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The Sciatic Nerve

The Sciatic Nerve in the Thigh (prone)

The sciatic nerve lies lateral to the tendinous origin of the biceps femoris in the proximal thigh. The sciatic nerve and proximal tendon of the biceps femoris muscle can be similar in sonographic appearance.

 
 
   
 

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The sciatic nerve divides into its common peroneal and tibial nerve components in the popliteal fossa (Video  1.3 MB).

 
 
   
 

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As those latter two nerves form they emerge superficial to the underlying muscles. The tibial nerve is larger than the common peroneal nerve which has a more lateral course. Foot motion can change the position of the nerves in this region. This “seesaw” sign is very useful for determining whether the common peroneal nerve is indeed part of the common sciatic nerve in the popliteal fossa near the division of the nerve.

References

Hoddick WK, Callen PW, Filly RA, Mahony BS, Edwards MB. Ultrasound evaluation of benign sciatic nerve sheath tumors. J Ultrasound Med. 1984 Nov;3(11):505-7. PMID: 6439894

Fornage BD. Sonography of peripheral nerves of the extremities. Radiol Med (Torino). 1993 May;85(5 Suppl 1):162-7. Review. PMID: 8392740

Heinemeyer O, Reimers CD. Ultrasound of radial, ulnar, median, and sciatic nerves in healthy subjects and patients with hereditary motor and sensory neuropathies. Ultrasound Med Biol. 1999 Mar;25(3):481-5. PMID: 10374990

Peer S, Kovacs P, Harpf C, Bodner G. High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease. J Ultrasound Med. 2002 Mar;21(3):315-22. PMID: 11883543

Graif M, Seton A, Nerubai J, Horoszowski H, Itzchak Y. Sciatic nerve: sonographic evaluation and anatomic-pathologic considerations. Radiology. 1991 Nov;181(2):405-8. PMID: 1924780

Grechenig W, Clement HG, Peicha G, Klein A, Weiglein A. [Ultrasound anatomy of the sciatic nerve of the thigh] Biomed Tech (Berl). 2000 Nov;45(11):298-303. German. PMID: 11155530

Silvestri E, Martinoli C, Derchi LE, Bertolotto M, Chiaramondia M, Rosenberg I. Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology. 1995 Oct;197(1):291-6. PMID: 7568840

Gray AT, Collins AB, Schafhalter-Zoppoth I. Sciatic nerve block in a child: a sonographic approach. Anesth Analg. 2003 Nov;97(5):1300-2. PMID: 14570642

Gray AT, Huczko EL, Schafhalter-Zoppoth I. Lateral popliteal nerve block with ultrasound guidance. Reg Anesth Pain Med. 2004 Sep-Oct;29(5):507-9. PMID: 15372402

Schafhalter-Zoppoth I, Younger SJ, Collins AB, Gray AT. The "seesaw" sign: improved sonographic identification of the sciatic nerve. Anesthesiology. 2004 Sep;101(3):808-9. Erratum in: Anesthesiology. 2005 Jan;102(1):248. PMID: 15329621 (video component online at journal’s website Enhancements 2004)

Schwemmer U, Markus CK, Greim CA, Brederlau J, Trautner H, Roewer N. Sonographic imaging of the sciatic nerve and its division in the popliteal fossa in children. Paediatr Anaesth. 2004 Dec;14(12):1005-8. PMID: 15601350

Schwemmer U, Markus CK, Greim CA, Brederlau J, Kredel M, Roewer N. Sonographic imaging of the sciatic nerve division in the popliteal fossa. Ultraschall Med. 2005 Dec;26(6):496-500. PMID: 16453221