Intraneural sciatic nerve pressures relative to the position of the hip and knee: a human cadaveric study.
Academic Article
Overview
abstract
OBJECTIVES: To determine the effects of ipsilateral hip and knee position on intraneural sciatic nerve pressures. DESIGN: Intraneural sciatic nerve pressures measured in intact, fresh cadaveric specimens relative to ipsilateral hip and knee positions. LOCATION: Medical school anatomy laboratory. SUBJECTS: Randomly acquired adult cadavers. INTERVENTION: Pressure transducer placed within the sciatic nerve distal to the femoral attachment of the gluteus maximus. Intraneural pressures measured with the hip placed in 0, 45, and 90 degrees of flexion while the knee was positioned in 90, 45, and 0 degrees of flexion. MAIN OUTCOME MEASUREMENTS: Tissue fluid pressures within the sciatic nerve relative to the position of the ipsilateral hip and knee. Tissue fluid pressure within the sciatic nerve exceeded previously defined critical thresholds for alteration of neural microcirculation and function. Although increased intraneural pressures were realized as the hip was positioned in greater flexion and the knee was extended, clinically relevant pressures were realized only when the hip was flexed to 90 degrees and the knee was fully extended. Pressures with the limbs in these positions were fifty-five millimeters of mercury (range 38 to 74 millimeters of mercury). RESULTS: With the hip held flexed to 90 degrees, statistically significantly increased intraneural pressures were measured as the knee was extended from 90 to 45 degrees of flexion (p = 0.048) and again from 45 to 0 degrees of flexion (p < or = 0.01). With the knee positioned in 45 degrees of flexion, statistically significantly increased intraneural pressures were measured as the hip was flexed from 45 to 90 degrees (p < or = 0.0062). When the knee was held fully extended, statistically significantly increased intraneural pressures were measured as the hip was flexed from 0 to 45 degrees of flexion (p = 0.0006) and again when the hip was brought from 45 to 90 degrees of flexion (p < or = 0.01). CONCLUSIONS: Intraneural sciatic nerve pressures are influenced by the position of the ipsilateral hip and knee. The magnitude of the pressure elevation appears to be related to the excursion of the nerve as the linear distance between the greater sciatic notch and the distal aspect of the leg increases. Intraneural tissue fluid pressures measured within a localized section of the sciatic nerve appeared to exceed published critical thresholds for alterations of blood flow and neural function only when the hip was flexed to 90 degrees and the knee was fully extended.
