Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Dec 21;131(6):1869-1875.
doi: 10.3171/2018.8.JNS181190.

The Anatomic Location and Importance of the Tibialis Posterior Fascicular Bundle at the Sciatic Nerve Bifurcation: Report of 3 Cases

Affiliations
Case Reports

The Anatomic Location and Importance of the Tibialis Posterior Fascicular Bundle at the Sciatic Nerve Bifurcation: Report of 3 Cases

Thomas J Wilson et al. J Neurosurg. .

Abstract

The authors present the cases of 3 patients with severe injuries affecting the peroneal nerve combined with loss of tibialis posterior function (inversion) despite preservation of other tibial nerve function. Loss of tibialis posterior function is problematic, since transfer of the tibialis posterior tendon is arguably the best reconstructive option for foot drop, when available. Analysis of preoperative imaging studies correlated with operative findings and showed that the injuries, while predominantly to the common peroneal nerve, also affected the lateral portion of the tibial nerve/division near the sciatic nerve bifurcation. Sunderland's fascicular topographic maps demonstrate the localization of the fascicular bundle subserving the tibialis posterior to the area that corresponds to the injury. This has clinical significance in predicting injury patterns and potentially for treatment of these injuries. The lateral fibers of the tibial division/nerve may be vulnerable with long stretch injuries. Due to the importance of tibialis posterior function, it may be important to perform internal neurolysis of the tibial division/nerve in order to facilitate nerve action potential testing of these fascicles, ultimately performing split nerve graft repair when nerve action potentials are absent in this important portion of the tibial nerve.

Keywords: FDL = flexor digitorum longus; FHL = flexor hallucis longus; MRC = Medical Research Council; NAP = nerve action potential; anatomy; fascicular map; peripheral nerve; peroneal nerve; sciatic nerve; tibial nerve; tibialis posterior.

Similar articles

See all similar articles

Cited by 1 article

Publication types

LinkOut - more resources

Feedback