Ultrasound Imaging of the Sciatic Nerve

Giulio Cocco; Vincenzo Ricci; Antonio Corvino; Patrizia Pacini; Andrea Boccatonda; Ondřej Naňka; Stefano L. Sensi; Massimo Caulo; Andrea Delli Pizzi

doi:10.1055/a-2095-2842

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2023; 44(05): e263-e273
DOI: 10.1055/a-2095-2842

Review

Ultrasound Imaging of the Sciatic Nerve

Ultraschall-Bildgebung des Nervus ischiadicus

Giulio Cocco ‡

¹Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy (Ringgold ID: RIN9301)

²Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy (Ringgold ID: RIN9301)

,

Vincenzo Ricci ‡

³Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, Milano, Italy (Ringgold ID: RIN18602)

,

Antonio Corvino

⁴Movement Sciences and Wellbeing Department, University of Naples Parthenope, Napoli, Italy (Ringgold ID: RIN18993)

,

Patrizia Pacini

⁵Department of Radiological, Oncological and Anatomopathological Sciences, Umberto I Polyclinic of Rome, Roma, Italy (Ringgold ID: RIN18652)

,

Andrea Boccatonda

⁶Internal Medicine, Bentivoglio Hospital, Bentivoglio, Italy (Ringgold ID: RIN146258)

,

Ondřej Naňka

⁷Institute of Anatomy, First Faculty of Medicine, Charles University, Praha, Czech Republic (Ringgold ID: RIN37740)

,

Stefano L. Sensi

⁸Advanced Computing Core, Center of Advanced Studies and Technology (CAST), Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy (Ringgold ID: RIN9301)

¹Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy (Ringgold ID: RIN9301)

,

Massimo Caulo

¹Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy (Ringgold ID: RIN9301)

,

Andrea Delli Pizzi

⁹Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy (Ringgold ID: RIN9301)

› Author Affiliations

Abstract

The sciatic nerve (SN) is the biggest nerve in the human body and innervates a large skin surface of the lower limb and several muscles of the thigh, leg, and foot. It originates from the ventral rami of spinal nerves L4 through S3 and contains fibers from both the posterior and anterior divisions of the lumbosacral plexus. After leaving the neural foramina, the nerve roots merge with each other forming a single peripheral nerve that travels within the pelvis and thigh. Non-discogenic pathologies of the SN are largely underdiagnosed entities due to nonspecific clinical tests and poorly described imaging findings. Likewise, to the best of our knowledge, a step-by-step ultrasound protocol to assess the SN is lacking in the pertinent literature. In this sense, the aim of the present manuscript is to describe the normal sono-anatomy of the SN from the greater sciatic foramen to the proximal thigh proposing a standardized and simple sonographic protocol. Then, based on the clinical experience of the authors, a few tips and tricks have been reported to avoid misinterpretation of confounding sonographic findings. Last but not least, we report some common pathological conditions encountered in daily practice with the main purpose of making physicians more confident regarding the sonographic “navigation” of a complex anatomical site and optimizing the diagnosis and management of non-discogenic neuropathies of the SN.

Zusammenfassung

Der Nervus ischiadicus (SN „sciatic nerve“) ist der größte Nerv des menschlichen Körpers und innerviert eine große Hautfläche der unteren Extremität sowie mehrere Muskeln des Oberschenkels, des Beins und des Fußes. Er entspringt aus den ventralen Ästen der Spinalnerven L4 bis S3 und enthält Fasern sowohl der hinteren als auch der vorderen Abschnitte des Plexus lumbosacralis. Nach dem Austritt aus den Neuralforamina verschmelzen die Nervenwurzeln miteinander und bilden einen einzigen peripheren Nerv, der im Becken und im Oberschenkel verläuft. Nicht diskogene Pathologien des SN sind aufgrund unspezifischer klinischer Tests und schlecht beschriebener bildgebender Befunde weitgehend unterdiagnostiziert. Ebenso fehlt unseres Wissens ein schrittweises Ultraschallprotokoll zur Beurteilung des SN in der einschlägigen Literatur. Diesbezüglich ist es das Ziel des vorliegenden Manuskripts, die normale Sonoanatomie des SN vom Foramen ischiadicum majus bis zum proximalen Oberschenkel zu beschreiben und ein standardisiertes und einfaches sonografisches Protokoll vorzuschlagen. Basierend auf der klinischen Erfahrung der Autoren wurden dann einige Tipps und Tricks beschrieben, um Fehlinterpretationen bei unklaren sonografischen Befunden zu vermeiden. Abschließend berichten wir über einige häufige pathologische Zustände, die in der täglichen Praxis auftreten, vor allem, um den Ärzten mehr Sicherheit bei der sonografischen „Navigation“ einer komplexen anatomischen Stelle zu geben und die Diagnose und Behandlung von nicht diskogenen Neuropathien des SN zu optimieren.

Keywords

METHODS & TECHNIQUES - ultrasound - sciatic nerve - dynamic ultrasound - THEMES - anatomy - non-discogenic pain

Full Text

References

References
1 Dupont G, Unno F, Iwanaga J. et al. A variant of the sciatic nerve and its clinical implications. Cureus 2018; 10 (06) e2874
2 Giuffre BA, Jeanmonod R. Anatomy, Sciatic Nerve. Treasure Island (FL): StatPearls Publishing; 2022
3 Mezian K, Ricci V, Güvener O. et al. EURO-MUSCULUS/USPRM dynamic ultrasound protocols for (adult) hip. Am J Phys Med Rehabil 2022; 101 (11) e162-e168
4 Hernando MF, Cerezal L, Pérez-Carro L. et al. Deep gluteal syndrome: anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skeletal Radiol 2015; 44 (07) 919-934
5 Pérez-Carro L, Fernandez-Hernando M, Cerezal L. et al. Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles Ligaments Tendons J 2016; 21: 384-396
6 Balius R, Susín A, Morros C. et al. Gemelli-obturator complex in the deep gluteal space: an anatomic and dynamic study. Skeletal Radiol 2018; 47 (06) 763-770
7 Ricci V, Ricci C, Cocco G. et al. Histopathology and high-resolution ultrasound imaging for peripheral nerve (injuries). J Neurol 2022; 269 (07) 3663-3675
8 Kanawati AJ. Variations of the sciatic nerve anatomy and blood supply in the gluteal region: a review of the literature. ANZ J Surg 2014; 84 (11) 816-9
9 Balius R, Pujol M, Pérez-Cuenca D. et al. Sciatic nerve movement in the deep gluteal space during hip rotations maneuvers. Clin Anat 2022; 35 (04) 482-491
10 Becciolini M, Bonacchi G, Bianchi S. Ultrasound features of the proximal hamstring muscle-tendon-bone unit. J Ultrasound Med 2019; 38 (05) 1367-1382
11 Chang KV, Wu WT, Özçakar L. Ultrasound imaging and guidance in peripheral nerve entrapment: hydrodissection highlighted. Pain Manag 2020; 10 (02) 97-106
12 Ishizawa A, Hayashi S, Nasu H. et al. An artery accompanying the sciatic nerve (arteria comitans nervi ischiadici) and the position of the hip joint: a comparative histological study using chick, mouse, and human foetal specimens. Folia Morphol (Warsz) 2013; 72 (01) 41-50
13 Ricci V, Ricci C, Cocco G. et al. From histology to sonography in skin and superficial tissue disorders: EURO-MUSCULUS/USPRM* approach. Pathol Res Pract 2022; 237: 154003
14 Cocco G, Ricci V, Villani M. et al. Ultrasound imaging of bone fractures. Insights Imaging 2022; 13 (01) 189
15 Wu WT, Chang KV, Mezian K. et al. Ischiofemoral Impingement Syndrome: Clinical and Imaging/Guidance Issues with Special Focus on Ultrasonography. Diagnostics (Basel) 2022; 13 (01) 139
16 Chen YT, Jenkins KM. Ultrasound finding of ischiofemoral impingement syndrome and novel treatment with botulinum toxin chemodenervation: a case report. PM R 2018; 10 (06) 665-670
17 Ricci V, Ricci C, Gervasoni F. et al. From histoanatomy to sonography in myofascial pain syndrome: a EURO-MUSCULUS/USPRM approach. Am J Phys Med Rehabil 2023; 102 (01) 92-97
18 Chang KV, Wu WT, Mezian K. et al. Letter to the Editor Regarding “Feasibility and Reliability of an Ultrasound Examination to Diagnose Piriformis Syndrome”. World Neurosurg 2020; 137: 483-484
19 Chang KV, Wu WT, Lew HL. et al. Ultrasound Imaging and Guided Injection for the Lateral and Posterior Hip. Am J Phys Med Rehabil 2018; 97 (04) 285-291
20 Finnoff JT, Johnson AC, Hollman JH. Can Ultrasound Accurately Assess Ischiofemoral Space Dimensions? A Validation Study. PM R 2017; 9 (04) 392-397
21 Guillin R, Botchu R, Bianchi S. Sonography of orthopedic hardware impingement of the extremities. J Ultrasound Med 2012; 31 (09) 1457-1463
22 Cornelson SM, Ruff AN, Wells C. et al. Sonographic measures and sensory threshold of the normal sciatic nerve and hamstring muscles. J Ultrasound 2022; 25 (01) 47-57
23 Bortolotto C, Turpini E, Felisaz P. et al. Median nerve evaluation by shear wave elastosonography: impact of “bone-proximity” hardening artifacts and inter-observer agreement. J Ultrasound 2017; 20 (04) 293-299
24 Çelebi UO, Burulday V, Özveren MF. et al. Sonoelastographic evaluation of the sciatic nerve in patients with unilateral lumbar disc herniation. Skeletal Radiol 2019; 48 (01) 129-136
25 Chen SP, Ye TT, Hong J. et al. Evaluation of Sciatic Nerve Stiffness Using Shear Wave Elastography in Patients with Unilateral Diabetic Foot Ulcers. Diagnostics (Basel) 2023; 13 (03) 547
26 Ellis R, Rohan M, Fox J. et al. Ultrasound Elastographic Measurement of Sciatic Nerve Displacement and Shear Strain During Active and Passive Knee Extension. J Ultrasound Med 2018; 37 (08) 2091-2103
27 Ricci V, Ricci C, Gervasoni F. et al. From histo-anatomy to sonography in lymphedema: EURO-MUSCULUS/USPRM approach. Eur J Phys Rehabil Med 2022; 58 (01) 108-117
28 Ricci V, Ricci C, Gervasoni F. et al. From physical to ultrasound examination in lymphedema: a novel dynamic approach. J Ultrasound 2022; 25 (03) 757-763
29 Kara M, Kaymak B, Frontera W. et al. Diagnosing sarcopenia: functional perspectives and a new algorithm from the ISarcoPRM. J Rehabil Med 2021; 53 (06) jrm00209
30 Ricci V, Soylu AR, Özçakar L. Artifacts and artistic facts: a visual simulation for ultrasound training. Am J Phys Med Rehabil 2019; 98 (06) 521-525
31 Jačisko J, Ricci V, Mezian K. et al. Mnemonics and metaphorical videos for detecting/diagnosing musculoskeletal sonopathologies. Am J Phys Med Rehabil 2022;

Supplementary Material

Supplementary material