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Oosterbos C, Weerdt OD, Lembrechts M, Radwan A, Brys P, Brusselmans M, Bogaerts K, Peeters R, Van Hoylandt A, Hoornaert S, Lemmens R, Theys T. Diagnostic accuracy of ultrasound and MR imaging in peroneal neuropathy: A prospective, single-center study. Muscle Nerve 2024; 70:360-370. [PMID: 38934723 DOI: 10.1002/mus.28187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION/AIMS Magnetic resonance imaging (MRI) findings in peroneal neuropathy are not well documented and the prognostic value of imaging remains uncertain. Upper limits of cross-sectional area (CSA) on ultrasound (US) have been established, but uncertainty regarding generalizability remains. We aimed to describe MRI findings of the peroneal nerve in patients and healthy controls and to compare these results to US findings and clinical characteristics. METHODS We prospectively included patients with foot drop and electrodiagnostically confirmed peroneal neuropathy, and performed clinical follow-up, US and MRI of both peroneal nerves. We compared MRI findings to healthy controls. Two radiologists evaluated MRI features in an exploratory analysis after images were anonymized and randomized. RESULTS Twenty-two patients and 38 healthy controls were included. Whereas significant increased MRI CSA values were documented in patients (mean CSA 20 mm2 vs. 13 mm2 in healthy controls), intra- and interobserver variability was substantial (variability of, respectively, 7 and 9 mm2 around the mean in 95% of repeated measurements). A pathological T2 hyperintense signal of the nerve was found in 52.6% of patients (50% interobserver agreement). Increased CSA measurements (MRI/US), pathological T2 hyperintensity of the nerve and muscle edema were not predictive for recovery. DISCUSSION Imaging is recommended in all patients with peroneal neuropathy to exclude compressive intrinsic and extrinsic masses but we do not advise routine MRI for diagnosis or prediction of outcome in patients with peroneal neuropathy due to high observer variability. Further studies should aim at reducing MRI observer variability potentially by semi-automation.
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Affiliation(s)
- Christophe Oosterbos
- Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Olaf De Weerdt
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Ahmed Radwan
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Brys
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Marius Brusselmans
- Department of Public Health and Primary Care, I-BioStat, Leuven, Belgium
- I-BioStat, UHasselt, Hasselt, Belgium
| | - Kris Bogaerts
- Department of Public Health and Primary Care, I-BioStat, Leuven, Belgium
- I-BioStat, UHasselt, Hasselt, Belgium
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Anaïs Van Hoylandt
- Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Sophie Hoornaert
- Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Theys
- Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute, Leuven, Belgium
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Moradian S, Taritsa IC, Sharma S, Mioton L, Dumanian GA, Ko JH. Management of Superficial and Deep Peroneal Nerve Neuromas with Targeted Muscle Reinnervation in Nonamputees: Operative Technique and Early Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5742. [PMID: 38623447 PMCID: PMC11018179 DOI: 10.1097/gox.0000000000005742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/20/2024] [Indexed: 04/17/2024]
Abstract
Background Targeted muscle reinnervation (TMR), a surgical technique developed by the senior authors that coapts proximal ends of nerves to distal motor nerves of adjacent muscles, has demonstrated efficacy in the treatment and prevention of neuroma pain. The objective of this study is to describe the surgical technique for TMR of the superficial peroneal nerve (SPN) and deep peroneal nerve (DPN) in nonamputee patients and provide data on postoperative functional outcomes. Methods A single-institution retrospective chart review was performed between March 2018 and April 2021. Patients were de-identified and included if they were nonamputees receiving TMR for pain in the peroneal nerve distribution. Data extracted included demographic information, symptoms before operation, relevant nerve coaptation, peri-, and postoperative complications, and long-term functional outcomes. Results Of the 19 patients reviewed, 11 patients underwent TMR of the SPN alone: eight had complete resolution of their symptoms; two indicated partial improvement in pain; and one patient had no improvement. Four patients underwent TMR of the DPN alone: two patients had complete resolution of their pain, and two patients had partial improvement with pain. Four patients underwent TMR of both the SPN/DPN: two patients had complete resolution of their symptoms, and two patients were noted to have significant improvement but had persistent pain from prior foot operations. Average follow-up time was 260 days. Conclusions TMR is a successful technique in the management of SPN and DPN neuroma pain. Our technique revealed excellent clinical outcomes, no procedure-specific complications, and improved subjective pain reports.
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Affiliation(s)
- Simon Moradian
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Iulianna C. Taritsa
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Sripadh Sharma
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Lauren Mioton
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Gregory A. Dumanian
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jason H. Ko
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Vial R, Orrego M, Espinosa J, Besa P, Irarrázaval S. The distance between the fibular collateral ligament tunnel and the common peroneal nerve allows a posterolateral corner reconstruction without neurolysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:705-709. [PMID: 37792015 DOI: 10.1007/s00264-023-05995-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The most popular knee posterolateral corner (PLC) reconstruction techniques describe that a common peroneal nerve (CPN) neurolysis must be done to safely address the posterolateral aspect of the knee. The purpose of this study was to measure the distance between the CPN and the fibular insertion of the FCL in different degrees of knee flexion in cadaveric specimens, to identify if tunnel drilling could be done anatomically and safely without a CPN neurolysis. METHODS Ex vivo experimental analytical study. Ten fresh frozen human knees were dissected leaving FCL and CPN in situ. Shortest distance from the centre of the FCL distal tunnel and CPN was measured (antero-posterior and proximal-distal wire-nerve distances) at 90°, 60°, 30°, and 0° of knee flexion. Measurements between different flexion angles were compared and correlation between knee flexion angle and distance was identified. RESULTS The mean distance between the FCL tunnel and the CPN at 90° were 21.15 ± 6.74 mm posteriorly (95% CI: 16.33-25.97) and 13.01 ± 3.55 mm distally (95% CI: 10.47-15.55). The minimum values were 9.8 mm posteriorly and 8.9 mm, respectively. These distances were smaller at 0° (p ≤ 0.017). At 90° of knee flexion, the mean distance from the fibular tip to the CPN distally was 23.46 ± 4.13 mm (20.51-26.41). CONCLUSION Anatomic localization and orientation of fibular tunnels can be done safely while avoiding nerve neurolysis. Further studies should aim to in vivo measurements and results.
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Affiliation(s)
- Raimundo Vial
- Department of Orthopaedic Surgery, School of Medicine, Pontifical Catholic University of Chile, 362 Diagonal Paraguay, 8330077, Santiago, Chile
| | - Mario Orrego
- Department of Orthopaedic Surgery, School of Medicine, Pontifical Catholic University of Chile, 362 Diagonal Paraguay, 8330077, Santiago, Chile
| | - Julio Espinosa
- Department of Orthopaedic Surgery, School of Medicine, Pontifical Catholic University of Chile, 362 Diagonal Paraguay, 8330077, Santiago, Chile
| | - Pablo Besa
- Department of Orthopaedic Surgery, School of Medicine, Pontifical Catholic University of Chile, 362 Diagonal Paraguay, 8330077, Santiago, Chile
| | - Sebastián Irarrázaval
- Department of Orthopaedic Surgery, School of Medicine, Pontifical Catholic University of Chile, 362 Diagonal Paraguay, 8330077, Santiago, Chile.
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Carlson Strother C, Dittman LE, Spinner RJ, Bishop AT, Shin AY. Surgical management of peroneal nerve injuries. Acta Neurochir (Wien) 2023; 165:2573-2580. [PMID: 37479915 DOI: 10.1007/s00701-023-05727-y] [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: 05/17/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Traumatic peroneal nerve injuries are typically associated with high-energy injuries. The aim of this study was to evaluate the demographics and outcomes following surgical management of peroneal nerve injuries. METHODS Patients evaluated at a single institution with peroneal nerve injuries between 2001 and 2022 were retrospectively reviewed. Mechanism of injury, time to surgery, pre- and postoperative examinations, and operative reports were recorded. Satisfactory outcome, defined as the ability to achieve anti-gravity dorsiflexion strength or stronger following surgery, was compared between nerve grafting and nerve transfers in patients with at least 9 months of postoperative follow-up. RESULTS Thirty-seven patients had follow-up greater than 9 months after surgery, with an average follow-up of 3.8 years. Surgeries included neurolysis (n=5), direct repair (n=2), tibial motor nerve fascicle transfer to the anterior tibialis motor branch (n=18), or interposition nerve grafting using sural nerve autograft (n=12). At last follow-up, 59.5% (n=22) of patients had anti-gravity strength or stronger dorsiflexion. Nineteen (51.4%) patients used an ankle-foot orthosis during all or some activities. In patients that underwent nerve grafting only across the peroneal nerve defect, 44.4% (n=4) were able to achieve anti-gravity strength or stronger dorsiflexion. In patients that had a tibial nerve fascicle transfer to the tibialis anterior motor branch of the peroneal nerve, 42.9% (n=6) were able to achieve anti-gravity strength or stronger dorsiflexion at last follow-up. There was no statistical difference between nerve transfers and nerve grafting in postoperative dorsiflexion strength (p = 0.51). CONCLUSION Peroneal nerve injuries frequently occur in the setting of knee dislocations and similar high-energy injuries. Nerve surgery is not universally successful in restoration of ankle dorsiflexion, with one-third of patients requiring an ankle-foot orthosis at mid-term follow-up. Patients should be properly counseled on the treatment challenges and variable outcomes following peroneal nerve injuries.
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Affiliation(s)
| | - Lauren E Dittman
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA
| | - Robert J Spinner
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Allen T Bishop
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.
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Abstract
Continued advancements in magnetic resonance (MR) neurography and ultrasound have made both indispensable tools for the workup of peripheral neuropathy. Ultrasound provides high spatial resolution of superficial nerves, and techniques such as "sonopalpation" and dynamic maneuvers can improve accuracy. Superior soft tissue contrast, ability to evaluate both superficial and deep nerves with similar high resolution, and reliable characterization of denervation are strengths of MR neurography. Nevertheless, familiarity with normal anatomy, anatomic variants, and common sites of nerve entrapment is essential for radiologists to use both MR neurography and ultrasound effectively.
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Thacker MM, Pargas C, Marky C, Rogers KJ, DiNardo AA, Sestokas AK. Neuromonitoring for Proximal Fibular Osteochondroma Excision. J Pediatr Orthop 2022; 42:e667-e673. [PMID: 35348549 DOI: 10.1097/bpo.0000000000002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The peroneal nerve is at risk when excising tumors in the proximal fibula. The rate of nerve injuries during proximal fibular tumor resection varies from 3% to 20%. Our goal was to report our experience with resection of osteochondromas in the proximal fibula and describe the technique and utility of neuromonitoring during excision of proximal fibular osteochondromas (PFO). METHODS Patients with a diagnosis of symptomatic PFO who had undergone excision at one institution from 1994 to 2018 were included. An institutional review board-approved retrospective review was performed. Intraoperative neuromonitoring was provided from 2006 on by a single group utilizing a multimodality protocol. RESULTS This study contains 29 patients who had excision of osteochondromas in the proximal fibula. Of these 29 consecutively monitored patients, there were 34 involved extremities. Intraoperative neuromonitoring alerts occurred in 10/29 (34.5%) procedures, which included 3 electromyography (EMG) (30%), 2 motor-evoked potential (20%), 1 somatosensory-evoked potential (10%), and 4 alerts with a combination of EMG/motor-evoked potential/somatosensory-evoked potential changes (40%). The interventions that were taken resulted in resolution of the neuromonitoring changes in all procedures. Postoperatively, we noted 2 (6.9%) new mild sensory deficits, which resolved during follow up. There were 3 patients in whom pre-existing sensory-motor deficits improved but not completely after surgery, 1 motor weakness, and 2 with residual paresthesia. In those initially presenting with paresis, there was improvement in 8 of the 8 extremities by the last follow-up visit. Pain as a symptom was resolved in all cases. There were no iatrogenic foot drop injuries. The average follow up was 32.2 months. CONCLUSIONS Neuromonitoring during PFO excision demonstrated a high number of alerts, all of which resolved following timely corrective action. The use of neuromonitoring may help decrease the risk of iatrogenic postoperative neurological deficits following fibular osteochondroma surgery. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Mihir M Thacker
- Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
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Yadav U, Nemani M, Devgun A, Malik M, Agrawal GK. Iatrogenic Foot Drop After Anterior Cruciate Ligament Reconstruction With Peroneus Longus Tendon Autograft: Report of a Rare Case. Cureus 2022; 14:e26476. [PMID: 35919368 PMCID: PMC9339104 DOI: 10.7759/cureus.26476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/05/2022] Open
Abstract
Reconstruction of the anterior cruciate ligament using autografts is a common procedure performed in the modern era. The peroneus longus tendon is an upcoming graft with several advantages over traditional autografts. It has minimal donor site morbidity in relation to biomechanical properties of the ankle. Common peroneal nerve injury during harvest is a theoretical concern while harvesting the peroneus longus tendon. The following case highlights the importance of careful surgical technique and timely intervention while dealing with such complications. A 25-year-old male suffered an anterior cruciate ligament rupture while wrestling. He had an unstable knee and difficulty performing daily activities. He underwent an arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft. Following surgery, the patient reported a foot drop and decreased sensations over the dorsum of the foot. The patient was advised of a foot drop splint and neuroprotective medications. Neurophysiological studies were not performed since they cannot differentiate between partial and complete nerve injury in the first week after injury. A surgical exploration of the nerve was done. An intraneural hematoma was found with contusions over the peroneus longus tendon. Neurolysis was performed to decompress the nerve. The functioning of the anterior cruciate ligament was satisfactory during follow-up. An advancing Tinel’s sign was noted on follow-up. The patient finally recovered after a 3-month follow-up.
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Shields LBE, Iyer VG, Harpring JE, Rao AJ, Zhang YP, Shields CB. Role of electromyography and ultrasonography in the diagnosis of double crush lumbar radiculopathy and common fibular injury: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21566. [PMID: 36303488 PMCID: PMC9379723 DOI: 10.3171/case21566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/09/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Double crush syndrome consists of two compression sites along a peripheral nerve and is rare in the lower extremities. Electrodiagnostic and ultrasound (US) studies may be helpful in evaluating foot drop involving overlapping pathologies. OBSERVATIONS Case 1 involved a man who presented with left dorsiflexor weakness and left foot numbness. Electromyography (EMG) revealed a left common fibular nerve entrapment neuropathy and left L5 radiculopathy. US and magnetic resonance imaging (MRI) revealed a large cystic lesion of the left common fibular nerve treated by cyst removal. The left foot drop persisted postoperatively. Lumbar computed tomography myelography revealed severe left foraminal stenosis at L5–S1. Multilevel lumbar laminectomies and facetectomies with an L5–S1 fusion were performed. Within 1 month postoperatively, the left foot drop had improved. Case 2 involved a man who developed a right foot drop caused by right lumbar foraminal stenosis at L4–5 and L5–S1. EMG and US of the right common fibular neuropathy showed large fascicles involving the right common fibular nerve. MRI revealed a hyperintense signal of the right common fibular nerve. Spontaneous improvement occurred within 6 months without surgery. LESSONS Spine surgeons should recognize double crush in the lower extremities. EMG and US are valuable in detecting peripheral nerve abnormalities, especially in cases with overlapping lumbar pathology.
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Affiliation(s)
| | | | - John E. Harpring
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky
| | - Abigail J. Rao
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky
| | - Yi Ping Zhang
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky
| | - Christopher B. Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
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Holmes SA, Staffa SJ, Karapanagou A, Lopez N, Karian V, Borra R, Zurakowski D, Lebel A, Borsook D. Biological laterality and peripheral nerve DTI metrics. PLoS One 2021; 16:e0260256. [PMID: 34914714 PMCID: PMC8675689 DOI: 10.1371/journal.pone.0260256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Clinical comparisons do not usually take laterality into account and thus may report erroneous or misleading data. The concept of laterality, well evaluated in brain and motor systems, may also apply at the level of peripheral nerves. Therefore, we sought to evaluate the extent to which we could observe an effect of laterality in MRI-collected white matter indices of the sciatic nerve and its two branches (tibial and fibular). Materials and methods We enrolled 17 healthy persons and performed peripheral nerve diffusion weighted imaging (DWI) and magnetization transfer imaging (MTI) of the sciatic, tibial and fibular nerve. Participants were scanned bilaterally, and findings were divided into ipsilateral and contralateral nerve fibers relative to self-reporting of hand dominance. Generalized estimating equation modeling was used to evaluate nerve fiber differences between ipsilateral and contralateral legs while controlling for confounding variables. All findings controlled for age, sex and number of scans performed. Results A main effect of laterality was found in radial, axial, and mean diffusivity for the tibial nerve. Axial diffusivity was found to be lateralized in the sciatic nerve. When evaluating mean MTR, a main effect of laterality was found for each nerve division. A main effect of sex was found in the tibial and fibular nerve fiber bundles. Conclusion For the evaluation of nerve measures using DWI and MTI, in either healthy or disease states, consideration of underlying biological metrics of laterality in peripheral nerve fiber characteristics need to considered for data analysis. Integrating knowledge regarding biological laterality of peripheral nerve microstructure may be applied to improve how we diagnosis pain disorders, how we track patients’ recovery and how we forecast pain chronification.
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Affiliation(s)
- Scott A. Holmes
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Steven J. Staffa
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Anastasia Karapanagou
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Natalia Lopez
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Victoria Karian
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Ronald Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - David Zurakowski
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Alyssa Lebel
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - David Borsook
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
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Shields LBE, Iyer VG, Shields CB, Zhang YP, Rao AJ. Varied Presentation and Importance of MR Neurography of the Common Fibular Nerve in Slimmer's Paralysis. Case Rep Neurol 2021; 13:555-564. [PMID: 34720962 PMCID: PMC8460930 DOI: 10.1159/000518377] [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: 03/25/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
Slimmer's paralysis refers to a common fibular nerve palsy caused by significant and rapid weight loss. This condition usually results from entrapment of the common fibular nerve due to loss of the fat pad surrounding the fibular head. Several etiologies of common fibular nerve palsy have been proposed, including trauma, surgical complications, improperly fitted casts or braces, tumors and cysts, metabolic syndromes, and positional factors. We present 5 cases of slimmer's paralysis in patients who had lost 32–57 kg in approximately 1 year. In 2 cases, MR neurogram of the knee demonstrated abnormalities of the common fibular nerve at the fibular head. Two patients underwent a common fibular nerve decompression at the fibular head and attained improved gait and sensorimotor function. Weight loss, diabetes mellitus, and immobilization may have contributed to slimmer's paralysis in 1 case. Awareness of slimmer's paralysis in patients who have lost a significant amount of weight in a short period of time is imperative to detect and treat a fibular nerve neuropathy that may ensue.
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Affiliation(s)
- Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA
| | - Vasudeva G Iyer
- Neurodiagnostic Center of Louisville, Louisville, Kentucky, USA
| | - Christopher B Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA.,Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Yi Ping Zhang
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA
| | - Abigail J Rao
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA
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Marconi GF, Simão MN, Fogagnolo F, Nogueira-Barbosa MH. Magnetic resonance imaging evaluation of common peroneal nerve injury in acute and subacute posterolateral corner lesion: a retrospective study. Radiol Bras 2021; 54:303-310. [PMID: 34602665 PMCID: PMC8475171 DOI: 10.1590/0100-3984.2020.0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/10/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate qualitative and quantitative magnetic resonance imaging (MRI) criteria for injury of the common peroneal nerve (CPN) in patients with acute or subacute injuries in the posterolateral corner (PLC) of the knee, as well as to evaluate the reproducibility of MRI evaluation of CPN alterations. Materials and Methods This was a retrospective study of 38 consecutive patients submitted to MRI and diagnosed with acute or subacute injury to the PLC of the knee (patient group) and 38 patients with normal MRI results (control group). Two musculoskeletal radiologists (designated radiologist A and radiologist B, respectively) evaluated the images. Nerve injury was classified as neurapraxia, axonotmesis, or neurotmesis. Signal strength was measured at the CPN, the tibial nerve (TN), and a superficial vein (SV). The CPN/TN and CPN/SV signal ratios were calculated. The status of each PLC structure, including the popliteal tendon, arcuate ligament, lateral collateral ligament, and biceps tendon, was classified as normal, partially torn, or completely torn, as was that of the cruciate ligaments. For the semiquantitative analysis of interobserver agreement, the kappa statistic was calculated, whereas a receiver operating characteristic (ROC) curve was used for the quantitative analysis. Results In the patient group, radiologist A found CPN abnormalities in 15 cases (39.4%)-neurapraxia in eight and axonotmesis in seven-whereas radiologist B found CPN abnormalities in 14 (36.8%)-neurapraxia in nine and axonotmesis in five. The kappa statistic showed excellent interobserver agreement. In the control group, the CPN/TN signal ratio ranged from 0.63 to 1.1 and the CPN/SV signal ratio ranged from 0.16 to 0.41, compared with 1.30-4.02 and 0.27-1.08, respectively, in the patient group. The ROC curve analysis demonstrated that the CPN/TN signal ratio at a cutoff value of 1.39 had high (93.3%) specificity for the identification of nerve damage, compared with 81.3% for the CPN/SV signal ratio at a cutoff value of 0.41. Conclusion CPN alterations are common in patients with PLC injury detected on MRI, and the level of interobserver agreement for such alterations was excellent. Calculating the CPN/TN and CPN/SV signal ratios may increase diagnostic confidence. We recommend systematic analysis of the CPN in cases of PLC injury.
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Affiliation(s)
- Gustavo Felix Marconi
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Marcelo Novelino Simão
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Fabricio Fogagnolo
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Wakefield CJ, Hamid KS, Lee S, Lin J, Holmes GB, Bohl DD. Transfer of the Posterior Tibial Tendon for Chronic Peroneal Nerve Palsy. JBJS Rev 2021; 9:01874474-202107000-00014. [PMID: 34297700 DOI: 10.2106/jbjs.rvw.20.00208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The common peroneal nerve (CPN) is one of the most frequently injured nerves of the lower extremity. » One-third of patients who develop CPN palsy proceed to chronic impairment without signs of recovery. » Ankle-foot orthoses can provide improvement with respect to gait dysfunction and are useful as a nonsurgical treatment option. » Severe cases of CPN palsy demonstrating no signs of recovery may require operative intervention with tendon transfer.
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Affiliation(s)
- Connor J Wakefield
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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13
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Moran J, Porrino J, Cheng R, Schneble CA, Kahan JB, Molho DA, Katz L, Miller MD, Medvecky MJ. An Imaging Overview of the Posterior Septum of the Knee and Trans-Septal Portal Procedure: Normal Anatomy, Indications, and Unique Imaging Considerations. Curr Probl Diagn Radiol 2021; 51:562-567. [PMID: 34217559 DOI: 10.1067/j.cpradiol.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/24/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
The posterior trans-septal portal technique is an arthroscopic surgery of the knee providing surgeons with the ability to fully visualize the posterior compartment. With this procedure, portals are placed at the posteromedial and posterolateral aspect of the knee. Visualization of the medial and lateral posterior compartments then allows working space for the creation of the intra-articular portal that is made by dividing the posterior septum. We provide an imaging overview of the posterior septum, the trans-septal portal technique, possible indications, and introduce how surrounding anatomy may warrant unique imaging considerations.
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Affiliation(s)
- Jay Moran
- Yale School of Medicine, Medical school, New Haven, CT
| | - Jack Porrino
- Yale School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, CT
| | - Ryan Cheng
- Yale School of Medicine, Medical school, New Haven, CT
| | | | - Joseph B Kahan
- Yale School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, CT
| | - David A Molho
- Yale School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, CT
| | - Lee Katz
- Yale School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, CT
| | - Mark D Miller
- University of Virginia, Department of Orthopaedics, Charlottesville, VA
| | - Michael J Medvecky
- Yale School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, CT.
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14
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MRI features of symptomatic amputation neuromas. Eur Radiol 2021; 31:7684-7695. [PMID: 33866387 DOI: 10.1007/s00330-021-07954-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/13/2021] [Accepted: 03/26/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To demonstrate the magnetic resonance imaging (MRI) features of amputation neuromas in lower extremity amputees and investigate independent predictive MRI features for symptomatic neuromas. METHODS This retrospective study included 45 amputation neuromas in 44 lower extremity amputees. Two radiologists assessed the imaging features, including shape, size, type (end-bulb or spindle), signal intensity (SI), heterogeneity, margins, enlarged fascicles, dark outer rim, tail sign, target sign, enhancement, perilesional fibrosis, and muscle denervation. The neuromas were categorized into symptomatic (n = 24) or asymptomatic (n = 21). Symptomatic neuromas were determined based on neuropathic pain characteristics, the presence of Tinel's sign or tenderness, and response to local anesthetic injection. Univariate and multivariate analyses were performed to identify independent predictive MRI features. RESULTS Of 45 neuromas, 80% (36/45) were end-bulb neuromas and 20% (9/45) were spindle-type neuromas. Eighty percent of the neuromas (36/45) were heterogeneous on T2-weighted images (WIs). Enlarged fascicles were present in 42% (19/45) and dark outer rims in 27% (12/45) of the neuromas. Among the 23 neuromas with enhanced images, 78% (18/23) showed enhancement. Heterogeneity on T2-WIs and enhancement ratios were significantly different between the asymptomatic and symptomatic neuroma groups (p < 0.05). The multivariate analyses indicated that heterogeneity on T2-WIs was an independent factor associated with symptomatic neuromas (p < 0.001). CONCLUSIONS Heterogeneity on T2-WIs could be a predictive indicator for symptomatic neuromas in lower extremity amputees. KEY POINTS • Amputation neuromas are classified as either end-bulb or spindle-type. They can show enlarged fascicles, dark outer rims, and enhancement. • Heterogeneity on T2-weighted images could be a predictive indicator for symptomatic neuromas. • Predicting the symptomatic neuroma on MRI would help in effective management of stump pain.
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15
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Abstract
Peroneal tendon disorders remain an often overlooked source of lateral hindfoot pain and tenderness. Medical professionals who specialize in foot and ankle care are still far more likely to diagnose a peroneal tendon disorder as an ankle injury. In fact, acute peroneal dislocations are misdiagnosed in up to 40% of cases. The major subsets of peroneal disorders include peroneal tendonitis and tenosynovitis, painful os peroneum syndrome, subluxation, and tearing of the peroneal tendons. Proper history and physical exam maneuvers must be performed to help identify the source of the injury and differentiate these categories. Detailed imaging through X-ray and magnetic resonance imaging must also be used to diagnose the etiology of the patient's condition in order to direct management. Currently, there is very limited knowledge on peroneal pathologies, and treatment protocol is highly variable and limited to expert opinion. Despite the individual preferences and nuances held by each surgeon when it comes to operating, the overarching principles that guide appropriate management of tendonitis, subluxation, and tendon tear should maintain a higher level of consistency. Therefore, the authors of this review aim to elucidate the most current methods to diagnose these disorders as well as evidence-based practices for optimal management.Levels of Evidence: Level V.
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Affiliation(s)
- Akhil Sharma
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).,Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).,Duke Fuqua School of Business, Durham, North Carolina (SGP)
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16
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The articular branch of the peroneal nerve to the proximal tibiofibular joint descends at a mean height of approximately 18 mm distal to the postero-lateral tip of the fibular head. Knee Surg Sports Traumatol Arthrosc 2021; 29:1232-1237. [PMID: 32691096 DOI: 10.1007/s00167-020-06156-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of the study was to evaluate the anatomical details of the articular branch of the peroneal nerve to the proximal tibiofibular joint and to project the height of its descent in relation to the fibular length. METHODS Twenty-five lower extremities were included in the study. Following identification of the common peroneal nerve, its course was traced to its division into the deep and superficial peroneal nerve. The articular branch was identified. The postero-lateral tip of the fibular head was marked and the interval from this landmark to the diversion of the articular branch was measured. The length of the fibula, as the interval between the postero-lateral tip of the fibular head and the tip of the lateral malleolus, was evaluated. The quotient of descending point of the articular branch in relation to the individual fibular length was calculated. RESULTS The articular branch descended either from the common peroneal nerve or the deep peroneal nerve. The descending point was located at a mean height of 18.1 mm distal to the postero-lateral tip of the fibular head. Concerning the relation to the fibular length, this was at a mean of 5.1%, starting from the same reference point. CONCLUSION The articular branch of the common peroneal nerve was located at a mean height of 18.1 mm distal to the the postero-lateral tip of the fibular head, respectively, at a mean of 5.1% of the whole fibular length starting from the same reference point. These details represent a convenient orientation during surgical treatment of intraneural ganglia of the common peroneal nerve, which may result directly from knee trauma and indirectly from ankle sprain.
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17
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Becciolini M, Pivec C, Riegler G. Ultrasound Imaging of the Deep Peroneal Nerve. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:821-838. [PMID: 32881065 DOI: 10.1002/jum.15455] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/14/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
Ultrasound is considered an excellent imaging modality to evaluate the nerves of the limbs. The deep peroneal nerve (DPN) is one of the terminal branches of the common peroneal nerve. The DPN may be affected by various disorders, which may be clinically challenging to show. This Pictorial Essay reviews the normal ultrasound anatomy of the DPN and presents disorders that may involve the nerve and its main branches along its course, from proximal to distal.
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Affiliation(s)
- Marco Becciolini
- Misericordia di Pistoia, Pistoia, Italy
- Scuola Siumb di Ecografia Muscolo-Scheletrica, Pisa, Italy
| | | | - Georg Riegler
- Private Ultrasound Center Graz, Lassnitzhoehe, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
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18
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Canelas AF, Santos RF, Ferreira JB, Pina CR, Serrano SE. Ultrasound examination and guidance for sudden non-traumatic drop foot. Eur J Phys Rehabil Med 2021; 57:312-314. [PMID: 33470580 DOI: 10.23736/s1973-9087.21.06775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- André F Canelas
- Department of Physical and Rehabilitation Medicine, Hospital of Leiria, Leiria, Portugal -
| | - Rita F Santos
- Department of Physical and Rehabilitation Medicine, Hospital of Leiria, Leiria, Portugal
| | - José B Ferreira
- Department of Physical and Rehabilitation Medicine, Hospital of Leiria, Leiria, Portugal
| | - Carlos R Pina
- Department of Orthopedics II, Hospital of Leiria, Leiria, Portugal
| | - Simão E Serrano
- Department of Physical and Rehabilitation Medicine, Hospital of Leiria, Leiria, Portugal
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19
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Khan AA, Rodriguez-Collazo ER, Lo E, Raja A, Yu S, Khan HA. Evaluation and Treatment of Foot Drop Using Nerve Transfer Techniques. Clin Podiatr Med Surg 2021; 38:83-98. [PMID: 33220746 DOI: 10.1016/j.cpm.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Foot drop represents a complex pathologic condition, requiring a multidisciplinary approach for appropriate evaluation and treatment. Multiple etiologic factors require recognition before considering invasive/operative intervention. When considering surgical management for the treatment of foot drop, it is first and foremost imperative to establish the cause of the condition. Not all causes resulting in clinical foot drop have surgical options. Establishing a cause allows the provider to more appropriately curtail a multidisciplinary approach to working-up, and ultimately, treating the patient. The authors offer an algorithm for evaluating and treating foot drop conditions associated with lumbar spine radiculopathy and peripheral nerve lesions.
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Affiliation(s)
- Arshad A Khan
- Department of Orthopedic Surgery, Indiana University School of Medicine, Gary/Northwest; SpineTech, Brain and Spine Centers of Southeast Texas, 6025 Metropolitan Drive, Suite 205, Beaumont, TX 77706, USA.
| | - Edgardo R Rodriguez-Collazo
- Chicago Foot and Ankle Deformity Correction Center, 2913 North Commonwealth Avenue, Chicago, IL 60657, USA; Reconstructive Foot & Ankle Fellowship Program, Saint Anthony Hospital; Department of Pediatrics, Center for Excellence in Limb Lengthening and Reconstruction
| | - Erwin Lo
- University of Texas Medical School, Mischer Neuroscience Institute, Houston, TX, USA; SpineTech, Brain and Spine Center of Southeast Texas, 111 Vision Park Boulevard, Shenandoah, TX 77384, USA
| | - Asim Raja
- PMSR/RRA, Department of Orthopedics and Rehabilitation (DO&R), Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310, USA
| | - Sujin Yu
- SpineTech, Brain and Spine Center of Southeast Texas, 111 Vision Park Boulevard, Shenandoah, TX 77384, USA
| | - Hamid A Khan
- SpineTech, Brain and Spine Center of Southeast Texas, 111 Vision Park Boulevard, Shenandoah, TX 77384, USA
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20
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Titolo P, Lavorato A, Isoardo G, Vincitorio F, Garbossa D, Battiston B. Transfer of the peroneal component of the sciatic nerve in total brachial plexus lesion: An anatomical feasibility study. Injury 2020; 51:2904-2909. [PMID: 32201119 DOI: 10.1016/j.injury.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/22/2020] [Accepted: 03/07/2020] [Indexed: 02/02/2023]
Abstract
Closed brachial plexus lesions (BPLs) are generally associated with a traumatic mechanism of forced traction between the neck and the shoulder-arm complex. For brachial plexus reconstruction different techniques have been proposed with donor motor nerves like intercostal nerves, or the ipsilateral cervical plexus, the phrenic nerve, the contralateral C7 root, and many others. Despite all these surgical possibilities, the overall recovery is generally poor and not satisfactory. The principal drawback is linked to the loss of upper limb proprioception, in a way that dramatically influences even a good motor recovery, so in complete BPLs the sensory loss still represents a debilitating problem. In this anatomical feasibility study, the possibility to transfer the peroneal component of the sciatic nerve as a donor for complete BPLs has been evaluated. This technique would conceptually bring an important motor and sensory contribution to the upper limb using pure motor and sensory branches of the sciatic nerve. Performing immediate tendon transfer for foot drop palsy could significantly decrease the morbidity of the surgical procedure.
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Affiliation(s)
- Paolo Titolo
- OU Traumatology-Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, CTO Hospital, Torino, Italy
| | - Andrea Lavorato
- OU Neurosurgery, Department of Neurosciences, University of Turin, Turin, Italy.
| | - Gianluca Isoardo
- Centre for Pain Treatment, Department of Anesthesiology, Resuscitation and Intensive Care, Città della Salute e della Scienza di Torino - Molinette Hospital, Italy
| | | | - Diego Garbossa
- OU Neurosurgery, Department of Neurosciences, University of Turin, Turin, Italy
| | - Bruno Battiston
- OU Traumatology-Reconstructive Microsurgery, Department of Orthopaedics and Traumatology, CTO Hospital, Torino, Italy
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21
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Peroneal Nerve Palsy due to Bulky Osteochondroma from the Fibular Head: A Rare Case and Literature Review. Case Rep Orthop 2020; 2020:8825708. [PMID: 33274093 PMCID: PMC7676958 DOI: 10.1155/2020/8825708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022] Open
Abstract
Common peroneal neuropathy is the most common compressive neuropathy in the lower extremities. The anatomical relationship of the fibular head with the peroneal nerve explains entrapment in this location. We report the case of a 14-year-old boy admitted with a left foot drop. The diagnosis was an osteochondroma of the proximal fibula compressing the common peroneal nerve. The patient underwent surgical decompression of the nerve and resection of the exostosis. Three months postoperatively, there was a complete recovery of the deficits. The association of osteochondroma and peroneal nerve palsy is rare. Early diagnosis is required in order to adjust the management and improve the results. It is worth to underscore that surgical resection is proven to be the appropriate treatment method ensuring high success rates.
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22
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Dean C, Davis I, Alvarez D. Fluoroscopically-guided therapeutic injection of the proximal tibiofibular joint in a patient with lateral knee pain. Radiol Case Rep 2020; 15:2510-2514. [PMID: 33072229 PMCID: PMC7548928 DOI: 10.1016/j.radcr.2020.09.019] [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: 09/08/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022] Open
Abstract
Proximal tibiofibular joint (PTFJ) pathology is an uncommon but perhaps underappreciated cause of lateral knee pain. While imaging guided therapeutic injections for diagnosis and management of joint related symptoms are now commonplace and numerous techniques for accessing most joints in the body have been documented, a technique for fluoroscopically guided injection of the PTFJ has not been yet described in the literature. We present a case of an adult patient who presented with lateral knee pain refractory to conservative management who opted for a fluoroscopically-guided therapeutic injection of her PTFJ.
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Affiliation(s)
- Cooper Dean
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, 1600 SW Archer Rd. Gainesville, FL 32610, USA
| | - Ivan Davis
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, 1600 SW Archer Rd. Gainesville, FL 32610, USA
| | - David Alvarez
- Department of Radiology, University of Florida College of Medicine, PO Box 100374, 1600 SW Archer Rd. Gainesville, FL 32610, USA
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23
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Rizzo MG, Seiter MN, Martin AR, Greif DN, Levi AD, Jose J, Kaplan LD. A rare case of peroneal nerve palsy following inside-out lateral meniscus repair in a healthy collegiate-level football player. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Kim GY, Ryou CH, Kim KH, Kim D, Rhyu IJ, Kim DH. Branching Patterns and Anatomical Course of the Common Fibular Nerve. Ann Rehabil Med 2019; 43:700-706. [PMID: 31918532 PMCID: PMC6960080 DOI: 10.5535/arm.2019.43.6.700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/12/2019] [Indexed: 11/21/2022] Open
Abstract
Objective To present the branching patterns and anatomical course of the common fibular nerve (CFN) and its relationship with fibular head (FH). Methods A total of 21 limbs from 12 fresh cadavers were dissected. The FH width (FH_width), distance between the FH and CFN (FH_CFN), and thickness of the nerve were measured. The ratio of the FH_CFN to FH_width was calculated as follows: <1, cross type and ≥1, posterior type. Angle between the CFN and vertical line of the lower limb 5 cm proximal to the tip of the FH was measured. Branching patterns of the lateral cutaneous nerve of the calf (LCNC) were classified into four types according to its origin and direction as follows: type 1a, lateral margin of the CFN; type 1b, medial margin of the CFN; type 2, lateral sural cutaneous nerve (LSCN); and type 3, CFN and LSCN. Results In the cross type (15 cases, 71.4%), the ratio of FH_CFN/FH_width was 0.83 and the angle was 13.0°. In the posterior type (6 cases, 28.6%), the ratio was 1.04 and the angle was 11.0°. In the branching patterns of LCNC, type 2 was the most common (10 cases), followed by types 1a and 1b (both, 5 cases). Conclusion Location of the CFN around the FH might be related to the development of its neuropathy, especially in the cross type of CFN. The LCNC showed various branching patterns and direction, which could be associated with difficulties of electrophysiologic testing.
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Affiliation(s)
- Goo Young Kim
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Ansan, Korea
| | - Chae Hyeon Ryou
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Ansan, Korea
| | - Ki Hoon Kim
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Ansan, Korea
| | - Dasom Kim
- Practical Anatomy Research Institute, Korea University College of Medicine, Ansan, Korea
| | - Im Joo Rhyu
- Practical Anatomy Research Institute, Korea University College of Medicine, Ansan, Korea
| | - Dong Hwee Kim
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Ansan, Korea
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Thread common peroneal nerve release-a cadaveric validation study. Acta Neurochir (Wien) 2019; 161:1931-1936. [PMID: 31270613 DOI: 10.1007/s00701-019-03998-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine if the thread release technique can be applied to common peroneal nerve entrapment at the fibular neck. METHODS The thread common peroneal nerve release was performed on 15 fresh frozen cadaveric lower extremity specimens. All procedures were performed under ultrasound guidance and immediately underwent post-procedural gross anatomic inspection for completeness of decompression and presence or absence of iatrogenic neurovascular injury. RESULTS All 15 specimens demonstrated complete transection of the deep fascia of the peroneus longus overlying the common peroneal nerve. The transections extended to the bifurcation of the superficial peroneal and deep peroneal nerves. There was no evidence of any iatrogenic damage to the neurovascular bundle or adjacent tendons. The average operating time was less than 30 min. CONCLUSION This cadaveric validation study demonstrates the accuracy of the thread common peroneal nerve release. Future pilot studies are warranted to ensure the safety of this procedure in the clinical setting.
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26
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Spinner RJ, Hanna AS, Maldonado AA, Wilson TJ. Peripheral Nerve. Oper Neurosurg (Hagerstown) 2019; 17:S229-S255. [DOI: 10.1093/ons/opz072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester Minnesota
| | - Amgad S Hanna
- Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin
| | - Andrés A Maldonado
- Department of Plastic, Hand, and Reconstructive Surgery, BG Unfallklinik, Frankfurt, Germany
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University, Stanford, California
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27
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Porrino J, Wang A, Kani K, Kweon CY, Gee A. Preoperative MRI for the Multiligament Knee Injury: What the Surgeon Needs to Know. Curr Probl Diagn Radiol 2019; 49:188-198. [PMID: 30824164 DOI: 10.1067/j.cpradiol.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 01/13/2023]
Abstract
The multiligament knee injury is devastating and potentially limb threatening. Preoperative magnetic resonance imaging for the evaluation of the multiligament knee injury is an invaluable clinical tool, and when the radiologist is familiar with how certain injury patterns influence management, optimal outcomes can be achieved. We provide a detailed description of the relationship between salient imaging features of the multiligament knee injury, focusing on the preoperative magnetic resonance imaging, and their influence on clinical decision-making.
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Affiliation(s)
- Jack Porrino
- Yale Radiology and Biomedical Imaging, New Haven, CT 06520.
| | - Annie Wang
- Yale Radiology and Biomedical Imaging, New Haven, CT 06520.
| | - Kimia Kani
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD 21201.
| | - Christopher Y Kweon
- University of Washington, Department of Orthopaedics & Sports Medicine, Seattle, WA 98195.
| | - Albert Gee
- University of Washington, Department of Orthopaedics & Sports Medicine, Seattle, WA 98195.
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28
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Martín Noguerol T, Barousse R, Gómez Cabrera M, Socolovsky M, Bencardino JT, Luna A. Functional MR Neurography in Evaluation of Peripheral Nerve Trauma and Postsurgical Assessment. Radiographics 2019; 39:427-446. [DOI: 10.1148/rg.2019180112] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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29
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Common Peroneal Nerve. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Tran TMA, Lim BG, Sheehy R, Robertson PL. Magnetic resonance imaging for common peroneal nerve injury in trauma patients: Are routine knee sequences adequate for prediction of outcome? J Med Imaging Radiat Oncol 2018; 63:54-60. [DOI: 10.1111/1754-9485.12840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Thi My Anh Tran
- Faculty of Medicine Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia
| | - Beng Ghee Lim
- Department of Radiology The Royal Melbourne Hospital The University of Melbourne Melbourne Victoria Australia
| | - Rohan Sheehy
- Department of Orthopaedics The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Patricia L Robertson
- Department of Radiology The Royal Melbourne Hospital The University of Melbourne Melbourne Victoria Australia
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31
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Sukerkar PA, Fast AM, Riley G. Extreme Sports Injuries to the Pelvis and Lower Extremity. Radiol Clin North Am 2018; 56:1013-1033. [PMID: 30322484 DOI: 10.1016/j.rcl.2018.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Extreme sports are growing in popularity, and physicians are becoming increasingly aware of injuries related to these activities. Imaging plays a key role in diagnosing and determining clinical management of many of these injuries. This article describes general imaging techniques and findings in various injuries specific to multiple extreme sports.
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Affiliation(s)
- Preeti Arun Sukerkar
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Angela M Fast
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Geoffrey Riley
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Broekx S, Weyns F. External neurolysis as a treatment for foot drop secondary to weight loss: a retrospective analysis of 200 cases. Acta Neurochir (Wien) 2018; 160:1847-1856. [PMID: 29961126 DOI: 10.1007/s00701-018-3614-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/25/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peroneal nerve entrapment is the most common peripheral mononeuropathy of the lower limbs. Foot drop, a common presentation, leads to an impaired eversion and dorsiflexion of the foot. An intriguing observation is the occurrence of foot drop secondary to weight loss. METHODS A retrospective study of patients surgically treated for peroneal nerve entrapment was performed between January 1, 1995 and December 31, 2016, at the Department of Neurosurgery, Genk, Belgium. Out of a total of 421 patients, 200 patients with foot drop secondary to weight loss were included. For each subject, motor and sensory outcomes after external neurolysis were investigated. As a primary objective, we examined the postoperative outcomes of external neurolysis as a treatment for foot drop in patients with peroneal nerve entrapment at the fibular head secondary to weight loss. As a secondary objective, we analyzed the correlation between patient characteristics and the success rate of external neurolysis. RESULTS When defining success as a postoperative MRC score of 4 or 5, external neurolysis has a success rate of 85% in patients with foot drop secondary to weight loss. A significant difference (P = < 0.0001) between postoperative and preoperative MRC scores indicates that external neurolysis leads to significant improvement of motor function in patients with foot drop secondary to weight loss. A multiple logistic regression model showed that "preoperative MRC scores" and "duration of symptoms" were the only variables with an impact on postoperative MRC scores. Other variables such as "age," "gender," and "side of entrapment" had no significant impact on postoperative results. CONCLUSIONS Statistical analysis emphasizes the important role of external neurolysis in the treatment of peripheral peroneal nerve entrapment. Therefore, external neurolysis at the fibular head should be regarded as a very effective and safe procedure in patients with foot drop secondary to weight loss.
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Affiliation(s)
- Senne Broekx
- Faculty of Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Frank Weyns
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
- Department of Neurosurgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
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Martínez-Rodríguez A, Senin-Camargo F, Raposo-Vidal I, Chouza-Insua M, Rodríguez-Romero B, Jácome MA. Effects of transcutaneous electrical nerve stimulation via peroneal nerve or soleus muscle on venous flow: A randomized cross-over study in healthy subjects. Medicine (Baltimore) 2018; 97:e12084. [PMID: 30200088 PMCID: PMC6133565 DOI: 10.1097/md.0000000000012084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Transcutaneous electrical nerve stimulation (TENS) is used to prevent venous stasis and thromboembolism. However, best electrostimulation parameters have yet to be established. The aim of the study was to compare the hemodynamic effects and the participants' relative discomfort of 3 TENS sequences at the maximum tolerated intensity stimulus. METHODS Twenty-four healthy university students (50% male) participated in a cross-over, randomized study. Each participant received 2 TENS sequences on peroneal nerve at 1 and 5 Hz, and the third one on soleus muscle at 5 Hz. Popliteal flow volume (FV) and peak velocity (PV) were measured using Doppler ultrasound and the relative change from basal values was recorded. Discomfort questionnaires -visual analogue scale (VAS) and verbal rating scale (VRS)- were also administered to compare sensations among the three applications. RESULTS All interventions produced significant hemodynamic responses compared to baseline. Both 5 Hz applications obtained higher FV increments than 1 Hz TENS (P < .001). The muscle application resulted in the lowest PV increment (P < .001). TENS at 5 Hz on nerve location was the worst tolerated, with higher values in VRS (P = .056) and VAS (P = .11), although not significant. CONCLUSION TENS at 5 Hz on soleus site may be the most appropriate protocol for enhancing venous return.
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Affiliation(s)
- Alicia Martínez-Rodríguez
- Psychosocial and Functional Rehabilitation Research Group
- Department of Physiotherapy, Medicine and Biomedical Sciences
| | | | - Isabel Raposo-Vidal
- Psychosocial and Functional Rehabilitation Research Group
- Department of Physiotherapy, Medicine and Biomedical Sciences
| | | | - Beatriz Rodríguez-Romero
- Psychosocial and Functional Rehabilitation Research Group
- Department of Physiotherapy, Medicine and Biomedical Sciences
| | - M. Amalia Jácome
- CITIC, Department of Mathematics, Faculty of Sciences, Universidade da Coruña, Campus de A Coruña, A Coruña, Spain
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Intraneural Ganglion Cysts of the Fibular Nerve: A Cause of Fluctuating Painful Foot Drop. Can J Neurol Sci 2018; 45:601-603. [PMID: 30041709 DOI: 10.1017/cjn.2018.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ratanshi I, Clark TA, Giuffre JL. Immediate Nerve Transfer for Treatment of Peroneal Nerve Palsy Secondary to an Intraneural Ganglion: Case Report and Review. Plast Surg (Oakv) 2018; 26:80-84. [PMID: 29845044 DOI: 10.1177/2292550317747844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Intraneural ganglion cysts, which occur within the common peroneal nerve, are a rare cause of foot drop. The current standard of treatment for intraneural ganglion cysts involving the common peroneal nerve involves (1) cyst decompression and (2) ligation of the articular nerve branch to prevent recurrence. Nerve transfers are a time-dependent strategy for recovering ankle dorsiflexion in cases of high peroneal nerve palsy; however, this modality has not been performed for intraneural ganglion cysts involving the common peroneal nerve. We present a case of common peroneal nerve palsy secondary to an intraneural ganglion cyst occurring in a 74-year-old female. The patient presented with a 5-month history of pain in the right common peroneal nerve distribution and foot drop. The patient underwent simultaneous cyst decompression, articular nerve branch ligation, and nerve transfer of the motor branch to flexor hallucis longus to a motor branch of anterior tibialis muscle. At final follow-up, the patient demonstrated complete (M4+) return of ankle dorsiflexion, no pain, no evidence of recurrence and was able to bear weight without the need for orthotic support. Given the minimal donor site morbidity and recovery of ankle dorsiflexion, this report underscores the importance of considering early nerve transfers in cases of high peroneal neuropathy due to an intraneural ganglion cyst.
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Affiliation(s)
- Imran Ratanshi
- Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tod A Clark
- Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer L Giuffre
- Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Causes of peroneal neuropathy associated with orthopaedic leg lengthening in different canine models. Strategies Trauma Limb Reconstr 2018; 13:95-102. [PMID: 29802558 PMCID: PMC6042218 DOI: 10.1007/s11751-018-0313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/22/2018] [Indexed: 11/17/2022] Open
Abstract
Peroneal neuropathy is one of the complications of orthopaedic leg lengthening. Methods of treatment include slowing of distraction and decompression both of which may lead to additional complications. The purpose of this study was to analyse the changes in histologic peroneal nerve structure during experimental orthopaedic lengthening using various modes of manual or automatic distraction. The obtained data provide the basis for better understanding of peroneal neuropathy pathogenesis and refinement of prophylaxis and preventive treatment protocols. Four experimental models of canine leg lengthening using the Ilizarov fixator were studied: 1 (n = 10)—manual distraction—1 mm/day divided into four increments; 2 (n = 12)—automatic distraction—1 mm/day in 60 increments, 3 (n = 9) and 4 (n = 9)—increased rate of high frequency automatic distraction: 3 mm/day in 120 and 180 increments, respectively. In peroneal nerves semi-thin sections cross-sectional fascicular areas, content of adipocytes in epineurium, endoneurial vascularisation, morphometric parameters of nerve fibres were assessed by computerised analysis at the end of distraction and of consolidation periods and 30 days after fixator removal. In Groups 1–2 massive nerve fibre degeneration along with epineural vessels obliteration was revealed in two cases from 22, whereas in Groups 3–4 there were 10 from 18 (p < 0.01). Injuries of perineurium and endoneurial vessels were noted in Group 3, and long-lasting thinning of nerve fascicles in Group 4. The decrease in epineurial fat tissue was revealed in all groups, more drastic in 3. Modifications and injuries of nerve sheaths and blood vessels depending on distraction rate and frequency contribute to peroneal neuropathy. Its mechanical, circulatory and metabolic causes are discussed.
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Abstract
PURPOSE OF REVIEW This article addresses relevant peripheral neuroanatomy, clinical presentations, and diagnostic findings in common entrapment neuropathies involving the median, ulnar, radial, and fibular (peroneal) nerves. RECENT FINDINGS Entrapment neuropathies are a common issue in general neurology practice. Early diagnosis and effective management of entrapment mononeuropathies are essential in preserving limb function and maintaining patient quality of life. Median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, radial neuropathy at the spiral groove, and fibular neuropathy at the fibular head are among the most frequently encountered entrapment mononeuropathies. Electrodiagnostic studies and peripheral nerve ultrasound are employed to help confirm the clinical diagnosis of nerve compression or entrapment and to provide precise localization for nerve injury. Peripheral nerve ultrasound demonstrates nerve enlargement at or near sites of compression. SUMMARY Entrapment neuropathies are commonly encountered in clinical practice. Accurate diagnosis and effective management require knowledge of peripheral neuroanatomy and recognition of key clinical symptoms and findings. Clinical diagnoses may be confirmed by diagnostic testing with electrodiagnostic studies and peripheral nerve ultrasound.
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Walker S, Snodgrass D, Chen D, Huynh W. Extraneural ganglion cyst as a rare cause for footdrop. Muscle Nerve 2017; 56:E173-E174. [DOI: 10.1002/mus.25765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/05/2017] [Accepted: 08/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Susan Walker
- Department of Neurology; Prince of Wales Hospital; Barker Street, Randwick Sydney 2031 Australia
| | | | | | - William Huynh
- Department of Neurology; Prince of Wales Hospital; Barker Street, Randwick Sydney 2031 Australia
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Ratanshi I, Clark TA, Giuffre JL. Immediate Nerve Transfer for the Treatment of Peroneal Nerve Palsy Secondary to an Intraneural Ganglion: Case Report and Review. Plast Surg (Oakv) 2017; 25:54-58. [PMID: 29026813 DOI: 10.1177/2292550317694842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Intraneural ganglion cysts that occur within the common peroneal nerve are a rare cause of foot drop. The current standard of treatment for intraneural ganglion cysts involving the common peroneal nerve involves (1) cyst decompression and (2) ligation of the articular nerve branch to prevent recurrence. Nerve transfers are a time-dependent strategy for recovering ankle dorsiflexion in cases of high peroneal nerve palsy; however, this modality has not been performed for intraneural ganglion cysts involving the common peroneal nerve. We present a case of common peroneal nerve palsy secondary to an intraneural ganglion cyst occurring in a 74-year-old female. The patient presents with a 5-month history of pain in the right common peroneal nerve distribution and foot drop. The patient underwent simultaneous cyst decompression, articular nerve branch ligation, and nerve transfer of the motor branch to the flexor hallucis longus to a motor branch of the anterior tibialis muscle. At final follow-up, the patient demonstrated complete (M4+) return of ankle dorsiflexion, no pain, and no evidence of recurrence and was able to weight bare without the need of orthotic support. Given the minimal donor site morbidity and recovery of ankle dorsiflexion, this report underscores the importance of considering early nerve transfers in cases of high peroneal neuropathy due to an intraneural ganglion cyst.
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Affiliation(s)
- I Ratanshi
- Section of Plastic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - T A Clark
- Section of Orthopedic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer L Giuffre
- Section of Plastic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Bernabeu Á, López-Celada S, Alfaro A, Mas JJ, Sánchez-González J. Is diffusion tensor imaging useful in the assessment of the sciatic nerve and its pathologies? Our clinical experience. Br J Radiol 2016; 89:20150728. [PMID: 27459247 DOI: 10.1259/bjr.20150728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the usefulness of diffusion tensor imaging (DTI) in the clinical setting as a complementary tool to conventional MRI in the study and assessment of the sciatic nerve and its pathologies. METHODS 17 patients diagnosed with different types of sciatic neuropathy and 10 healthy controls underwent a conventional MRI and a DTI study in a 3-T MR scanner (Achieva(®) 3-T X-Series; Philips Healthcare, Netherlands). RESULTS In the control group, we were able to track and visualize the common sciatic nerve and its main branches from hip to foot. In the patient group, the affected sciatic nerves presented statistically significant lower fractional anisotropy values and higher apparent diffusion coefficient values when compared with controls, suggesting nerve damage. In all cases, DTI offered complementary information for diagnosis and/or confirmation of the suspected pathology. When compared with conventional MRI, DTI showed higher sensitivity for nerve damage detection. CONCLUSION DTI offers a significant improvement and an important complement to visualize the sciatic nerve and its main branches. In patients with sciatic nerve pathology DTI allows to a better detection and characterization of the nerve damage. ADVANCES IN KNOWLEDGE DTI enables in vivo dissection of the sciatic nerve white matter fibres; its use offers a significant improvement and complement to conventional MRI.
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Affiliation(s)
- Ángela Bernabeu
- 1 Magnetic Resonance Department, Inscanner SL, Alicante, Spain
| | | | - Arantxa Alfaro
- 2 Department of Neurology, Hospital Vega Baja de Orihuela, Alicante, Spain.,3 CIBER-BBN, Madrid, Spain
| | - Jesús J Mas
- 4 Orthopaedic Surgery Department, Clinica Vistahermosa, Alicante, Spain
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Erickson BJ, Brown N, Fernandez J, Della Valle CJ. Acute Decompression for Peroneal Nerve Palsy Following Primary Total Knee Arthroplasty: A Report of Two Cases. JBJS Case Connect 2015; 5:e16. [PMID: 29252449 DOI: 10.2106/jbjs.cc.n.00134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Two cases of peroneal nerve palsy following primary total knee arthroplasty are presented. Treatment included acute decompression of the peroneal nerve, with full neurological recovery. CONCLUSION Acute peroneal nerve decompression is a viable option for patients with peroneal nerve palsy after primary total knee arthroplasty.
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Affiliation(s)
- Brandon J Erickson
- Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL, 60611.
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Ben Amotz O, Ramirez R, Husain T, Lehrman C, Teotia S, Sammer DM. Complications related to harvest of the proximal end of the fibula: A systematic review. Microsurgery 2014; 34:666-9. [DOI: 10.1002/micr.22309] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/09/2014] [Accepted: 07/31/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Oded Ben Amotz
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas TX
| | - Rey Ramirez
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas TX
| | - Tarik Husain
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas TX
| | - Craig Lehrman
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas TX
| | - Sumeet Teotia
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas TX
| | - Douglas M. Sammer
- Department of Plastic Surgery; University of Texas Southwestern Medical Center; Dallas TX
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Pineda D, Barroso F, Cháves H, Cejas C. High resolution 3T magnetic resonance neurography of the peroneal nerve. RADIOLOGIA 2014. [DOI: 10.1016/j.rxeng.2014.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pineda D, Barroso F, Cháves H, Cejas C. Neurografía de alta resolución del nervio peroneo en resonancia magnética 3T. RADIOLOGIA 2014; 56:107-17. [DOI: 10.1016/j.rx.2013.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 10/26/2013] [Accepted: 11/02/2013] [Indexed: 01/30/2023]
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