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Gasemaltayeb R, Wannarong T, Ticku H, Preston DC. Neuromuscular ultrasound: Impact on diagnosis and management. Muscle Nerve 2024; 69:295-302. [PMID: 37818726 DOI: 10.1002/mus.27983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION/AIM High-resolution ultrasound (HRUS) is increasingly used in evaluating neuromuscular conditions. Its potential advantages include its ability to discern anatomic information and make specific etiological diagnoses. Although many studies have demonstrated HRUS effectiveness, especially in mononeuropathies, more information is needed to better determine how often and to what extent useful information is obtained; how it influences diagnosis, clinical decision-making, and patient management; and how it is used with electrodiagnostic (EDx) studies. METHODS A retrospective cohort study was performed on patients referred for HRUS at a university laboratory during 2021. Demographic information, referral diagnoses, clinical information, HRUS findings, and follow-up patient management were analyzed. For patients who had EDx, results were compared with HRUS. Determinations were made whether HRUS did or did not aid in the diagnosis. For patients in whom HRUS resulted in a diagnosis, determination was made whether it confirmed the diagnosis made clinically or by EDx but did not change management; added additional important information; and/or made a decisive impact on subsequent management. RESULTS Five hundred two patients were analyzed, most referred for mononeuropathy, brachial plexopathy, and polyneuropathy. HRUS was abnormal in 81.7% of patients. HRUS added additional useful information in 79.0% and was decisive in management in 62.7%. In patients who also had abnormal EDx, HRUS resulted in decisive management in 49.5%. DISCUSSION HRUS is an effective diagnostic tool that frequently adds localizing and structural information that is otherwise not obtainable by clinical and EDx evaluation. In a substantial number of patients selected for HRUS, it is decisive in guiding further management.
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Affiliation(s)
- Raed Gasemaltayeb
- Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Thapat Wannarong
- Neuromuscular Division, Department of Neurology, Duke University Hospital, Durham, North Carolina, USA
| | - Hemani Ticku
- Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - David C Preston
- Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Ruiz Santiago F, Moraleda Cabrera B, Láinez Ramos-Bossini AJ. Ultrasound guided injections in ankle and foot. J Ultrasound 2024; 27:153-159. [PMID: 37518823 PMCID: PMC10908885 DOI: 10.1007/s40477-023-00808-1] [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: 04/02/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Ultrasound guidance is particularly useful for percutaneous injections in the diagnosis and management of painful conditions of the ankle and foot. The injectates used include steroids and local anesthetics, such as lidocaine, mepivacaine, bupivacaine, ropivacaine, and platelet-rich plasma. Osteoarthritis is the main indication for joint injections. Joints amenable to being injected include the tibiotalar, subtalar, midtarsal, and metatarsophalangeal joints. Tendon injections mainly involve the Achilles, peroneus, extensors, and tibialis tendons, while plantar fascia injections are useful for treating plantar fasciitis and plantar fibromatosis. Forefoot injections include joint arthritis, intermetatarsal bursitis, and Morton neuroma. The standardized approaches and doses reviewed in this paper are based on the authors' experience and can lead to high success in symptomatic relief for various conditions. These injections can be curative or serve as a guide to identify the source of pain when surgery or other therapeutic options are planned.
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Affiliation(s)
- Fernando Ruiz Santiago
- Department of Radiology and Physical Medicine, Faculty of Medicine, University of Granada, 18071, Granada, Spain.
- Musculoskeletal Radiology Unit, Hospital Universitario Virgen de Las Nieves, 18014, Granada, Spain.
- Instituto de Investigación Biosanitaria ibs. Granada, 18012, Granada, Spain.
- , C-Julio Verne 8, 7 B, 18003, Granada, Spain.
| | - Beatriz Moraleda Cabrera
- Musculoskeletal Radiology Unit, Hospital Universitario Virgen de Las Nieves, 18014, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, 18012, Granada, Spain
| | - Antonio Jesús Láinez Ramos-Bossini
- Musculoskeletal Radiology Unit, Hospital Universitario Virgen de Las Nieves, 18014, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, 18012, Granada, Spain
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3
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Gehlen M, Schwarz-Eywill M, Mahn K, Pfeiffer A, Prinz F, Maier A. [Ultrasound of nerves of the lower extremities]. Z Rheumatol 2024; 83:54-67. [PMID: 38019334 DOI: 10.1007/s00393-023-01458-8] [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] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
The ability to visualize the nerves of the lower extremities differs from that of the upper extremities in sonography because the soft tissue cover is significantly larger in some cases. Landmarks are also defined for the lower extremities, which enable precise visualization of the nerves. Nerves and muscles are to be understood as a functional unit. In addition to the clarification of nerve compression syndromes, polyneuropathies and nerve tumors, sonography is also used to visualize muscle atrophy.
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Affiliation(s)
- Martin Gehlen
- Ausbildungsabteilung Sonographie DEGUM, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Fachklinik für Rheumatologie, Orthopädie und Osteologie, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland.
| | - Michael Schwarz-Eywill
- Ausbildungsabteilung Sonographie DEGUM, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Fachklinik für Rheumatologie, Orthopädie und Osteologie, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - Karin Mahn
- Ausbildungsabteilung Sonographie DEGUM, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Fachklinik für Rheumatologie, Orthopädie und Osteologie, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - Andreas Pfeiffer
- Abteilung für Neurologie, St. Josefs-Hospital Cloppenburg, Cloppenburg, Deutschland
| | - Florian Prinz
- Klinik für Rheumatologie und Immunologie & Sektion Rheumatologie und entzündliche Systemerkrankungen, UKE, Bad Bramstedt, Deutschland
| | - Anna Maier
- Abteilung für Rheumatologie, Interdisziplinäres Ultraschallzentrum & Ausbildungsabteilung Sonographie DEGUM, Nordwestdeutsches Rheumazentrum, St. Josef Stift, Sendenhorst, Deutschland
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Duarte ML, da Silva MO, Soares ODSR, Moreira NSA, Arie EK. Weight-bearing Ultrasound to Diagnose Talar Dislocation Causing Tarsal Tunnel Syndrome. Prague Med Rep 2024; 125:172-177. [PMID: 38761051 DOI: 10.14712/23362936.2024.17] [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] [Indexed: 05/20/2024] Open
Abstract
The neuropathic compression of the tibial nerve and/or its branches on the medial side of the ankle is called tarsal tunnel syndrome (TTS). Patients with TTS presents pain, paresthesia, hypoesthesia, hyperesthesia, muscle cramps or numbness which affects the sole of the foot, the heel, or both. The clinical diagnosis is challenging because of the fairly non-specific and several symptomatology. We demonstrate a case of TTS caused by medial dislocation of the talar bone on the calcaneus bone impacting the tibial nerve diagnosed only by ultrasound with the patient in the standing position.
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Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
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Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
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Kumar S, Mangi MD, Zadow S, Lim W. Nerve entrapment syndromes of the lower limb: a pictorial review. Insights Imaging 2023; 14:166. [PMID: 37782348 PMCID: PMC10545616 DOI: 10.1186/s13244-023-01514-6] [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: 04/16/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Peripheral nerves of the lower limb may become entrapped at various points during their anatomical course. While clinical assessment and nerve conduction studies are the mainstay of diagnosis, there are multiple imaging options, specifically ultrasound and magnetic resonance imaging (MRI), which offer important information about the potential cause and location of nerve entrapment that can help guide management. This article overviews the anatomical course of various lower limb nerves, including the sciatic nerve, tibial nerve, medial plantar nerve, lateral plantar nerve, digital nerves, common peroneal nerve, deep peroneal nerve, superficial peroneal nerve, sural nerve, obturator nerve, lateral femoral cutaneous nerve and femoral nerve. The common locations and causes of entrapments for each of the nerves are explained. Common ultrasound and MRI findings of nerve entrapments, direct and indirect, are described, and various examples of the more commonly observed cases of lower limb nerve entrapments are provided.Critical relevance statement This article describes the common sites of lower limb nerve entrapments and their imaging features. It equips radiologists with the knowledge needed to approach the assessment of entrapment neuropathies, which are a critically important cause of pain and functional impairment.Key points• Ultrasound and MRI are commonly used to investigate nerve entrapment syndromes.• Ultrasound findings include nerve hypo-echogenicity, calibre changes and the sonographic Tinel's sign.• MRI findings include increased nerve T2 signal, muscle atrophy and denervation oedema.• Imaging can reveal causative lesions, including scarring, masses and anatomical variants.
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Affiliation(s)
- Shanesh Kumar
- Department of Radiology, Royal Adelaide Hospital, Port Rd, Adelaide, Australia
| | - Mohammad Danish Mangi
- Department of Radiology, Royal Adelaide Hospital, Port Rd, Adelaide, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Steven Zadow
- Department of Medical Imaging, Flinders Medical Centre, Flinders Drive, Bedford Park, Australia
- Jones Radiology, Eastwood, Australia
| | - WanYin Lim
- Department of Radiology, Royal Adelaide Hospital, Port Rd, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Jones Radiology, Eastwood, Australia
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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.
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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.
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8
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Duarte ML, da Silva MO, Soares ODSR. Tortuosity and Pulsatility of the Tibial Artery - Two Case Reports of a Rare Etiology of Tarsal Tunnel Syndrome. ACTA MEDICA (HRADEC KRALOVE) 2023; 66:161-164. [PMID: 38588395 DOI: 10.14712/18059694.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Tarsal tunnel syndrome is a neuropathic compression of the tibial nerve and its branches on the medial side of the ankle. It is a challenging diagnosis that constitutes symptoms arising from damage to the posterior tibial nerve or its branches as they proceed through the tarsal tunnel below the flexor retinaculum in the medial ankle, easily forgotten and underdiagnosed. Neural compression by vascular structures has been suggested as a possible etiology in some clinical conditions. Tibial artery tortuosity is not that rare, but only that it affects the nerve can cause tarsal tunnel syndrome. Therefore, a study care must be taken to avoid false-positive errors.
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Affiliation(s)
- Márcio Luís Duarte
- Radiology professor at Universidade de Ribeirão Preto Campus Guarujá, Guarujá-SP, Brazil.
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Hasab ElNaby MM, Abdel Rahman AF, Ibrahim RA. Novel electrodiagnostic provocative techniques for the diagnosis of suspected tarsal tunnel syndrome. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [PMCID: PMC9522436 DOI: 10.1186/s43166-022-00151-z] [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] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Electrodiagnostic tests (EDXTs) have been considered the gold standard method for the diagnosis of tarsal tunnel syndrome (TTS); however, definitive tests has not yet been discovered. Our aim was to develop new nerve conduction provocative techniques in the double and single leg stance as well as combined ankle dorsiflexion with foot eversion accompanied by compression for the diagnosis of suspected TTS.
Results
Routine combined nerve conduction studies (NCSs) using medial plantar (MP) and lateral plantar (LP) nerves had a 60.9% sensitivity for the diagnosis of TTS. The diagnostic sensitivity increased when combining the three novel tests reaching 82.6% and 78.3% using either MP or LP NCSs respectively. The diagnostic sensitivity further increased to reach 100% when combining the MP and LP novel NCSs considering either the latency or amplitude.
Conclusion
The full diagnostic sensitivity for TTS reached 100% by using a battery of novel tests. The proposed diagnostic workup by this study recommends using these biomechanically challenging tests to complete the diagnostic battery of tests especially in symptomatic patients with negative routine tests.
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Symanski JS, Ross AB, Davis KW, Brunner MC, Lee KS. US for Traumatic Nerve Injury, Entrapment Neuropathy, and Imaging-guided Perineural Injection. Radiographics 2022; 42:1546-1561. [PMID: 35776677 DOI: 10.1148/rg.210152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
US is commonly performed to help diagnose traumatic peripheral nerve injury and entrapment neuropathy, particularly with superficial nerves, where higher spatial resolution provides an advantage over MRI. Other advantages of US include dynamic evaluation, easy contralateral comparison, fewer implant contraindications, less artifact from ferromagnetic debris, and facile needle guidance for perineural injections. The authors review peripheral nerve US for traumatic peripheral nerve injury with an emphasis on injury grading and entrapment neuropathy and describe best-practice techniques for US-guided perineural injections while highlighting specific techniques and indications. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- John S Symanski
- From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 (J.S.S., A.B.R., K.W.D., M.C.B., K.S.L.); and Department of Radiology, William S. Middleton Veterans Hospital, Madison, Wis (M.C.B.)
| | - Andrew B Ross
- From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 (J.S.S., A.B.R., K.W.D., M.C.B., K.S.L.); and Department of Radiology, William S. Middleton Veterans Hospital, Madison, Wis (M.C.B.)
| | - Kirkland W Davis
- From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 (J.S.S., A.B.R., K.W.D., M.C.B., K.S.L.); and Department of Radiology, William S. Middleton Veterans Hospital, Madison, Wis (M.C.B.)
| | - Michael C Brunner
- From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 (J.S.S., A.B.R., K.W.D., M.C.B., K.S.L.); and Department of Radiology, William S. Middleton Veterans Hospital, Madison, Wis (M.C.B.)
| | - Kenneth S Lee
- From the Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI 53792 (J.S.S., A.B.R., K.W.D., M.C.B., K.S.L.); and Department of Radiology, William S. Middleton Veterans Hospital, Madison, Wis (M.C.B.)
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Atesok K, Pierce J, Small B, Perumal V, Cooper T, Park J. The Course of Tarsal Tunnel Syndrome after Ultrasound-Guided Injections. Orthop Rev (Pavia) 2022; 14:35455. [DOI: 10.52965/001c.35455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Local ultrasound (US)-guided injections of anesthetics with corticosteroids are commonly performed for the conservative treatment of tarsal tunnel syndrome (TTS). OBJECTIVE This retrospective study aimed to investigate the outcomes of TTS after US-guided injections. METHODS The study included patients who were diagnosed with TTS and received US-guided injections as part of their initial treatment. The pain levels were noted on a scale between zero and ten before and after each injection. The patients were divided into non-surgical and surgical groups. The nonsurgical group included patients who had received US-guided injections and did not proceed to surgical treatment, and the surgical group included those who received US-guided injections and ultimately underwent tarsal tunnel release (TTR). The two groups were compared in terms of age, post-injection follow-up time, and the amount of pain reduction immediately after injection (ΔPN). In the surgical group, outcomes of surgical treatment were also assessed. RESULTS A total of 218 patients were diagnosed with TTS and received US-guided injections. After the injections, 169 patients (77.5%) did not go on to TTR (nonsurgical group) and 49 patients (22.5%) underwent TTR (surgical group). The average ages for the nonsurgical and surgical groups were 53.8 and 48.9 years (P = 0.03). The average time between the injection and final follow-up for the nonsurgical group was 339 days. The average time between the injection and TTR for the surgical group was 145 days. There were no differences in pain relief after the injections between the nonsurgical and surgical groups (mean ΔPN: 3.6 and 3.8, respectively). The average post-surgical follow-up time was 117 days. At final follow-up, 41 patients (84%) in the surgical group had complete resolution of pain and neurological symptoms. CONCLUSION US-guided injection can be an effective conservative treatment option for patients with TTS. Younger patients may be more likely to proceed to TTR. Level of Evidence Level III
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Lalevée M, Coillard JY, Gauthé R, Dechelotte B, Fantino O, Boublil D, Grisard JL, Viste A, Klouche S, Bouysset M. Tarsal Tunnel Syndrome: Outcome According to Etiology. J Foot Ankle Surg 2022; 61:583-589. [PMID: 34799273 DOI: 10.1053/j.jfas.2021.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/29/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
Surgical results in tarsal tunnel syndrome are variable, and etiology seems to be a factor. Three possible etiologies can be distinguished. The aim of the present study was to compare surgical results according to etiology. Three continuous retrospective series (45 patients overall) of tarsal tunnel syndrome were compared. Group 1 presented a permanent intra- or extra-tunnel space-occupying compressive structure. Group 2 presented intermittent intra-tunnel venous dilatations. Group 3 comprised idiopathic tarsal tunnel syndrome. The mean follow-up was 3.6 +/- 1.8 years. The main endpoint was subjective postoperative improvement on Likert scale. Group 1 reported greater improvement than groups 2 and 3. Preoperative neuropathy on ultrasound was associated with poorer improvement, which was not the case for neuropathy on electromyography. Surgical treatment of tarsal tunnel syndrome provides better results in etiologies involving structural compression.
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Affiliation(s)
- Matthieu Lalevée
- Orthopedic Surgeon, Centre Hospitalier Universitaire de Rouen, Service Orthopédie et Traumatologie, Rouen, France.
| | | | - Rémi Gauthé
- Orthopedic Surgeon, Centre Hospitalier Universitaire de Rouen, Service Orthopédie et Traumatologie, Rouen, France
| | - Benoît Dechelotte
- Statistician, Biologist, Centre Hospitalier Universitaire de Rouen, Institut de biologie clinique Laboratoire immunologie, Rouen, France
| | - Olivier Fantino
- Orthopedic Surgeon, Groupe ELSAN, Clinique du Parc, Lyon, France
| | - Daniel Boublil
- Orthopedic Surgeon, Groupe ELSAN, Clinique du Parc, Lyon, France
| | - Jean-Luc Grisard
- Orthopedic Surgeon, Groupe ELSAN, Clinique du Parc, Lyon, France; Radiologist, Clinique du Parc, Lyon, France
| | - Anthony Viste
- Orthopedic Surgeon, Hospices Civils de Lyon, CHU Lyon Sud, Chirurgie Orthopédique et Traumatologique, Pierre Bénite Cedex, France; IFSTARR, LBMC, Bron, France; Université de Lyon, Lyon, France
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13
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de Souza Reis Soares O, Duarte ML, Brasseur JL. Tarsal Tunnel Syndrome: An Ultrasound Pictorial Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1247-1272. [PMID: 34342896 DOI: 10.1002/jum.15793] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/30/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
Tarsal tunnel syndrome may be idiopathic or may be caused by various conditions: bone disease, thickening of the retinaculum, hematoma, or iatrogenic nerve damage; tendinopathy or tenosynovitis; the presence of supernumerary muscles such as an accessory soleus, peroneocalcaneus internus, or accessory flexor digitorum muscle; bone or joint disorders; expansile tumors or cysts; and venous aneurysm or kinking of the tibial artery. The purpose of this article is to describe and illustrate most of the causes of tarsal tunnel syndrome, as diagnosed by ultrasound, which is a practical, inexpensive method.
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14
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Jorgensen SP, Cartwright MS, Norbury J. Neuromuscular Ultrasound: Indications in the Electrodiagnostic Laboratory. Am J Phys Med Rehabil 2022; 101:78-88. [PMID: 33990480 DOI: 10.1097/phm.0000000000001790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Accurate assessment of neuromuscular disorders is critical to facilitate timely treatment and achieve the best outcomes. Historically, electrodiagnostic studies have filled this role, but recently, neuromuscular ultrasound is being used in the electrodiagnostic laboratory. This review discusses the uses of neuromuscular ultrasound in the electrodiagnostic laboratory that have strong evidence, emphasizing those that could be adopted in a typical electrodiagnostic laboratory with a reasonable level of equipment and training. The evidence currently supports using neuromuscular ultrasound to diagnose carpal tunnel syndrome and ulnar neuropathies at the elbow and as a supplementary test when electrodiagnostic studies are suspected to be falsely negative or in axonal nonlocalizing lesions. Neuromuscular ultrasound can identify the causes of focal mononeuropathies, which can change treatment in specific cases. It is sensitive at identifying fasciculations and providing complementary evidence of autoimmune demyelinating polyneuropathies. It is particularly helpful in assessing nerves after trauma. Neuromuscular ultrasound is likely to prove even more useful in the electrodiagnostic laboratory as the technology continues to advance.
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Affiliation(s)
- Shawn P Jorgensen
- From the Department of Physical Medicine and Rehabilitation, Albany Medical College, Albany, New York (SPJ); Department of Family Medicine, Larner Medical College at the University of Vermont, Burlington, Vermont (SPJ); Adirondack Rehabilitation Medicine, PLLC, Queensbury, New York (SPJ); Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (MSC); and Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas (JN)
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15
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Kim YH, Chai JW, Kim DH, Kim HJ, Seo J. A problem-based approach in musculoskeletal ultrasonography: heel pain in adults. Ultrasonography 2021; 41:34-52. [PMID: 34674456 PMCID: PMC8696136 DOI: 10.14366/usg.21069] [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: 03/22/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Musculoskeletal ultrasonography (US) has unique advantages, such as excellent spatial resolution for superficial structures, the capability for dynamic imaging, and the ability for direct correlation and provocation of symptoms. For these reasons, US is increasingly used to evaluate problems in small joints, such as the foot and ankle. However, it is almost impossible to evaluate every anatomic structure within a limited time. Therefore, US examinations can be faster and more efficient if radiologists know where to look and image patients with typical symptoms. In this review, common etiologies of heel pain are discussed in a problem-based manner. Knowing the common pain sources and being familiar with their US findings will help radiologists to perform accurate and effective US examinations.
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Affiliation(s)
- Yong Hee Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jiwoon Seo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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16
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Fantino O, Bouysset M, Pialat JB. Can the axial cross-sectional area of the tibial nerve be used to diagnose tarsal tunnel syndrome? An ultrasonography study. Orthop Traumatol Surg Res 2021; 107:102630. [PMID: 32682728 DOI: 10.1016/j.otsr.2020.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 11/11/2019] [Accepted: 02/20/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The axial cross-sectional area (CSA) of the tibial nerve can be measured with ultrasonography. In patients who have posteromedial tarsal tunnel syndrome (TTS), there is little information on the nerve's CSA even though this information could be useful for determining whether the nerve is damaged. This led us to carry out a case-control study in which the tibial nerve's axial CSA was measured in healthy patients and in patients with TTS. HYPOTHESIS The tibial nerve's axial CSA can be used as a diagnostic criterion for TTS. METHODS Twenty-three patients (27 feet) (11 men, 12 women, mean age=54±14 years), who had clinical and electroneuromyography signs of TTS, were compared to 21 healthy adults (8 men, 13 women, mean age 39±10 years). An ultrasonography examination was carried out to look for a source of nerve compression, then the axial CSA of the tibial nerve was measured 10cm above the tarsal tunnel (lCSA) and inside the tunnel itself (ttCSA). The difference between the two measurements was then calculated: ΔCSA=ttCSA-lCSA. The data were analysed using correlation tests and non-parametric tests, a multivariate linear regression and ROC tests. RESULTS A compressive cause was found by ultrasonography in 13 patients. The mean values of ttCSA and ΔCSA were 20.1±8.8 mm2 [6-42] vs. 10.3±2.3 mm2 [8-14] (p=0.0001) and 9.8±6.7 mm2 [0-29] vs. -0.2±1.8 mm2 [-3-4] (p<0.0001) in the patients and the controls, respectively. The differences in ΔCSA remained significant in the multivariate analysis after adjusting for age and weight. The best threshold for ttCSA in the TTS group was 15 mm2 with 74% sensitivity and 100% specificity. The best threshold for ΔCSA was 5mm2 with 81% sensitivity and 100% specificity. DISCUSSION The difference in the measured axial CSA of the tibial nerve by ultrasonography between the posteromedial tarsal tunnel and 10cm above the tunnel is a key data point for the diagnosis of tarsal tunnel syndrome with and without compressive etiology. LEVEL OF EVIDENCE III, diagnostic case-control study.
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Affiliation(s)
- Olivier Fantino
- Imagerie Médicale du Parc, Clinique du Parc, 155 bis, boulevard Stalingrad, 69006 Lyon, France; Service de Radiologie, Groupement Hospitalier Sud, 165, chemin du Grand-Revoyet, 69310 Pierre Bénite, France.
| | - Maurice Bouysset
- Cabinet de Rhumatologie, 19, cours Lafayette, 69006 Lyon, France
| | - Jean-Baptiste Pialat
- Service de Radiologie, Groupement Hospitalier Sud, 165, chemin du Grand-Revoyet, 69310 Pierre Bénite, France; Université de Lyon, Lyon, France
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17
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Hannaford A, Vucic S, Kiernan MC, Simon NG. Review Article "Spotlight on Ultrasonography in the Diagnosis of Peripheral Nerve Disease: The Evidence to Date". Int J Gen Med 2021; 14:4579-4604. [PMID: 34429642 PMCID: PMC8378935 DOI: 10.2147/ijgm.s295851] [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: 06/22/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Neuromuscular ultrasound is rapidly becoming incorporated into clinical practice as a standard tool in the assessment of peripheral nerve diseases. Ultrasound complements clinical phenotyping and electrodiagnostic evaluation, providing critical structural anatomical information to enhance diagnosis and identify structural pathology. This review article examines the evidence supporting neuromuscular ultrasound in the diagnosis of compressive mononeuropathies, traumatic nerve injury, generalised peripheral neuropathy and motor neuron disease. Extending the sonographic evaluation of nerves beyond simple morphological measurements has the potential to improve diagnostics in peripheral neuropathy, as well as advancing the understanding of pathological mechanisms, which in turn will promote precise therapies and improve therapeutic outcomes.
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Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Steve Vucic
- Westmead Clinical School, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, Australia
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18
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López-de-Celis C, Caudevilla Polo S, González-Rueda V, Bueno-Gracia E, Pérez-Bellmunt A, Simon M, Estébanez-de-Miguel E. Dimensional Changes of the Tarsal Tunnel During Foot and Ankle Positions: Anatomical Study. J Foot Ankle Surg 2021; 59:763-767. [PMID: 32253152 DOI: 10.1053/j.jfas.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/13/2020] [Indexed: 02/03/2023]
Abstract
The tarsal tunnel is a fibrous osseous conduit for the tibial nerve and associated tendons. It is mechanically dynamic, and foot and ankle movements appear to move and change tunnel shape. However, the effect of foot and ankle movements is not clear. The aim of this study was to measure tarsal tunnel dimensions in anatomical position of the foot and ankle and quantify its changes at different positions in cadavers. A cross-sectional study with a total of 16 cryopreserved lower extremities from cadaveric specimens were used. The foot was cut using an anatomical saw at the level of the tarsal tunnel. Measurements of the cross-sectional area (CSA), transverse diameter (TD), longitudinal diameter (LD) were taken in anatomical position and during foot and ankle movements. All the tarsal tunnel measurements were significantly modified by ankle plantar flexion (p < .05). The CSA increased by 68.97 mm2 (p < .001), the TD increased by 1.40 mm (p < .002) and the LD increased by 2.55 mm (p < .007). The TD was also significantly modified by the inversion position of the ankle, showing an increase of 0.84 mm (p < .004). The rest of the ankle positions did not produce significant changes in tarsal tunnel measurements. Foot and ankle plantar flexion position produce and increase in the CSA and the TD of the tarsal tunnel at its distal end in cadavers. This could suggest a reduction in tarsal tunnel pressure during plantar flexion.
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Affiliation(s)
- Carlos López-de-Celis
- Professor, Faculty of Medicine and Health Sciences, Universitat Intenacional de Catalunya, Barcelona, Spain
| | | | - Vanessa González-Rueda
- Professor, Faculty of Medicine and Health Sciences, Universitat Intenacional de Catalunya, Barcelona, Spain
| | - Elena Bueno-Gracia
- Professor, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
| | - Albert Pérez-Bellmunt
- Professor, Faculty of Medicine and Health Sciences, Universitat Intenacional de Catalunya, Barcelona, Spain
| | - Mathias Simon
- Professor, Faculty of Medicine and Health Sciences, Universitat Intenacional de Catalunya, Barcelona, Spain
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19
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 2 Lower limb. Eur J Radiol 2020; 135:109482. [PMID: 33360825 DOI: 10.1016/j.ejrad.2020.109482] [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: 08/15/2019] [Revised: 06/15/2020] [Accepted: 12/14/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE This review discusses the relevant anatomy, etiopathogenesis, current notions in clinical and imaging features as well as management outline of lower limb entrapment neuropathies. METHODS The review is based on critical analysis of the current literature as well as our experience in dealing with entrapment neuropathies of the lower limb. RESULTS The complex anatomical network of nerves supplying the lower extremities are prone to entrapment by a heterogenous group of etiologies. This leads to diverse clinical manifestations making them difficult to diagnose with traditional methods such as clinical examination and electrodiagnostic studies. Moreover, some of these may mimic other common conditions such as disc pain or fibromyalgia leading to delay in diagnosis and increasing morbidity. Addition of imaging improves the diagnostic accuracy and also help in correct treatment of these entities. Magnetic resonance imaging is very useful for deeply situated nerves in pelvis and thigh while ultrasound is well validated for superficial entrapment neuropathies. CONCLUSION The rapidly changing concepts in these conditions accompanied by the advances in imaging has made it essential for a clinical radiologist to be well-informed with the current best practices.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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20
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Formigo-Couceiro J, Otero-Villaverde S, Alonso-Bidegain M. [Proposal for approach to selective tibial nerve block in spastic patient. A propos of a case]. Rehabilitacion (Madr) 2020; 55:71-74. [PMID: 32741573 DOI: 10.1016/j.rh.2020.06.006] [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: 03/05/2020] [Revised: 06/14/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
The most frequent pattern of spasticity in the lower limb is equinovarus foot. Patients with central nervous system injury and severe spasticity, conservative treatment and botulinum toxin type A often have a limited effect. In these cases, nerve blocks can be very useful in deciding our therapeutic action. We present a clinical case as an example of a new ultrasound-guided approach to tibial nerve block, as this is the main nerve involved in equinovarus foot pattern, specific for spastic patients and its usefulness for the clinical management of spasticity.
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Affiliation(s)
- J Formigo-Couceiro
- Servicio de Medicina Física y Rehabilitación, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, España.
| | - S Otero-Villaverde
- Servicio de Medicina Física y Rehabilitación, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, España
| | - M Alonso-Bidegain
- Servicio de Medicina Física y Rehabilitación, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, España
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21
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Technical report: dynamic assessment of plantar fasciitis and plantar fascia tears utilising dorsiflexion of the great toe. J Ultrasound 2019; 23:397-400. [PMID: 31721101 DOI: 10.1007/s40477-019-00411-3] [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: 09/17/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022] Open
Abstract
Discrimination between plantar fasciitis and partial tears of the plantar fascia can be difficult on ultrasound given laxity of the plantar fascia in the region of its calcaneal insertion and anisotropy. Dynamic assessment with great toe dorsiflexion can improve visualisation of the proximal portion of the plantar fascia on ultrasound, by straightening the plantar fascia due to the windlass mechanism. This article describes the technique and its anatomical basis.
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Bueno-Gracia E, Salcedo-Gadea J, López-de-Celis C, Salcedo-Gadea E, Pérez-Bellmunt A, Estébanez-de-Miguel E. Dimensional Changes of the Tibial Nerve and Tarsal Tunnel in Different Ankle Joint Positions in Asymptomatic Subjects. J Foot Ankle Surg 2019; 58:1129-1133. [PMID: 31679666 DOI: 10.1053/j.jfas.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/19/2018] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
Abstract
The tarsal tunnel is a clinically important fibrous osseous conduit for the tibial nerve and associated tendons. It is mechanically dynamic, and normal ankle movements appear to change the tunnel shape, potentially having an impact on the tibial nerve. The objective of this study was to measure changes in the tibial nerve and tarsal tunnel dimensions in plantarflexion and dorsiflexion of the ankle joint in healthy subjects. A cross-sectional study with 13 volunteer subjects and a total of 18 records was designed. The cross-sectional area, anterior-posterior distance, transverse distance, and flattening ratio of the tibial nerve were measured by using ultrasound in plantarflexion and dorsiflexion of the ankle joint. The anterior-posterior distance of the tarsal tunnel was also measured. The tunnel anterior-posterior distance significantly increased during plantarflexion (p < .001) and decreased during dorsiflexion (p = .027) of the ankle. From plantarflexion to dorsiflexion of the ankle, the tibial nerve cross-sectional area significantly decreased (p = .035). The anterior-posterior distance also decreased significantly (p < .001), whereas the transverse distance increased (p < .001), thus decreasing the flattening ratio of the tibial nerve (p < .001). Ankle joint position determined significant changes in the shape and dimensions of the tibial nerve at the tarsal tunnel.
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Affiliation(s)
- Elena Bueno-Gracia
- Physiotherapist, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - Carlos López-de-Celis
- Physiotherapist, Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
| | | | - Albert Pérez-Bellmunt
- Physiotherapist, Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
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23
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Gonzalez NL, Hobson-Webb LD. Neuromuscular ultrasound in clinical practice: A review. Clin Neurophysiol Pract 2019; 4:148-163. [PMID: 31886438 PMCID: PMC6921231 DOI: 10.1016/j.cnp.2019.04.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022] Open
Abstract
Neuromuscular ultrasound (NMUS) is becoming a standard element in the evaluation of peripheral nerve and muscle disease. When obtained simultaneously to electrodiagnostic studies, it provides dynamic, structural information that can refine a diagnosis or identify a structural etiology. NMUS can improve patient care for those with mononeuropathies, polyneuropathy, motor neuron disease and muscle disorders. In this article, we present a practical guide to the basics of NMUS and its clinical application. Basic ultrasound physics, scanning techniques and clinical applications are reviewed, along with current challenges.
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Affiliation(s)
- Natalia L. Gonzalez
- Department of Neurology/Neuromuscular Division, Duke University Hospital, DUMC 3403, Durham, NC 27710, USA
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24
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Ultrasound facilitates the diagnosis of tarsal tunnel syndrome: intraneural ganglion cyst of the tibial nerve. J Ultrasound 2018; 22:95-98. [PMID: 30019288 DOI: 10.1007/s40477-018-0314-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/11/2018] [Indexed: 02/06/2023] Open
Abstract
The tibial nerve intraneural ganglion cyst-which presents with fluid accumulated inside the nerve epineurium-is a rare etiology of tarsal tunnel syndrome. We report a case with insidious onset of numbness over his left medial ankle. Ultrasound imaging revealed that the tibial nerve was encircled by crescent-shaped anechoic substances, spanning from the distal leg to the sole. Magnetic resonance imaging disclosed a thickened tibial nerve wrapped by hyperintense materials in the tarsal tunnel. Some effusion was observed besides the tibialis posterior and flexor digitorum tendons as well. The patient underwent a surgical treatment and an intraneural ganglion cyst was confirmed. This report elaborated the clinical and imaging presentations of a tibial nerve intraneural ganglion cyst and highlighted the usefulness of ultrasound in exploring the cause of compressive neuropathy at the ankle region.
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25
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Mufty H, Matricali GA, Thomis S. Venous malformation as source of a tarsal tunnel syndrome: treat the source or the cause of the complaints? A case report. Acta Chir Belg 2018; 118:188-191. [PMID: 28454504 DOI: 10.1080/00015458.2017.1321268] [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: 10/19/2022]
Abstract
Painful tarsal tunnel syndrome is a compression neuropathy with a variety of possible sources. As it presents a challenging differential diagnostic problem, it is often under-diagnosed. Among the intrinsic and extrinsic factors, varicose veins are the main source in case of a venous etiology. We report a case of a 39-year old male patient who presented with complaints of paresthesia and excessive pain of the right foot, especially the medial side. Further work up by ultrasonography, magnetic resonance imaging and electromyography revealed an extensive congenital venous malformation of the right lower limb with subsequent compression of the tibial nerve in the tarsal tunnel. We did not treat the source, but the cause by open tarsal tunnel release. Excellent result with immediate full relieve of the patients complaints was achieved.
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Affiliation(s)
- H. Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - G. A. Matricali
- Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - S. Thomis
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
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26
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Iborra A, Villanueva M, Barrett SL, Rodriguez-Collazo E, Sanz P. Anatomic Delineation of Tarsal Tunnel Innervation via Ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1325-1334. [PMID: 29205431 DOI: 10.1002/jum.14499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES High-resolution ultrasonography (US) can play an important role in studying nerves, as it has several advantages. Entrapments of distal tibial nerve branches can be mapped out or diagnosed with selective anesthetic blocks, and US can guide therapeutic procedures, such as radiofrequency ablation and selective infiltrations of specific nerve branches. The aim of this study was to verify that US is an effective method for accurately locating the posterior tibial nerve and its terminal branches, such as the medial calcaneal branch, the first calcaneal branch, and the medial and lateral plantar nerves. METHODS In this study, we analyzed the correlation between US mapping and real anatomy after cadaveric dissection, assessing the distribution and variability of the tibial nerve and its terminal branches. We used 12 fresh anatomic specimens of the foot and ankle, including the calf. A high-resolution US study of the tibial nerve and its branches was performed. RESULTS The results of the US studies of the anatomic specimens were drawn as paper diagrams and in data collection tables. Both were completed twice per anatomic specimen, first using the results of the US study and second using the results from dissection of the anatomic specimens; this approach enabled us to compare the results and verify whether the US study and the dissection correlated on the topography of the tibial nerve and its terminal branches. We found almost total agreement between the US and dissection results, with no significant differences between the evaluations. CONCLUSIONS On the basis of this work, we can conclude that high-resolution US is almost 100% effective as a tool for identifying the tibial nerve and its branches, enabling the specialist to make diagnoses or perform selective treatments on each nerve branch and even to design surgical interventions by observing the patient's anatomy before performing the dissection.
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Affiliation(s)
| | | | | | | | - Pablo Sanz
- Gregorio Marañón Hospital, Madrid, Spain
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27
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Kim KH, Park BK, Kim DH. Reply. Muscle Nerve 2016; 54:1149-1150. [PMID: 27615410 DOI: 10.1002/mus.25402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Ki Hoon Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Ansan City, Gyeonggi Province, Republic of Korea
| | - Byung Kyu Park
- Department of Physical Medicine and Rehabilitation, College of Medicine, Ansan City, Gyeonggi Province, Republic of Korea
| | - Dong Hwee Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Ansan City, Gyeonggi Province, Republic of Korea
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29
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Tawfik EA, El Zohiery AK, Abouelela AAK. Proposed Sonographic Criteria for the Diagnosis of Idiopathic Tarsal Tunnel Syndrome. Arch Phys Med Rehabil 2015; 97:1093-9. [PMID: 26705883 DOI: 10.1016/j.apmr.2015.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/20/2015] [Accepted: 11/16/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To propose new sonographic criteria for the diagnosis of idiopathic tarsal tunnel syndrome (TTS). DESIGN Prospective case-control study. SETTING Academic referral center. PARTICIPANTS Adult healthy volunteers (n=17) and adult patients (n=14) with electrodiagnostically proven idiopathic TTS (mean age, 43.4±8.7y; height, 161.4±7.0cm; weight, 90.6±13.9kg) (N=31). The exclusion criteria were patients with diabetes, neurological disorders, associated ankle and/or foot disorders, electrodiagnostic evidence of a widespread lesion, or feet that were electrophysiologically negative for TTS or with structural abnormalities detected via ultrasound imaging. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Tibial nerve CSA at the proximal tarsal tunnel, tibial nerve CSA within the tunnel, within tunnel-to-proximal tunnel CSA ratio. RESULTS There was a significant difference in the within tunnel CSA and within tunnel-to-proximal tunnel CSA ratio between the TTS group and controls (P=.002 and P=.001, respectively). The optimum cutoff value was 19mm(2) for the within tunnel CSA and 1 for the within tunnel-to-proximal tunnel CSA ratio. Sensitivities were 61% and 74%, respectively. CONCLUSIONS The within tunnel-to-proximal tunnel CSA ratio and the within tunnel CSA are the most accurate sonographic parameters and can be helpful in the assessment of idiopathic TTS.
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Affiliation(s)
- Eman A Tawfik
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Abeer K El Zohiery
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr A K Abouelela
- Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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30
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Bilateral tarsal tunnel syndrome related to intense cycling activity: proposal of a multimodal diagnostic approach. Neurol Sci 2015; 36:1921-3. [PMID: 26044912 DOI: 10.1007/s10072-015-2275-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
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