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Chiu PE, Fu Z, Tsai YC, Tsai CY, Hsu WJ, Chou LW, Lai DW. Fu's subcutaneous needling promotes axonal regeneration and remyelination by inhibiting inflammation and endoplasmic reticulum stress. Transl Res 2024; 273:46-57. [PMID: 38950695 DOI: 10.1016/j.trsl.2024.06.005] [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: 11/01/2023] [Revised: 05/03/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024]
Abstract
Fu's subcutaneous needling (FSN) is a traditional Chinese acupuncture procedure used to treat pain-related neurological disorders. Moreover, the regulation of inflammatory cytokines may provide a favorable environment for peripheral nerve regeneration. In light of this, FSN may be an important novel therapeutic strategy to alleviate pain associated with peripheral neuropathy; however, the underlying molecular mechanisms remain unclear. This study revealed that patients who had osteoarthritis with peripheral neuropathic pain significantly recovered after 1 to 2 weeks of FSN treatment according to the visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, Lequesne index, walking speed, and passive range of motion. Similarly, we demonstrated that FSN treatment in an animal model of chronic constriction injury (CCI) significantly improved sciatic nerve pain using paw withdrawal thresholds, sciatic functional index scores, and compound muscle action potential amplitude tests. In addition, transmission electron microscopy images of sciatic nerve tissue showed that FSN effectively reduced axonal swelling, abnormal myelin sheaths, and the number of organelle vacuoles in CCI-induced animals. Mechanistically, RNA sequencing and gene set enrichment analysis revealed significantly reduced inflammatory pathways, neurotransmitters, and endoplasmic reticulum stress pathways and increased nerve regeneration factors in the FSN+CCI group, compared with that in the CCI group. Finally, immunohistochemistry, immunoblotting and enzyme-linked immunosorbent assay showed similar results in the dorsal root ganglia and sciatic nerve. Our findings suggest that FSN can effectively ameliorate peripheral neuropathic pain by regulate inflammation and endoplasmic reticulum stress, thereby determine its beneficial application in patients with peripheral nerve injuries.
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Affiliation(s)
- Po-En Chiu
- Department of Chinese Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan; Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Zhonghua Fu
- Institute of Fu's Subcutaneous Needling, Beijing University of Chinese Medicine, Beijing, China; Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi-Ching Tsai
- Department of Immune Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chia-Yun Tsai
- Experimental Animal Center, Department of Molecular Biology and Cell Research, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Wei-Jen Hsu
- Experimental Animal Center, Department of Molecular Biology and Cell Research, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan; Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan.
| | - De-Wei Lai
- Experimental Animal Center, Department of Molecular Biology and Cell Research, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan; Department of Pharmacy and Master Program, Tajen University, Pingtung, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
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2
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Onger ME, Altun G, Yildiran A. Pigment epithelium-derived factor enhances peripheral nerve regeneration through modulating oxidative stress and stem cells: An experimental study. Anat Rec (Hoboken) 2023; 306:2621-2635. [PMID: 36787348 DOI: 10.1002/ar.25177] [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: 08/15/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 02/15/2023]
Abstract
Peripheral nerve injury is common and negatively affects an individual's quality of life. Drugs used for peripheral nerve regeneration should aim to eliminate symptoms such as neuropathic pain and have therapeutic effects. In recent studies, pigment epithelium-derived factor (PEDF) has been considered an essential therapeutic agent because of its potential neuroprotective properties. In this study, we aimed to investigate the efficacy of locally applied PEDF for peripheral nerve regeneration. Twenty-four Wistar albino male rats were used. The study groups included Injury (n = 12) and Injury+PEDF (n = 12). An injury model was created by applying 50 N pressure to the right sciatic nerves in groups, and 10 μg/kg local PEDF was injected into the Injury+PEDF group. After 28 days of recovery, functional tests and stereological, immunohistochemical, and biochemical analyses were performed. A significant difference was found between the Injury and Injury+PEDF groups in amplitude, whereas no difference was found in latency. The number of myelinated axons and the myelinated axon area increased significantly in the Injury+PEDF group, while no statistically significant difference was found in myelin sheath thickness. Superoxide dismutase, catalase, and glutathione peroxidase activities were increased by PEDF, whereas they were suppressed in mesenchymal stem cells. PEDF exerts functional, quantitative, and antioxidative effects on sciatic nerve injury during neuroregeneration. In addition, when oxidative stress parameters were examined, it was seen that PEDF reduced oxidative stress following sciatic nerve injury.
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Affiliation(s)
- Mehmet Emin Onger
- Department of Histology and Embryology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
- Department of Neuroscience, Health Science Institute, Ondokuz Mayıs University, Samsun, Turkey
| | - Gamze Altun
- Department of Histology and Embryology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Alisan Yildiran
- Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
- Department of Immunology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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3
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Kim Y, Min K, Park MW, Shin HI, Kim DH. Injury to the Left Sciatic and Right Common Peroneal Nerves Combined With Multifocal Rhabdomyolysis in a Survivor of the Itaewon Crowd Crush: A Case Report. J Korean Med Sci 2023; 38:e233. [PMID: 37489720 PMCID: PMC10366412 DOI: 10.3346/jkms.2023.38.e233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/30/2023] [Indexed: 07/26/2023] Open
Abstract
We report the case of a 27-year-old survivor of the Halloween crowd crush in Itaewon, Seoul, Korea who was diagnosed with left sciatic neuropathy and right common peroneal neuropathy accompanied by multifocal rhabdomyolysis. The patient presented to the emergency room complaining of pain from her lower back to her whole lower extremities with paraparesis and paresthesia. Her blood test showed the marked elevation of creatine kinase and liver enzymes. Magnetic resonance imaging revealed multifocal signal changes in the abdominalis and pelvic girdle muscles suggestive of rhabdomyolysis. Magnetic resonance neurography demonstrated injury to the left sciatic and right peroneal nerves. Electrophysiologic studies also revealed lesions in the left sciatic and right peroneal nerves. After comprehensive rehabilitation and conservative treatment for three months, her muscle strength improved, and she could walk independently. Although several previous studies have reported peripheral neuropathy in immobilized patients, to the best of our knowledge, no case associated with a crowd crush has been reported. Therefore, we report the case of multifocal neuropathy combined with rhabdomyolysis in a victim of a crowd crush incident with good recovery.
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Affiliation(s)
- Yoonhee Kim
- Department of Physical & Rehabilitation Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyeongil Min
- Department of Physical & Rehabilitation Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myung Woo Park
- Department of Physical & Rehabilitation Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Iee Shin
- Department of Physical & Rehabilitation Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Du Hwan Kim
- Department of Physical & Rehabilitation Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
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Differentiating Lumbar Spinal Etiology from Peripheral Plexopathies. Biomedicines 2023; 11:biomedicines11030756. [PMID: 36979737 PMCID: PMC10044821 DOI: 10.3390/biomedicines11030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Clinicians have managed and treated lower back pain since the earliest days of practice. Historically, lower back pain and its accompanying symptoms of radiating leg pain and muscle weakness have been recognized to be due to any of the various lumbar spine pathologies that lead to the compression of the lumbar nerves at the root, the most common of which is the radiculopathy known as sciatica. More recently, however, with the increased rise in chronic diseases, the importance of differentially diagnosing a similarly presenting pathology, known as lumbosacral plexopathy, cannot be understated. Given the similar clinical presentation of lumbar spine pathologies and lumbosacral plexopathies, it can be difficult to differentiate these two diagnoses in the clinical setting. Resultingly, the inappropriate diagnosis of either pathology can result in ineffective clinical management. Thus, this review aims to aid in the clinical differentiation between lumbar spine pathology and lumbosacral plexopathy. Specifically, this paper delves into spine and plexus anatomy, delineates the clinical assessment of both pathologies, and highlights powerful diagnostic tools in the hopes of bolstering appropriate diagnosis and treatment. Lastly, this review will describe emerging treatment options for both pathologies in the preclinical and clinical realms, with a special emphasis on regenerative nerve therapies.
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Dietmann A, von Martial R, Scheidegger O. Spontaneous ischemic neuropathy of the sciatic nerve due to arterial occlusion – a rare cause of acute neuropathy not to be missed, a report of two cases. BMC Neurol 2022; 22:410. [PMCID: PMC9636630 DOI: 10.1186/s12883-022-02944-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Ischemic neuropathy of the sciatic nerve without preceding vascular surgical procedures is a rare condition and may be due to arterial occlusion in one limb.
Case presentations
We present two cases with acute onset of pain and sensory symptoms such as pins and needles and numbness in the foot with no or mild motor symptoms. In the neurological work-up, electrophysiological signs of axonal neuropathy of both peroneal and tibial nerves were demonstrated and T2 hyperintensity was seen in the distal sciatic nerves on MR neurography as well as signs indicating arterial thrombosis in the corresponding vessels. Recanalization was obtained in both patients angiographically with significant improvement in one patient.
Conclusions
Spontaneous arterial occlusion of major or peripheral arteries is a rare but important cause of acute onset of single or multiple axonal mononeuropathies of one extremity. Recognition of this infrequent cause is essential since it requires immediate and specific therapeutic options.
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Spiliopoulos KC, Veltsista D, Theodoroula E, Soldatos T, Kelekis A, Chroni E. Long-term outcome of bilateral sciatic nerve palsy due to unrecognized thigh compartment syndrome. Acta Neurol Belg 2022; 122:809-811. [PMID: 33829372 DOI: 10.1007/s13760-021-01669-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
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León-Andrino A, Noriega DC, Lapuente JP, Pérez-Valdecantos D, Caballero-García A, Herrero AJ, Córdova A. Biological Approach in the Treatment of External Popliteal Sciatic Nerve (Epsn) Neurological Injury: Review. J Clin Med 2022; 11:2804. [PMID: 35628928 PMCID: PMC9144828 DOI: 10.3390/jcm11102804] [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: 03/28/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
The external popliteal sciatic nerve (EPSN) is the nerve of the lower extremity most frequently affected by compressive etiology. Its superficial and sinuous anatomical course is closely related to other rigid anatomical structures and has an important dynamic neural component. Therefore, this circumstance means that this nerve is exposed to multiple causes of compressive etiology. Despite this fact, there are few publications with extensive case studies dealing with treatment. In this review, we propose to carry out a narrative review of the neuropathy of the EPSN, including an anatomical reminder, its clinical presentation and diagnosis, as well as its surgical and biological approach. The most novel aspect we propose is the review of the possible role of biological factors in the reversal of this situation.
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Affiliation(s)
- Alejandro León-Andrino
- Department of Orthopedic Surgery, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain;
| | - David C. Noriega
- Department of Orthopedic Surgery, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain;
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain
| | - Juan P. Lapuente
- SCO (Scientific Chief Officer) Laboratorio de Biología Molecular y Celular R4T, University Hospital of Fuenlabrada, 28942 Fuenlabrada, Spain;
| | - Daniel Pérez-Valdecantos
- Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, University of Valladolid, Campus Duques de Soria, 42004 Soria, Spain; (D.P.-V.); (A.C.)
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, University of Valladolid, Campus Duques de Soria, 42004 Soria, Spain;
| | - Azael J. Herrero
- Department of Health Sciences, Miguel de Cervantes European University, 47012 Valladolid, Spain;
| | - Alfredo Córdova
- Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, University of Valladolid, Campus Duques de Soria, 42004 Soria, Spain; (D.P.-V.); (A.C.)
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8
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Bilateral foot drop after COVID-19-related acute respiratory distress syndrome: A case report. Turk J Phys Med Rehabil 2021; 67:378-381. [PMID: 34870128 PMCID: PMC8606987 DOI: 10.5606/tftrd.2021.8194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/02/2021] [Indexed: 12/15/2022] Open
Abstract
In these days of the pandemic, we have faced with the locomotor system problems following severe acute respiratory syndrome-coro- navirus 2 (SARS-CoV-2) infection. While some of these problems are related to the disease itself, some of them are associated with the prolonged immobilization during the infection. Long-term intensive care unit admissions of patients may also lead to various types of neuropathies, extending the recovery period. The real burden of the novel coronavirus-2019 (COVID-19) is still unclear. In particular, after a prolonged hospitalization period, the duration of rehabilitation may be longer to gain independence in daily living activities. In this report, we present a different aspect of the COVID-19 with bilateral foot drop in a 53-year-old female patient. To the best of our knowledge, this case is the first report of both peroneal and sciatic nerve damage following COVID-19.
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9
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Abstract
Neuropathies are a common problem encountered by neurologist in the hospitalized setting. Nerve injury may occur secondary to compression, stretch, and direct trauma, among other causes. Common focal neuropathies include the ulnar, median, and radial nerve in the upper extremities and sciatic, peroneal, and femoral nerve in the lower extremities. Surgical and obstetric risk factors are especially important considerations in evaluation of patients with focal neuropathies. Treatment is either conservative therapy or surgery depending on the mechanism of injury and extent of recovery.
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Affiliation(s)
- Mark Terrelonge
- University of California San Francisco, 400 Parnassus Avenue, 8th Floor, San Francisco, CA 94143, USA.
| | - Laura Rosow
- University of California San Francisco, 400 Parnassus Avenue, 8th Floor, San Francisco, CA 94143, USA
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10
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Kurt Oktay KN, Akpinar P, Unlu Ozkan F, Aktas I, Ersoy Canillioglu Y, Erkanli Senturk G. The Effect of Alpha Lipoic Acid on the Recovery of Sciatic Nerve Injury in Rats: A Prospective Randomized Controlled Trial. Am J Phys Med Rehabil 2021; 100:780-789. [PMID: 33229887 DOI: 10.1097/phm.0000000000001642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the regenerative effects of alpha lipoic acid on the recovery of sciatic nerve crush injury (SNCI) in rats. DESIGN This was a randomized, experimental, and sham-controlled study. The sciatic nerves of 28 rats in four groups were traumatized for 60 secs: G1, sham operated + saline; G2, SNCI + saline; G3, SNCI + alpha lipoic acid 50 mg/kg/day; and G4, SNCI + alpha lipoic acid 100 mg/kg/day. Sciatic functional index values were measured on day 0, 1, 7, 14, 21, and 28. Sciatic nerve stimulation threshold values were recorded on day 1, 14, and 28. End-point histopathologic evaluation was conducted. RESULTS The mean sciatic functional index value of G2 but not G3/G4 on day 7 was significantly lower than on day 0 (P = 0.035, P = 0.447/P = 0.800). The mean sciatic functional index value of G2 but not G3/G4 increased significantly between day 7 and 14 (P = 0.035, P = 0.447/P = 0.438). The day 14 mean sciatic nerve stimulation threshold values of G3/G4 but not G2 were decreased significantly compared with those on day 1 (P = 0.022/P = 0.022, P = 0.933). The mean sciatic nerve stimulation threshold values of G3/G4 on day 14 were similar to those on day 0 (P = 0.106/P = 0.418). Regeneration in muscle and nerve connective tissues and nerve structures was observed in G3/G4. Inflammation in the muscle and nerve tissues of G4 was suppressed down to similar levels of G1. Myelinated nerve fibers were less degenerated in G3/G4. CONCLUSION Alpha lipoic acid has the potential to accelerate the process of nerve healing in the context of SNCI in rats.
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Affiliation(s)
- Kubra Neslihan Kurt Oktay
- From the University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation (KNKO, PA, FUO, IA); Bahcesehir University Faculty of Medicine, Department of Histology and Embryology (YEC); and Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Histology and Embryology (GES), Istanbul, Turkey
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11
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Abstract
This article addresses the importance of anesthesiologists providing regional anesthesia techniques that are beneficial to the care of trauma patients in the field. It also discusses the advantages and risks associated with regional anesthesia in the field along with how to avoid those risks. In addition, it describes some of the benefits of modern ultrasound techniques compared with landmark techniques with stimulation and other important considerations when performing regional anesthesia in the field. The article gives the unique indications, risks, and key points of the most useful regional techniques for anesthesiologists operating in field environments.
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Affiliation(s)
- Robert Vietor
- Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Chester Buckenmaier
- Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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12
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Reel BA, Odedokun TA, Simmons DB, Hong L. Bilateral Sciatic Neuropathies as a Complication of Positioning During Neuraxial Anesthesia for Cesarean Delivery: A Case Report. A A Pract 2019; 13:173-175. [PMID: 31265445 DOI: 10.1213/xaa.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neurologic complications following neuraxial anesthesia for cesarean delivery are rare. We present a 33-year-old parturient who developed prolonged lower extremity weakness following a single-shot subarachnoid block for cesarean delivery. After neurologic evaluation, she was diagnosed with bilateral sciatic neuropathies due to prolonged positioning for the anesthetic. We review the incidence of nerve injury associated with neuraxial anesthesia and risk factors for developing peripheral nerve injury in this context. We offer a solution to prevent this complication from occurring.
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13
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Clinical and Electrodiagnostic Features Of Nontraumatic Sciatic Neuropathy. Muscle Nerve 2018; 59:309-314. [DOI: 10.1002/mus.26380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/07/2022]
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Daniels SP, Feinberg JH, Carrino JA, Behzadi AH, Sneag DB. MRI of Foot Drop: How We Do It. Radiology 2018; 289:9-24. [DOI: 10.1148/radiol.2018172634] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Steven P. Daniels
- From the Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY (S.P.D., A.H.B.); Electrodiagnostic Services, Department of Physiatry (J.H.F.), and Department of Radiology & Imaging (J.A.C., D.B.S.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Joseph H. Feinberg
- From the Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY (S.P.D., A.H.B.); Electrodiagnostic Services, Department of Physiatry (J.H.F.), and Department of Radiology & Imaging (J.A.C., D.B.S.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - John A. Carrino
- From the Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY (S.P.D., A.H.B.); Electrodiagnostic Services, Department of Physiatry (J.H.F.), and Department of Radiology & Imaging (J.A.C., D.B.S.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Ashkan Heshmatzadeh Behzadi
- From the Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY (S.P.D., A.H.B.); Electrodiagnostic Services, Department of Physiatry (J.H.F.), and Department of Radiology & Imaging (J.A.C., D.B.S.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Darryl B. Sneag
- From the Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY (S.P.D., A.H.B.); Electrodiagnostic Services, Department of Physiatry (J.H.F.), and Department of Radiology & Imaging (J.A.C., D.B.S.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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15
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Abstract
RATIONALE Sciatic neuropathy has various causes; however, cases in which a pressure ulcer led to sciatic neuropathy have not been reported to date. PATIENT CONCERNS A 33-year-old woman with no pre-existing mobility problems visited our department with the chief complaint of an extensive pressure ulcer and necrosis in her right buttock. She had a medical history of being bedridden for 2 days while in a coma due to a drug overdose 2 months previously. Physical examination revealed loss of sensation and foot drop in the right foot. DIAGNOSIS Physical examination, magnetic resonance imaging, and nerve conduction studies were conducted; the patient was diagnosed with a common peroneal branch injury of the right sciatic nerve. INTERVENTIONS The necrotic tissue was debrided and sciatic nerve decompression was performed, followed by frequent dressing changes. In addition, psychiatric treatment and physical therapy were performed simultaneously. OUTCOMES The pressure ulcer decreased in size and healed to some extent with granulation tissue. However, gait disorders, accompanied by symptoms of sciatic neuropathy, continued. The patient was transferred to the department of gastroenterology for the treatment of toxic hepatitis, which occurred during her inpatient treatment. LESSONS Physicians should be aware that sciatic neuropathy may occur during the treatment of patients with a pressure ulcer who exhibit no symptoms of paraplegia or quadriplegia. To prevent neuropathy, aggressive treatment of the pressure ulcer is necessary.
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16
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VanWye WR, Wallmann HW, Norris ES, Furgal KE. Differential diagnosis of knee pain following a surgically induced lumbosacral plexus stretch injury. A case report. Physiother Theory Pract 2018; 35:1355-1362. [PMID: 29877751 DOI: 10.1080/09593985.2018.1477891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background and Purpose: Knee joint biomechanics requires an understanding of lower extremity (LE) segmental interactions. In some cases, knee pain may arise as a result of altered LE biomechanics; while in other cases, knee pain may stem from other causes, such as a peripheral nerve injury. Case Description: A 33-year-old woman presented via direct access for physical therapist (PT) examination with a chief complaint of left knee pain. The day after undergoing a dilation and curettage (D&C) procedure the patient had an acute onset of gait dysfunction. Over the next few days, the patient developed left anterior knee pain (7/10 at worst) in addition to a significant change in physical functioning (Lower Extremity Functional Scale [LEFS] 38/80). Physical examination revealed left LE weakness, altered sensation, and an absent Achilles deep tendon reflex. Outcomes: The patient's presentation was consistent with a lumbosacral plexus stretch injury, with S1 being most affected. A physiatrist was consulted and recommended initiating PT treatment with bi-weekly re-examination. The 6-week (14 visits) re-examination revealed abolished left knee pain and improved physical functioning (LEFS 66/80). Conclusion: Stretch injuries are a known complication of lithotomy positioning. Knowledge of this and the addition of a thorough examination allowed the PT to identify the possible cause of the patient's abrupt onset of left LE dysfunction. Regardless of mode of patient access, screening for referral is crucial and may include referral or, as in this case, consultation with other professionals.
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Affiliation(s)
- William R VanWye
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA
| | - Harvey W Wallmann
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA
| | - Elizabeth S Norris
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA
| | - Karen E Furgal
- Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA
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17
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Lolis AM, Falsone S, Beric A. Common peripheral nerve injuries in sport: diagnosis and management. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:401-419. [PMID: 30482369 DOI: 10.1016/b978-0-444-63954-7.00038-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Peripheral nerve injuries are unusual in sport but impact an athlete's safe return to play. Nerve injuries result from either acute trauma (most commonly in contact/collision sports) or from repetitive microtrauma and overuse. Diagnosis of overuse nerve injuries includes nerve localization and surrounding soft-tissue anatomy, and must account for possible causes of repetitive microtrauma, including biomechanics, equipment, training schedule, and recovery. Prognosis is related to the type of nerve injury. Management should not simply be rest and gradual return to sport but should address biomechanical and training predispositions to injury. Understanding the type of injury and the tissues involved will guide appropriate rehabilitation decisions. Recognizing acute care considerations and implementing appropriate strategies can help minimize secondary trauma to an area following acute injury.
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Affiliation(s)
- Athena M Lolis
- Division of Clinical Neurophysiology, Department of Neurology, NYU School of Medicine, New York, NY, United States
| | - Susan Falsone
- Department of Athletic Training, A.T. Still University, Mesa, AZ, United States
| | - Aleksandar Beric
- Division of Clinical Neurophysiology, Department of Neurology, NYU School of Medicine, New York, NY, United States.
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18
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Lee J, Lee JH, Kim GS, Park MC, Woo N, Cho JH. Ischemic Sciatic Neuropathy in a Patient with Liposarcoma. JOURNAL OF NEUROCRITICAL CARE 2017. [DOI: 10.18700/jnc.160100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Leach MJ, Francis A, Ziaian T. Transcendental Meditation for the improvement of health and wellbeing in community-dwelling dementia caregivers [TRANSCENDENT]: a randomised wait-list controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:145. [PMID: 25952550 PMCID: PMC4429365 DOI: 10.1186/s12906-015-0666-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/30/2015] [Indexed: 11/26/2022]
Abstract
Background Dementia is a prevalent neurodegenerative disorder affecting an estimated 24.3 million people across the globe. The burden on those caring for people with dementia is substantial, with widespread implications for the caregiver, the care recipient and the community. Relaxation techniques, such as Transcendental Meditation® (TM), have been shown to reduce stress and anxiety in healthy workers; similar benefits are anticipated in dementia caregivers. The objective of this study was to ascertain whether TM can improve psychological stress, quality of life, affect and cognitive performance in dementia caregivers. Methods The study was conducted as a pilot prospective, multi-centre, community-based, randomised wait-list controlled trial. Community-dwelling caregivers of persons with diagnosed dementia were randomly assigned to a 12-week (14-hour) TM training program or wait-list control. Participants were assessed for quality of life, stress, affect, cognitive performance and adverse effects. The feasibility of the study was also evaluated. Results Seventeen caregivers were recruited and randomised. Improvements in WebNeuro response speed scores over time were significantly (p = 0.03) greater in the TM group relative to control. Changes between groups over time in all other primary and secondary outcome measures did not reach statistical significance. However, there was a trend toward greater improvement in WebNeuro stress, depression and negativity bias scores in the TM group. Adverse events were reported amongst 63 % of TM-treated subjects; however, events were generally transient, of mild-moderate intensity and only ‘possibly’ related to TM. Conclusions Dementia caregivers exposed to TM demonstrated varying degrees of improvement in several measures of cognitive function, mood, quality of life and stress following exposure to TM. However, as the pilot study was underpowered, no firm conclusions can be made about the effectiveness of TM in this caregiver population. Findings from full-scale trials are now warranted. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12613000184774 (Registered 15th February 2013).
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Topakian R, Wimmer S, Pischinger B, Pichler R. Hereditary neuropathy with liability to pressure palsies presenting with sciatic neuropathy. BMJ Case Rep 2014; 2014:bcr-2014-206883. [PMID: 25326571 DOI: 10.1136/bcr-2014-206883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant disorder associated with recurrent mononeuropathies following compression or trivial trauma. Reports on sciatic neuropathy as the presenting manifestation of HNPP are very scarce. We report on a 21-year-old previously healthy man who was admitted with sensorimotor deficits in his left leg. He had no history of preceding transient episodes of weakness or sensory loss. Clinical and electrophysiological examinations were consistent with sciatic neuropathy. Cerebrospinal fluid investigation and MRI of the nerve roots, plexus, and sciatic nerve did not indicate the underlying aetiology. When extended electrophysiological tests revealed multiple subclinical compression neuropathies in the upper limbs, HNPP was contemplated and eventually confirmed by genetic testing.
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Affiliation(s)
- Raffi Topakian
- Department of Neurology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Sibylle Wimmer
- Institute of Radiology, Wagner-Jauregg Hospital, Linz, Austria
| | | | - Robert Pichler
- Institute of Nuclear Medicine, Academic Teaching Hospital Wagner-Jauregg, Linz, Austria
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Yoon DH, Cho H, Seol SJ, Kim T. Right calf claudication revealing leriche syndrome presenting as right sciatic neuropathy. Ann Rehabil Med 2014; 38:132-7. [PMID: 24639938 PMCID: PMC3953357 DOI: 10.5535/arm.2014.38.1.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/25/2013] [Indexed: 11/30/2022] Open
Abstract
The syndrome of aortoiliac occlusive disease, also known as Leriche syndrome, is characterized by claudication, pain, and diminished femoral pulse. We highlight an unusual case of right sciatic neuropathy caused by Leriche syndrome, which was initially misdiagnosed. A 52-year-old male, with a past medical history of hypertension and bony fusion of the thoracolumbar spine, visited our hospital complaining of right leg pain and claudication, and was initially diagnosed with spinal stenosis. The following electrophysiologic findings showed right sciatic neuropathy; but his symptom was not relieved, despite medications for neuropathy. A computed tomography angiography of the lower extremities revealed the occlusion of the infrarenal abdominal aorta, and bilateral common iliac and right external iliac arteries. All these findings suggested omitted sciatic neuropathy associated with Leriche syndrome, and the patient underwent a bilateral axillo-femoral and femoro-femoral bypass graft.
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Affiliation(s)
- Do Hyun Yoon
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyungpil Cho
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Jun Seol
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Taikon Kim
- Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
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