves of the right lower extremity. Front and posterior views.
Diagram of the segmental distribution of the cutaneous nerves of the sole of the foot.
Deep nerves of the front of the leg.
Nerves of the dorsum of the foot.

References

This article incorporates text from a public domain edition of Gray's Anatomy.

^ ^a ^b Functional Anatomy, (2009, Nov 26). The Sural Nerve, Anatomy and entrapment, Functional Anatomy Blog. Retrieved from http://functionalanatomyblog.com/2009/11/26/the-sural-nerve-anatomy-and-entrapment/
^ Crystal CS, Blankenship RB. Local anesthetics and peripheral nerve blocks in the emergency department. Emerg Med Clin North Am. May 2005;23(2):477-502.
^ Myerson MS, Ruland CM, Allon SM. Regional anesthesia for foot and ankle surgery. Foot Ankle. Jun 1992;13(5):282-8. [Medline].
^ Tassone, H. (2013, Sep 17). Sural Nerve Block, Medscape. Retrieved from http://emedicine.medscape.com/article/83199-overview#a01
^ Sluijter M, Racz G. Technical aspects of radiofrequency. Pain Pract 2002; 2:195-200.
^ Cohen SP, Foster A. Pulse radiofrequency as a treatment for groin pain and orchialgia. Jrology 2003; 61:645.
^ Cosman E Jr./ Cosman E Sr. Electric and thermal field effects in tissue around radiofrequency electrods. Pain Medicine 2005; 6:405-424.
^ Cahana A, Vutskits A, Muller D. Acute differential modulation of synaptic transmission and cell survivial during exposure to pulsed and continuous radiofrequency energy. J Pain 2003; 4:197-202.
^ Todorov, L. Pulsed Radiofrequency of the Sural Nerve for the Treatment of Chronic Ankle Pain. Pain Physician 2011; 14:301-304 http://www.painphysicianjournal.com/2011/may/2011;14;301-304.pdf

External links

Anatomy photo:11:07-0202 at the SUNY Downstate Medical Center
Sural_nerve at the Duke University Health System's Orthopedics program
sural+nerve at eMedicine Dictionary
Cutaneous field

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 末梢神経疾患および筋疾患の鑑別診断 differential diagnosis of peripheral nerve and muscle disease
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3. 多発性神経障害の概要 overview of polyneuropathy
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5. 遺伝性感覚自律神経ニューロパチー hereditary sensory and autonomic neuropathies

English Journal

Cutaneous innervation of the ankle: An anatomical study showing danger zones for ankle surgery.

Duscher D1, Wenny R, Entenfellner J, Weninger P, Hirtler L.Author information 1Department for Systematic Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medcine, California, United States of America.AbstractThree nerves innervate the skin in the foot and ankle region: the saphenous, sural, and superficial peroneal nerves. Because they are close to the medial and lateral malleoli, these nerves are at significant risk during orthopedic interventions. The aims of this study were to investigate the distal courses of the three cutaneous nerves of the ankle and to determine their exact relationships with easily identifiable bony landmarks. Ten freshly frozen and 40 embalmed lower extremities of adults were dissected. The positions of the superficial peroneal, sural, and saphenous nerves were determined using reference lines based on easily palpable osseous landmarks. The frequencies and distributions of all three nerves and their branches were converted into absolute numbers. A danger zone for each nerve was established on the basis of the distribution of crossings between the nerves and the different reference lines. Determination of the exact orientation of the nerves around the ankle should help minimize the nerve injury rate during surgical approaches in this area. Using this easily translatable new grid system, the course and danger zones of each cutaneous nerve around the ankle can be estimated clinically. Clin. Anat. 653-658, 2014. © 2013 Wiley Periodicals, Inc.
Clinical anatomy (New York, N.Y.).Clin Anat.2014 May;27(4):653-8. doi: 10.1002/ca.22347. Epub 2013 Dec 17.
Three nerves innervate the skin in the foot and ankle region: the saphenous, sural, and superficial peroneal nerves. Because they are close to the medial and lateral malleoli, these nerves are at significant risk during orthopedic interventions. The aims of this study were to investigate the distal
PMID 24343871

Safety profile of sural nerve in posterolateral approach to the ankle joint: MRI study.

Ellapparadja P1, Husami Y, McLeod I.Author information 1Hairmyres Hospital, East Kilbride, Scotland, UK, pregashe@rediffmail.com.AbstractThe posterolateral approach to ankle joint is well suited for ORIF of posterior malleolar fractures. There are no major neurovascular structures endangering this approach other than the sural nerve. The sural nerve is often used as an autologous peripheral nerve graft and provides sensation to the lateral aspect of the foot. The aim of this paper is to measure the precise distance of the sural nerve from surrounding soft tissue structures so as to enable safe placement of skin incision in posterolateral approach. This is a retrospective image review study involving 64 MRI scans. All measurements were made from Axial T1 slices. The key findings of the paper is the safety window for the sural nerve from the lateral border of tendoachilles (TA) is 7 mm, 1.3 cm and 2 cm at 3 cm above ankle joint, at the ankle joint and at the distal tip of fibula respectively. Our study demonstrates the close relationship of the nerve in relation to TA and fibula in terms of exact measurements. The safety margins established in this study should enable the surgeon in preventing endangerment of the sural nerve encountered in this approach.
European journal of orthopaedic surgery & traumatology : orthopédie traumatologie.Eur J Orthop Surg Traumatol.2014 May;24(4):615-9. doi: 10.1007/s00590-013-1343-6. Epub 2013 Oct 25.
The posterolateral approach to ankle joint is well suited for ORIF of posterior malleolar fractures. There are no major neurovascular structures endangering this approach other than the sural nerve. The sural nerve is often used as an autologous peripheral nerve graft and provides sensation to the l
PMID 24158742

Postural leg tremor in X-linked spinal and bulbar muscular atrophy.

Nishiyama A1, Sugeno N2, Tateyama M1, Nishiyama S1, Kato M1, Aoki M1.Author information 1Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.2Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. Electronic address: sugeno@med.tohoku.ac.jp.AbstractX-linked spinal and bulbar muscular atrophy (SBMA) is an adult-onset neuromuscular disorder caused by a CAG repeat expansion in the androgen receptor gene. Postural hand tremor is well known as a non-motor neuron sign, but to our knowledge postural leg tremor has not been reported. We studied the occurrence and physiological features of postural leg tremor in 12 male patients (38-64years old) with genetically proven SBMA. Three patients had postural leg tremor with a frequency of 4-7Hz. In these patients, sensory nerve action potential (SNAP) was not detected in the lower limbs. There were significant differences between the patients with postural leg tremor and those without postural leg tremor in both the SNAP of the sural nerve and the length of the CAG repeat. Phenotypical differences between shorter CAG repeats, which indicate a sensory-dominant phenotype, and longer CAG repeats, which indicate a motor-dominant phenotype, have been previously reported. In the present study, 60% of patients with shorter CAG repeats (<47) showed leg tremor and none of the patients with longer CAG repeats (⩾47) did. Postural leg tremor could be a clinical feature that predicts shorter CAG repeats of the androgen receptor gene.
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia.J Clin Neurosci.2014 May;21(5):799-802. doi: 10.1016/j.jocn.2013.07.026. Epub 2013 Oct 3.
X-linked spinal and bulbar muscular atrophy (SBMA) is an adult-onset neuromuscular disorder caused by a CAG repeat expansion in the androgen receptor gene. Postural hand tremor is well known as a non-motor neuron sign, but to our knowledge postural leg tremor has not been reported. We studied the oc
PMID 24256885

Japanese Journal

遠位茎腓腹皮弁を用いた下肢再建14例の経験

黒川憲史,宇根千尋,久徳茂雄
日形会誌 : 日本形成外科学会会誌 = Journal of Japan Society of Plastic and Reconstructive Surgery 31(9), 613-618, 2011-09-20
NAID 10029693942

Effect of hydroalcoholic extract of Acorus calamus on tibial and sural nerve transection-induced painful neuropathy in rats

MUTHURAMAN Arunachalam,SINGH Nirmal,JAGGI Amteshwar S.
Journal of natural medicines 65(2), 282-292, 2011-04-20
NAID 10029461178

Related Pictures

★リンクテーブル★

リンク元	「腓腹神経」
関連記事	「nerve」「sural」「sura」

「腓腹神経」

Nerve: Sural nerve
	The small saphenous vein (sural nerve visible running vertically)
Latin	nervus suralis
Gray's	p.963
From	Medial sural cutaneous nerve, communicating branch with the common fibular nerve (S1, S2)
MeSH	Sural+Nerve

　　[★]

英: sural nerve (KH,B)
ラ: nervus suralis
関: 下肢の皮神経

図：N.522

由来

外側腓腹皮神経と内側腓腹皮神経

腓腹神経は脛骨神経からの内皮腓腹皮神経と総腓骨神経からの交通枝が合流して起こり、下腿の後外側部と足の外側部の皮膚を支配(M.307)

支配

走行

枝

外側足背皮神経

Henry Gray (1825-1861). Anatomy of the Human Body. 1918.

「nerve」

　　[★]

n.

神経

関: nervi、nervous、nervus、neural、neuro、neuron

「sural」

　　[★]

adj.

腓腹の

関: calf、sura

「sura」

　　[★] 腓腹

関: calf、sural

[FA2009-1] Functional Anatomy, (2009, Nov 26). The Sural Nerve, Anatomy and entrapment, Functional Anatomy Blog. Retrieved from http://functionalanatomyblog.com/2009/11/26/the-sural-nerve-anatomy-and-entrapment/

[2] Crystal CS, Blankenship RB. Local anesthetics and peripheral nerve blocks in the emergency department. Emerg Med Clin North Am. May 2005;23(2):477-502.

[3] Myerson MS, Ruland CM, Allon SM. Regional anesthesia for foot and ankle surgery. Foot Ankle. Jun 1992;13(5):282-8. [Medline].

[4] Tassone, H. (2013, Sep 17). Sural Nerve Block, Medscape. Retrieved from http://emedicine.medscape.com/article/83199-overview#a01

[5] Sluijter M, Racz G. Technical aspects of radiofrequency. Pain Pract 2002; 2:195-200.

[6] Cohen SP, Foster A. Pulse radiofrequency as a treatment for groin pain and orchialgia. Jrology 2003; 61:645.

[7] Cosman E Jr./ Cosman E Sr. Electric and thermal field effects in tissue around radiofrequency electrods. Pain Medicine 2005; 6:405-424.

[8] Cahana A, Vutskits A, Muller D. Acute differential modulation of synaptic transmission and cell survivial during exposure to pulsed and continuous radiofrequency energy. J Pain 2003; 4:197-202.

[9] Todorov, L. Pulsed Radiofrequency of the Sural Nerve for the Treatment of Chronic Ankle Pain. Pain Physician 2011; 14:301-304 http://www.painphysicianjournal.com/2011/may/2011;14;301-304.pdf

匿名

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案内

案内

sural nerve