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THR: Identification and Protection of Sciatic Nerve


- See: Neurologic Injuries in THR:

- Discussion:
    - sciatic nerve is palpated by rolling it under surgeon's finger as it crosses ischial projection from posteroinferior aspect of the acetabulum;
    - palpate sciatic nerve as it passes superficial to obturator internus & gemelli;
           - sciatic nerve emerges below piriformis & passes downwards superficial to obturator internus & gemelli & quadratus femoris;
    - if possible, sciatic nerve should be reidentified every time hip is moved;
    - it is not always necessary to identify sciatic nerve, unless hip joint is grossly distorted;
         - in fact, dissection to see nerve may cause unnecessary bleeding from the vessels lying in the fat around it;
    - sciatic nerve sometimes divides into a tibial and peroneal brach within pelvis, and on occassion one may identify the sciatic nerve but think that it looks to small, then search for the other branch

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Strain on the human sciatic nerve in vivo during movement of the hip and knee

Exposure of the sciatic nerve in the gluteal region without sectioning the gluteus maximus: Analysis of a series of 18 cases.

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