1
|
Pirri C, Pirri N, Macchi V, Porzionato A, De Caro R, Stecco C. Ultrasound Imaging of Ankle Retinacula: A Comprehensive Review. Tomography 2024; 10:1277-1293. [PMID: 39195730 PMCID: PMC11359401 DOI: 10.3390/tomography10080095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/28/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
The retinacula of the ankle are specialized anatomical structures characterized by localized thickenings of the crural fascia that envelop the deep components of the lower leg, ankle and foot. The ankle retinacula include the extensor retinacula, the peroneal retinacula and flexor retinaculum. Despite their potential to explain persistent and unexplained pain following an injury, these structures are often overlooked or incorrectly diagnosed. Hence, this comprehensive review was performed aiming to investigate the use and the methodology of US imaging to assess ankle retinacula. The search was performed on PubMed and Web of Science databases from inception to May 2024. The MeSH keywords used were as follows: "Ankle Retinacula", "Foot Retinacula", "Superior extensor retinaculum", "Inferior extensor retinaculum", "peroneal retinaculum", "superior peroneal retinaculum", "inferior peroneal retinaculum", "flexor retinaculum", "Ultrasound Imaging", "Ultrasound", "Ultrasonography" and "Ultrasound examination". In total, 257 records underwent screening, resulting in 22 studies meeting the criteria for inclusion after the process of revision. Data heterogeneity prevents synthesis and consistent conclusions. The results showed that advanced US imaging holds promise as a crucial tool to perform an US examination of ankle retinacula, offering static and dynamic insights into ankle retinacula pathology. Understanding normal anatomy and US imaging is essential for accurately identifying injuries. Future research should focus on clinical trials to validate parameters and ensure their reliability in clinical practice.
Collapse
Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Nina Pirri
- Department of Medicine—DIMED, School of Radiology, Radiology Institute, University of Padova, 35122 Padova, Italy;
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| |
Collapse
|
2
|
Sveva V, Farì G, Fai A, Savina A, Viva MG, Agostini F, Ranieri M, Megna M, Mangone M, Paoloni M, Bernetti A. Safety and Efficacy of Ultrasound-Guided Perineural Hydrodissection as a Minimally Invasive Treatment in Carpal Tunnel Syndrome: A Systematic Review. J Pers Med 2024; 14:154. [PMID: 38392587 PMCID: PMC10890373 DOI: 10.3390/jpm14020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Ultrasound-guided perineural hydrodissection (HD) is a novel technique that has been found to be effective in providing mechanical release of perineural adhesions and decompression of the nerve, reducing inflammation and edema and restoring its physiological function. It has a significant impact on chronic neuropathic pain (20 ± 4 weeks with VAS < 5 or VAS diminished by 2 points after the procedure). Carpal tunnel syndrome (CTS) is a common entrapment mononeuropathy, and its distribution is typically innervated by the median nerve. Patients with mild or moderate CTS may benefit from nonsurgical treatments or conservative therapies. This review was conducted following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Four investigators assessed each title, abstract, and full-text article for eligibility, with disagreements being resolved by consensus with two experienced investigators. The qualitative assessment of the studies was carried out using the modified Oxford quality scoring system, also known as the modified Jadad score. Furthermore, risk of possible biases was assessed using the Cochrane collaboration tool. The results of this review suggest that US-guided HD is an innovative, effective, well-tolerated, and safe technique (11 out of 923 patients had collateral or side effects after the procedure). However, further studies comparing all drugs and with a larger sample population are required to determine the most effective substance.
Collapse
Affiliation(s)
- Valerio Sveva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Giacomo Farì
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Università del Salento, 73100 Lecce, Italy
| | - Annatonia Fai
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Alessio Savina
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Mattia Giuseppe Viva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Maurizio Ranieri
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Andrea Bernetti
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Università del Salento, 73100 Lecce, Italy
| |
Collapse
|
3
|
Lopes JG, Rodrigues-Pinho A, Neves MA, Pinto FF, Relvas-Silva M, Vital L, Serdoura F, Nogueira-Sousa A, Madeira MD, Pereira PA. An anatomical approach to the tarsal tunnel syndrome: what can ankle's medial side anatomy reveal to us? J Foot Ankle Res 2023; 16:80. [PMID: 37957735 PMCID: PMC10644421 DOI: 10.1186/s13047-023-00682-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main nerves of the region and knowing its anatomical topography is mandatory. The purpose of this work is to evaluate if tibial nerve (TN) and its main branches relate to the main anatomical landmarks of the ankle's medial side and if so, do they have a regular path after emerging from TN. METHODS The distal part of the legs, ankles and feet of 12 Thiel embalmed cadavers were dissected. The pattern of the branches of the TN was registered and the measurements were performed according to the Dellon-McKinnon malleolar-calcaneal line (DML) and the Heimkes Triangle (HT). RESULTS The TN divided proximal to DML in 87.5%, on top of the DML in 12,5% and distal in none of the feet. The Baxter's nerve (BN) originated proximally in 50%, on top of the DML in 12,5% and distally in 37.5% of the cases. There was a strong and significant correlation between the length of DML and the distance from the center of the medial malleolus (MM) to the lateral plantar nerve (LPN), medial plantar (MPN) nerve, BN and Medial Calcaneal Nerve (MCN) (ρ: 0.910, 0.866, 0.970 and 0.762 respectively, p < 0.001). CONCLUSIONS In our sample the TN divides distal to DML in none of the cases. We also report a strong association between ankle size and the distribution of the MPN, LPN, BN and MCN. We hypothesize that location of these branches on the medial side of the ankle could be more predictable if we take into consideration the distance between the MM and the medial process of the calcaneal tuberosity.
Collapse
Affiliation(s)
- Jorge Gomes Lopes
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - André Rodrigues-Pinho
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Maria Abreu Neves
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Filipe Fonseca Pinto
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Miguel Relvas-Silva
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Luísa Vital
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Francisco Serdoura
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - António Nogueira-Sousa
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Maria Dulce Madeira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Pedro Alberto Pereira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| |
Collapse
|
4
|
Deniel C, Guenoun D, Guillin R, Moraux A, Champsaur P, Le Corroller T. Anatomical study of the medial calcaneal nerve using high-resolution ultrasound. Eur Radiol 2023; 33:7330-7337. [PMID: 37209124 DOI: 10.1007/s00330-023-09699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/10/2023] [Accepted: 02/26/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To determine whether high-resolution ultrasound (US) can identify the course and relations of the medial calcaneal nerve (MCN). METHODS This investigation was initially undertaken in eight cadaveric specimens and followed by a high-resolution US study in 20 healthy adult volunteers (40 nerves) by two musculoskeletal radiologists in consensus. The location and course of the MCN as well as its relationship to adjacent anatomical structures were evaluated. RESULTS The MCN was consistently identified by US along its entire course. The mean cross-sectional area of the nerve was 1 mm2 (range 0.5-2). The level at which the MCN branched from the tibial nerve was variable, located a mean of 7 mm (range - 7-60) proximal to the tip of the medial malleolus. At the level of the medial retromalleolar fossa, the MCN was located inside the proximal tarsal tunnel a mean of 8 mm (range 0-16) posterior to the medial malleolus. More distally, the nerve was depicted in the subcutaneous tissue at the surface of the abductor hallucis fascia with a mean direct distance to the fascia of 1.5 mm (range 0.4-2.8). CONCLUSIONS High-resolution US can identify the MCN at the level of the medial retromalleolar fossa, as well as more distally in the subcutaneous tissue at the surface of the abductor hallucis fascia. In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of nerve compression or neuroma, and perform selective US-guided treatments. CLINICAL RELEVANCE STATEMENT In the setting of heel pain, sonography is an attractive tool for diagnosing compression neuropathy or neuroma of the medial calcaneal nerve, and enables the radiologist to perform selective image-guided treatments such as diagnostic blocks and injections. KEY POINTS • The MCN is a small cutaneous nerve which rises from the tibial nerve in the medial retromalleolar fossa to the medial side of the heel. • The MCN can be depicted by high-resolution ultrasound along its entire course. • In the setting of heel pain, precise sonographic mapping of the MCN course may enable the radiologist to make diagnosis of neuroma or nerve entrapment, and perform selective ultrasound-guided treatments such as steroid injection or tarsal tunnel release.
Collapse
Affiliation(s)
| | - Daphne Guenoun
- Radiology Department, APHM, Marseille, France
- Aix Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Raphaël Guillin
- Service de Radiologie, Hôpital Sud du CHU de Rennes, 16 Boulevard de Bulgarie, 35000, Rennes, France
| | - Antoine Moraux
- Imagerie Médicale Jacquemars Giélée, 73 Rue Jacquemars Giélée, 59000, Lille, France
| | - Pierre Champsaur
- Radiology Department, APHM, Marseille, France
- Aix Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Thomas Le Corroller
- Radiology Department, APHM, Marseille, France.
- Aix Marseille University, CNRS, ISM UMR 7287, Marseille, France.
| |
Collapse
|
5
|
Harej N, Salapura V, Cvetko E, Snoj Ž. Sonographic assessment of the tarsal tunnel compared to cadaveric findings: a pictorial study. J Ultrason 2023; 23:e144-e150. [PMID: 37701055 PMCID: PMC10494809 DOI: 10.15557/jou.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/11/2023] [Indexed: 09/14/2023] Open
Abstract
Aim of the study To present the anatomy of the tarsal tunnel and demonstrate the utility of high-resolution ultrasound for tarsal tunnel examination. Materials and methods Anatomical dissection was performed on a defrosted cadaveric model to demonstrate relevant anatomical structures of the tarsal tunnel, namely tendons, vessels and nerves. The tibial nerve division was demonstrated; the bifurcation of the tibial nerve into the medial and lateral plantar nerve, two medial calcaneal nerve branches were identified originating from the tibial nerve and the Baxter's nerve was identified as the first branch of the lateral plantar nerve. An ultrasound examination of the tarsal tunnel region was performed on a healthy volunteer. A linear probe was used and sonographic images were obtained at different levels of the tarsal tunnel: the proximal tarsal tunnel, the tibial nerve division into the medial and lateral plantar nerves, the distal tarsal tunnel, the Baxter's nerve branching point and the Baxter's nerve crossing between the abductor hallucis and quadratus plantae muscle. Results Sonographic images were correlated with anatomical structures exposed during cadaveric dissection. Conclusions We presented the anatomic-sonographic correlation of the tarsal tunnel and showed that high-resolution ultrasound is a useful imaging modality for tarsal tunnel assessment.
Collapse
Affiliation(s)
- Nežka Harej
- University Medical Centre Ljubljana, Clinical Radiology Institute, Ljubljana, Slovenia
| | - Vladka Salapura
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Erika Cvetko
- Institute of Anatomy, Faculty of Medicine, Ljubljana, Slovenia
| | - Žiga Snoj
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
6
|
Honis HR, Gruber H, Honold S, Konschake M, Moriggl B, Brenner E, Skalla-Oberherber E, Loizides A. Anatomical considerations of US-guided carpal tunnel release in daily clinical practice. J Ultrason 2023; 23:e131-e143. [PMID: 37732109 PMCID: PMC10508271 DOI: 10.15557/jou.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/28/2023] [Indexed: 09/22/2023] Open
Abstract
Carpal tunnel syndrome is the most frequent compression neuropathy with an incidence of one to three subjects per thousand. As specific anatomical variations might lead to unintended damage during surgical interventions, we present a review to elucidate the anatomical variability of the carpal tunnel region with important considerations for daily clinical practice: several variants of the median nerve branches in and around the transverse carpal ligament are typical and must - similarly to the variant courses of the median artery, which may be found eccentric ulnar to the median nerve - be taken into account in any interventional therapy at the carpal tunnel. Unintended interference in these structures might lead to heavy arterial bleeding and, in consequence, even underperfusion of segments of the median nerve or, if neural structures such as variant nerve branches are impaired or even cut, severe pain-syndromes with a profound impact on the quality of life. This knowledge is thus crucial for outcome- and safety-optimization of different surgical procedures at the volar aspect of the wrist and surgical therapy of the carpal tunnel syndrome e.g., US-guided carpal tunnel release, as injury might result in dysfunction and/or pain on wrist motion or direct impact in the region concerned. For most variations, anatomical and surgical descriptions vary, as official classifications are still lacking.
Collapse
Affiliation(s)
- Hanne-Rose Honis
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Gruber
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Sarah Honold
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Moriggl
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Erich Brenner
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | | | - Alexander Loizides
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
7
|
Khodatars D, Gupta A, Welck M, Saifuddin A. An update on imaging of tarsal tunnel syndrome. Skeletal Radiol 2022; 51:2075-2095. [PMID: 35562562 DOI: 10.1007/s00256-022-04072-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 02/02/2023]
Abstract
Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the tibial nerve (TN) within the tarsal tunnel (TT) at the level of the tibio-talar and/or talo-calcaneal joints. Making a diagnosis of TTS can be challenging, especially when symptoms overlap with other conditions and electrophysiological studies lack specificity. Imaging, in particular MRI, can help identify causative factors in individuals with suspected TTS and help aid surgical management. In this article, we review the anatomy of the TT, the diagnosis of TTS, aetiological factors implicated in TTS and imaging findings, with an emphasis on MRI.
Collapse
Affiliation(s)
- Davoud Khodatars
- Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Ankur Gupta
- Foot and Ankle Orthopaedic Surgery Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Matthew Welck
- Foot and Ankle Orthopaedic Surgery Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK
| |
Collapse
|
8
|
Fortier LM, Leethy KN, Smith M, McCarron MM, Lee C, Sherman WF, Varrassi G, Kaye AD. An Update on Posterior Tarsal Tunnel Syndrome. Orthop Rev (Pavia) 2022; 14:35444. [PMID: 35769658 PMCID: PMC9235437 DOI: 10.52965/001c.35444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/12/2022] [Indexed: 09/14/2023] Open
Abstract
Posterior tarsal tunnel syndrome (PTTS) is an entrapment neuropathy due to compression of the tibial nerve or one of its terminal branches within the tarsal tunnel in the medial ankle. The tarsal tunnel is formed by the flexor retinaculum, while the floor is composed of the distal tibia, talus, and calcaneal bones. The tarsal tunnel contains a number of significant structures, including the tendons of 3 muscles as well as the posterior tibial artery, vein, and nerve. Focal compressive neuropathy of PTTS can originate from anything that physically restricts the volume of the tarsal tunnel. The variety of etiologies includes distinct movements of the foot, trauma, vascular disorders, soft tissue inflammation, diabetes mellitus, compression lesions, bony lesions, masses, lower extremity edema, and postoperative injury. Generally, compression of the posterior tibial nerve results in clinical findings consisting of numbness, burning, and painful paresthesia in the heel, medial ankle, and plantar surface of the foot. Diagnosis of PTTS can be made with the presence of a positive Tinel sign in combination with the physical symptoms of pain and numbness along the plantar and medial surfaces of the foot. Initially, patients are treated conservatively unless there are signs of muscle atrophy or motor nerve involvement. Conservative treatment includes activity modification, heat, cryotherapy, non-steroidal anti-inflammatory drugs, corticosteroid injections, opioids, GABA analog medications, tricyclic antidepressants, vitamin B-complex supplements, physical therapy, and custom orthotics. If PTTS is recalcitrant to conservative treatment, standard open surgical decompression of the flexor retinaculum is indicated. In recent years, a number of alternative minimally invasive treatment options have been investigated, but these studies have small sample sizes or were conducted on cadaveric models.
Collapse
Affiliation(s)
| | - Kenna N Leethy
- Louisiana State University Shreveport School of Medicine
| | - Miranda Smith
- Louisiana State University Shreveport School of Medicine
| | | | - Christopher Lee
- Department of Internal Medicine, Creighton University School of Medicine-Phoenix Regional Campus
| | | | | | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University New Orleans
| |
Collapse
|
9
|
Efficacy of a single botulinum toxin A injection for distal tarsal tunnel syndrome: A protocol for a randomized, double-blinded trial. Contemp Clin Trials Commun 2021; 21:100725. [PMID: 33553799 PMCID: PMC7844121 DOI: 10.1016/j.conctc.2021.100725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/18/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Distal tarsal tunnel syndrome (DTTS) is characterised by compression of the tibial nerve as it passes underneath the abductor hallucis muscle belly. There is no current consensus on treatment for DTTS. This study was conducted to compare and evaluate the effect of ultrasound-guided botulinum toxin A (BTX-A) versus ultrasound-guided corticosteroid injection (CSI) for the treatment of DTTS. Methods This study was a single-centre, randomized, and double-blinded trial. The study protocol was submitted to the local ethics committee board and subsequently registered in a research registry. 88 patients with DTTS were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 12 weeks. Evaluation was via the Foot Health Status Questionnaire (FHSQ). The primary outcome measures were pain and the secondary outcomes were function and the use of oral analgesics. All of the assessments were performed at baseline and at 3, 6, and 12 weeks after treatment. Results This is a randomized controlled trial evaluating the efficacy of BTX-A versus CSI in the treatment of DTTS. This study has limited inclusion and exclusion criteria and a well-controlled intervention. Conclusions The results of this trial will provide more evidence on which method can better treat DTTS. Trial registration We have registered this trial with the Australian New Zealand Clinical Trials Registry and the temporary trial number is 380,105.
Collapse
|
10
|
Fu Y, Chen Q, Yu Z, Dong H, Li X, Chen Q, Hu B, Li H, Miao J. Clinical application of ultrasound-guided mediastinal lymph node biopsy through cervical mediastinoscopy. Thorac Cancer 2020; 12:297-303. [PMID: 33141499 PMCID: PMC7862788 DOI: 10.1111/1759-7714.13717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cervical mediastinoscopy is useful for diagnosing lung and mediastinal disease. Ultrasound is a safe real-time diagnostic tool widely employed in many surgical fields. Ultrasound was used in cervical mediastinoscopy in our cohort with satisfactory results. This study investigated the safety, feasibility, and availability of video-assisted mediastinoscopy (VAM) combined with ultrasound for mediastinal lymph node biopsy. METHODS A total of 87 cases involving cervical mediastinal lymph node biopsy performed from November 2015 to May 2020, with complete clinical and pathological information, were retrospectively analyzed in the Department of Thoracic Surgery at Beijing Chaoyang Hospital. The cohort was divided into two groups: ultrasound-guided biopsy under video-assisted mediastinoscopy (UVAM) (44 cases) and routine VAM (43 cases). Operation time, biopsy number and nodal stations, postoperative complications, pathological conditions, and surgical difficulty were compared between the two nodal stations. RESULTS UVAM was significantly shorter and more lymph node specimens were obtained than with VAM. There was one case of fatal bleeding and two cases of right recurrent laryngeal nerve injury in the VAM group, and no postoperative complications in the UVAM group. CONCLUSIONS When used with cervical VAM, ultrasound guidance assists physicians assess the space between lymph nodes, surrounding tissues, and large vessels systematically, making biopsy safer and easier, improving lymph node sampling, and decreasing postoperative complications. Furthermore, surgeons can easily learn and master this method. KEY POINTS Significant findings of the study: Ultrasound was used in combination with cervical mediastinoscopy and the results showed that ultrasound guidance makes biopsy in patients safer and easier, improves lymph node sampling, and decreases postoperative complications. WHAT THIS STUDY ADDS Surgeons can easily learn and master this method.
Collapse
Affiliation(s)
- Yili Fu
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qingshan Chen
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zexing Yu
- Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Honghong Dong
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qirui Chen
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jinbai Miao
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
11
|
Nieves GC, Fernández-Gibello A, Moroni S, Montes R, Márquez J, Ortiz MS, Vázquez T, Duparc F, Moriggl B, Konschake M. Anatomic basis for a new ultrasound-guided, mini-invasive technique for release of the deep transverse metatarsal ligament. Clin Anat 2020; 34:678-684. [PMID: 33012024 PMCID: PMC8246909 DOI: 10.1002/ca.23692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022]
Abstract
Introduction Morton's neuroma is an entrapment neuropathy of the third common plantar digital nerve, caused by the deep transverse metatarsal ligament (DTML). Minimally invasive or percutaneous surgery is a very common procedure, but surgical effectivity of this technique remains controversial. The goal of our study was to prove the effectiveness and safety of a new ultrasound‐guided technique for DTML‐release in a cadaver model. Materials, Methods, and Results The DTML was visualized in 10 fresh frozen donated body to science‐feet (eight male and two females, five left and five right) using an US device (GE Logic R7; 13 MHz linear probe, Madrid, Spain). Consecutively, minimally invasive ultrasound‐guided surgery was performed. Exclusion criteria of the donated bodies to science were previous history of forefoot surgery and space occupying mass lesions. The complete release of the ligament was achieved in all specimens without damage of any important anatomical structures as proven by anatomical dissection. Conclusions The results of this study indicate that our novel approach of an ultrasound‐guided release of the DTML is safer and more effective compared to blind techniques. The DTML could reliably be visualized and securely cut through a dorsal, minimally invasive surgical incision of only 2 mm.
Collapse
Affiliation(s)
- Gabriel Camunas Nieves
- Clínica Vitruvio, Madrid, Spain.,Faculty of Health Sciences, Department of Podiatry, University of La Salle, Madrid, Spain
| | - Alejandro Fernández-Gibello
- Clínica Vitruvio, Madrid, Spain.,Faculty of Health Sciences, Department of Podiatry, University of La Salle, Madrid, Spain
| | - Simone Moroni
- Clínica Vitruvio, Madrid, Spain.,Faculty of Health Sciences at Manresa, Department of Podiatry, Universidad de Vic - Universidad Central de Catalunya (UVic-Ucc), Barcelona, Spain
| | | | | | - Mario Suárez Ortiz
- Faculty of Health Sciences, Department of Podiatry, Universidad Católica de Valencia, Valencia, Spain.,Clínica Podosalud, Madrid, Spain
| | - Teresa Vázquez
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine, Rouen-Normandy University, Rouen, France
| | - Bernhard Moriggl
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Marko Konschake
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria
| |
Collapse
|
12
|
Moroni S, Fernández-Gibello A, Nieves GC, Montes R, Zwierzina M, Vazquez T, Garcia-Escudero M, Duparc F, Moriggl B, Konschake M. Anatomical basis of a safe mini-invasive technique for lengthening of the anterior gastrocnemius aponeurosis. Surg Radiol Anat 2020; 43:53-61. [PMID: 32705404 PMCID: PMC7838137 DOI: 10.1007/s00276-020-02536-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/15/2020] [Indexed: 11/24/2022]
Abstract
Background The surgical procedure itself of lengthening the gastrocnemius muscle aponeurosis is performed to treat multiple musculoskeletal, neurological and metabolical pathologies related to a gastro-soleus unit contracture such as plantar fasciitis, Achilles tendinopathy, metatarsalgia, cerebral palsy, or diabetic foot ulcerations. Therefore, the aim of our research was to prove the effectiveness and safety of a new ultrasound-guided surgery-technique for the lengthening of the anterior gastrocnemius muscle aponeurosis, the “GIAR”- technique: the gastrocnemius-intramuscular aponeurosis release. Methods and results An ultrasound-guided surgical GIAR on ten fresh-frozen specimens (10 donors, 8 male, 2 females, 5 left and 5 right) was performed. Exclusion criteria of the donated bodies to science were BMI above 35 (impaired ultrasound echogenicity), signs of traumas in the ankle and crural region, a history of ankle or foot ischemic vascular disorder, surgery or space-occupying mass lesions. The surgical procedures were performed by two podiatric surgeons with more than 6 years of experience in ultrasound-guided procedures. The anterior gastrocnemius muscle aponeurosis was entirely transected in 10 over 10 specimens, with a mean portal length of 2 mm (± 1 mm). The mean gain at the ankle joint ROM after the GIAR was 7.9° (± 1.1°). No damages of important anatomical structures could be found. Conclusion Results of this study indicate that our novel ultrasound-guided surgery for the lengthening of the anterior gastrocnemius muscle aponeurosis (GIAR) might be an effective and safe procedure.
Collapse
Affiliation(s)
- Simone Moroni
- Faculty of Health Sciences At Manresa, Department of Podiatry, Universidad de Vic-Universidad Central de Catalunya (UVic-Ucc), Clinic Vitruvio Biomecánica, BarcelonaMadrid, Spain
| | - Alejandro Fernández-Gibello
- Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Gabriel Camunas Nieves
- Universidad La Salle, Centro adscrito a la Universidad Autónoma de Madrid, Madrid, Spain.,Vitruvio Biomecanica Y Cirugia Clinic, Madrid, Spain
| | - Ruben Montes
- Universidad La Salle, Centro adscrito a la Universidad Autónoma de Madrid, Madrid, Spain.,Vitruvio Biomecanica Y Cirugia Clinic, Madrid, Spain
| | - Marit Zwierzina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Teresa Vazquez
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Maria Garcia-Escudero
- School of Physiotherapy and Podiatry, University Catolica de Valencia, Valencia, Spain
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine, Rouen-Normandy University, Rouen, France
| | - Bernhard Moriggl
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria
| | - Marko Konschake
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria.
| |
Collapse
|
13
|
The injection site in the tarsal tunnel to minimize neurovascular injury for heel pain: an anatomical study. Surg Radiol Anat 2020; 42:681-684. [PMID: 31938852 DOI: 10.1007/s00276-019-02411-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the location and distribution patterns of neurovascular structures and determine the effective injection point in the tarsal tunnel for heel pain. METHODS Fifteen adult non-embalmed cadavers with a mean age of 71.5 years were studied. The most inferior point of the medial malleolus of the tibia (MM) and the tuberosity of the calcaneus (TC) were identified before dissection. A line connecting the MM and TC was used as a reference line. The reference point was expressed in absolute distance along the reference line using the MM as the starting point. For measurements using MRI, the depth from the skin was measured to inferior at an interval of 1 cm from the MM. RESULTS The posterior tibial artery, lateral plantar nerve, and medial plantar nerve were located from 29.0 to 37.3% of the reference line from the MM. The distribution frequencies of the medial calcaneal nerve on the reference line from the MM were 0%, 8.60%, 37.15%, 37.15%, and 17.10%, respectively. The mean depth of the neurovascular structures was 0.3 cm. DISCUSSION This study recommended an effective injection site from 45.0 to 80.0% of the reference line.
Collapse
|