M.
Shuja Tahir
Faisalabad, Pakistan
Clinical Skills
EXAMINATION OF
SCIATIC NERVE
ANATOMY
It is the largest nerve in the body and
forms the greatest part of sacral plexus.
The Root Value of sciatic nerve is
Lumbar 4,5 Sacral 1,2,3. It divides into
two branches at variable level. Tibial
nerve and common peroneal nerve.
It supplies;
Semi membranosus
Semitendinosus
Part of adductor magnus
Both heads of biceps femoris
Skin of foot and most of the leg
The sciatic nerve is injured due to
misplaced intra-gluteal injections,
penetrating wounds or missile injuries
of buttock area. It may also be injured
in posterior dislocation of hip joint.
SPECIAL INTERVIEW
History of buttock injury or hip
dislocation should always be asked.
EXPOSURE AND POSITION
The examination is conducted in a
lying patient with both lower limbs
completely exposed.
Patient may wear underpants only.
CLINICAL ASSESSMENT
LOOK
Look for foot drop
Ask the patient to walk on tip toes;
He/she is unable to walk on affected
side.
109 April to June, 2010
IR-036
There is complete loss of function of
muscles below the knee joint in
complete sciatic nerve injuries.
There is complete loss of sensation
over lower legs and feet.
FEEL
Check fine touch, pin prick and
temperature sensation.
There is complete loss of sensations
below the knee except for an area
along the medial side of leg over the
medial malleolus and down to hallux.
MOVE
Check movements of the joints below
the knee. (ankle, tarsometatarsal &
inter phalangeal joints.
Failure to do is due to paralysis of all
the muscles.
Check flexion at knee joint ;
Weakness is due to paralysis of some
of the muscles.
Check that no bony injury is present.
Ask the patient to move his big toe.
Failure to flex it is due to paralysis of
the medial popliteal and posterior
tibial nerves.
Failure to extend the big toe is due to
paralysis of lateral popliteal and
anterior tibial nerves.
INDEPENDENT REVIEWS
Sensory, motor and vasomotor CHECK LIST
changes are examined for adequate
assessment of the neuronal injury.
SPECIAL INTERVIEW
LOOK
Motor function grading is described as
below ; for Foot drop
inability to walk on affected side
Grade Power FEEL
0
1
No contraction Sensation below knee joint on whole
Flicker or trace of contraction leg and foot
2
Active movement in a plane perpendicular to
3
gravity MOVE
Active movement against gravity
4
Active movement against gravity and resistance Ankle joint and foot joints
(weaker than normal) Flexion of knee joint
5
Normal power Ankle reflex

The author :
Muhammad Shuja Tahir
FRCS (Ed), FCPS (Hon)
is professor and head of the
department of Surgery at
Independent Medical
College Faisalabad.
shuja@iu-hospital.com

April to June, 2010 INDEPENDENT REVIEWS 110