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Valenzuela-Fuenzalida JJ, Inostroza-Wegner A, Osorio-Muñoz F, Milos-Brandenberg D, Santana-Machuca A, Nova Baeza P, Donoso MO, Bruna-Mejias A, Iwanaga J, Sanchis-Gimeno J, Gutierrez-Espinoza H. The Association between Anatomical Variants of Musculoskeletal Structures and Nerve Compressions of the Lower Limb: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:695. [PMID: 38611609 PMCID: PMC11011940 DOI: 10.3390/diagnostics14070695] [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: 02/12/2024] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Objective: The aim of this study was to describe the main anatomical variants and morphofunctional alterations in the lower limb that compress surrounding nervous structures in the gluteal region, thigh region, and leg and foot region. Methods: We searched the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to October 2023. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality, and the Joanna Briggs Institute assessment tool for case reports was also used. Forest plots were generated to assess the prevalence of variants of the gluteal region, thigh, and leg. Results: According to the forest plot of the gluteal region, the prevalence was 0.18 (0.14-0.23), with a heterogeneity of 93.52%. For the thigh region, the forest plot presented a prevalence of 0.10 (0.03-0.17) and a heterogeneity of 91.18%. The forest plot of the leg region was based on seven studies, which presented a prevalence of 0.01 (0.01-0.01) and a heterogeneity of 96.18%. Conclusions: This review and meta-analysis showed that, in studies that analyzed nerve compressions, the prevalence was low in the thigh and leg regions, while in the gluteal region, it was slightly higher. This is mainly due to the PM region and its different variants. We believe that it is important to analyze all the variant regions defined in this study and that surgeons treating the lower limb should be attentive to these possible scenarios so that they can anticipate possible surgical situations and thus avoid surgical complications.
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Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Department of Morphology and Function, Faculty of Health Sciences, Universidad De Las Américas, Santiago 7500000, Chile; (J.J.V.-F.); (A.S.-M.)
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
| | - Alfredo Inostroza-Wegner
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
| | - Francisca Osorio-Muñoz
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
| | - Daniel Milos-Brandenberg
- Escuela de Medicina, Facultad Ciencias de la Salud, Universidad del Alba, Santiago 8320000, Chile;
| | - Andres Santana-Machuca
- Department of Morphology and Function, Faculty of Health Sciences, Universidad De Las Américas, Santiago 7500000, Chile; (J.J.V.-F.); (A.S.-M.)
| | - Pablo Nova Baeza
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
| | - Mathias Orellana Donoso
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile
| | - Alejandro Bruna-Mejias
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8320000, Chile; (A.I.-W.); (F.O.-M.); (P.N.B.); (M.O.D.); (A.B.-M.)
| | - Joe Iwanaga
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain;
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Greenwood K, Mogale N, Van Zyl R, Keough N, Hohmann E. A Posteromedial Portal Allows Access to the Posteromedial Knee, While a Posterolateral Portal Risks Common Fibular Nerve Injury: A Cadaveric Analysis. Arthrosc Sports Med Rehabil 2024; 6:100880. [PMID: 38318393 PMCID: PMC10839260 DOI: 10.1016/j.asmr.2023.100880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024] Open
Abstract
Purpose To investigate the safety and accessibility of direct posterior medial and lateral portals into the knee. Methods This study was a controlled laboratory study that comprised a sample of 95 formalin-embalmed cadaveric knees and 9 fresh-frozen knees. Cannulas were inserted into the knees, 16 mm from the vertical plane between the medial epicondyle of the femur and the medial condyle of the tibia, and 8 (females) and 14 mm (males) from the vertical plane connecting the lateral femoral epicondyle and lateral tibial condyle. Landmarks were identified in full extension, and cannula insertion was completed with the formalin-embalmed knees in full extension and the fresh-frozen knees in 90 degrees of flexion. The posterior aspects of the knees were dissected from superficial to deep to assess potential damage caused by the cannula insertion. Results The incidence of neurovascular damage was 9.6% (n = 10): 0.96% for the medial cannula and 8.7% for the lateral cannula. The medial cannula damaged 1 small saphenous vein (SSV). The lateral cannula damaged 1 SSV, 7 common fibular nerves (CFNs), and both the CFN and lateral cutaneous sural nerve in 1 specimen. All incidences of damage occurred in formalin-embalmed knees. The posterior horns of the menisci were accessible in all specimens. Conclusions A direct posterior portal into the knee with reference to the medial bony landmarks of the knee proved safe in 99% of the cadaveric sample and allowed access to the posterior horn of the medial meniscus. A direct posterior portal with reference to the lateral bony landmarks demonstrated a higher risk of neurovascular damage in the embalmed sample but no damage in the fresh-frozen sample. Given the severe consequences of common fibular nerve injury, recommending this approach at this stage is not advisable. Clinical Relevance Direct posterior arthroscopy portals are understudied but may allow safe visualization of the posterior knee compartments and may also assist to manage repair of ramp lesions and posterior meniscus pathology.
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Affiliation(s)
- Kelsi Greenwood
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Nkhensani Mogale
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Reinette Van Zyl
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Natalie Keough
- Department of Clinical Anatomy and Imaging, Warwick Medical School, The University of Warwick, Warwick, UK
| | - Erik Hohmann
- Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates
- School of Medicine, Medical School, University of Pretoria, South Africa
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Drăghici NC, Văcăraș V, Bolchis R, Bashimov A, Domnița DM, Iluț S, Popa LL, Lupescu TD, Mureșanu DF. Diagnostic Approach to Lower Limb Entrapment Neuropathies: A Narrative Literature Review. Diagnostics (Basel) 2023; 13:3385. [PMID: 37958280 PMCID: PMC10647627 DOI: 10.3390/diagnostics13213385] [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: 10/09/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Entrapment neuropathies of the lower limb are a misunderstood and underdiagnosed group of disorders, characterized by pain and dysesthesia, muscular weakness, and specific provoking movements on physical examination. The most frequent of these syndromes encountered in clinical practice are fibular nerve entrapment, proximal tibial neuropathy, sural nerve neuropathy, deep gluteal syndrome or sciatic nerve entrapment, and lateral femoral cutaneous nerve entrapment, also known as meralgia paresthetica. These are commonly mistaken for lumbar plexopathies, radiculopathies, and musculotendinous diseases, which appear even more frequently and have overlapping clinical presentations. A comprehensive anamnesis, physical examination, and electrodiagnostic studies should help clarify the diagnosis. If the diagnosis is still unclear or a secondary cause of entrapment is suspected, magnetic resonance neurography, MRI, or ultrasonography should be conducted to clarify the etiology, rule out other diseases, and confirm the diagnosis. The aim of this narrative review was to help clinicians gain familiarity with this disease, with an increase in diagnostic confidence, leading to early diagnosis of nerve damage and prevention of muscle atrophy. We reviewed the epidemiology, anatomy, pathophysiology, etiology, clinical presentation, and EDX technique and interpretation of the entrapment neuropathies of the lower limb, using articles published from 1970 to 2022 included in the Pubmed, MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Scopus databases.
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Affiliation(s)
- Nicu Cătălin Drăghici
- “IMOGEN” Institute, Centre of Advanced Research Studies, 400012 Cluj-Napoca, Romania;
- “RoNeuro” Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania; (S.I.); (L.L.P.)
- Department of Clinical Neurosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Vitalie Văcăraș
- “RoNeuro” Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania; (S.I.); (L.L.P.)
- Department of Clinical Neurosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Roxana Bolchis
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (R.B.)
| | - Atamyrat Bashimov
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (R.B.)
| | - Diana Maria Domnița
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (R.B.)
| | - Silvina Iluț
- “RoNeuro” Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania; (S.I.); (L.L.P.)
- Department of Clinical Neurosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Livia Livinț Popa
- “RoNeuro” Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania; (S.I.); (L.L.P.)
- Department of Clinical Neurosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Tudor Dimitrie Lupescu
- “RoNeuro” Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania; (S.I.); (L.L.P.)
- Department of Clinical Neurosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Dafin Fior Mureșanu
- “RoNeuro” Institute for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania; (S.I.); (L.L.P.)
- Department of Clinical Neurosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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Khodulev V, Klimko A, Charnenka N, Zharko M, Khoduleva H. Acute Radial Compressive Neuropathy: The Most Common Injury Induced by Japanese Rope Bondage. Cureus 2023; 15:e39588. [PMID: 37384078 PMCID: PMC10294117 DOI: 10.7759/cureus.39588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/30/2023] Open
Abstract
Japanese rope bondage (RB), or Shibari, is an art form involving the voluntary and aesthetic binding of a person with a rope, which may result in compression injuries to peripheral nerves. To investigate the nature and extent of nerve injuries associated with this practice, we conducted a survey of four experienced RB practitioners (riggers) and participants who were willing to share their experiences of injury. Injuries presented acutely and immediately following full-body suspensions, with a total of 10 individuals (16 injuries) identified with damage to the radial, axillary, or femoral nerves. Notably, the radial nerve was the most commonly affected structure in our patient cohort, with 90.0% of individuals experiencing an injury at this level. We present a rare case of acute repeated compression of the radial nerve during full-body suspension RB. A 29-year-old female was suspended for 25 minutes using a 6-mm jute rope, resulting in wrist and finger drop, as well as reduced sensation in the left hand. Analysis revealed a 77.3% conduction block in the upper arm segment. Improvement was observed after three months, fully achieved after five months. Seventeen months later, re-compression of both radial nerves occurred during a similar suspension lasting 8-10 minutes. Improvement occurred after one week, fully achieved after four weeks. The third compression episode occurred three years later, lasting five minutes, with full recovery within two minutes. This study focuses on the injury of peripheral nerves, including the radial, axillary, and femoral nerves, namely, acute compression neuropathy induced by Japanese RB. Because the radial nerve is the most frequently injured structure, the findings underscore the significance of recognizing the anatomical course of the radial nerve, particularly its position posteriorly at the distal deltoid tuberosity level, as a means of preventing nerve injury in this region. This knowledge is particularly crucial for individuals engaged in the practice of RB, emphasizing the importance of taking precautions to avoid potential nerve damage.
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Affiliation(s)
- Vasily Khodulev
- Department of Functional Diagnostics, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, BLR
| | - Artsiom Klimko
- Department of Neurology, University Hospital of Zurich, Zurich, CHE
| | - Nataliya Charnenka
- Department of Diagnostic Sonography, Multidisciplinary Medical Center "Healthy Sleep Center", Minsk, BLR
| | - Marina Zharko
- Department of Anatomical Pathology, City Clinical Pathologoanatomic Bureau, Minsk, BLR
| | - Hanna Khoduleva
- Department of Pediatrics, Belarusian State Medical University, Minsk, BLR
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Gomez YDLC, Remotti E, Momah DU, Zhang E, Swanson DD, Kim R, Urits I, Kaye AD, Robinson CL. Meralgia Paresthetica Review: Update on Presentation, Pathophysiology, and Treatment. Health Psychol Res 2023; 11:71454. [PMID: 36937080 PMCID: PMC10019995 DOI: 10.52965/001c.71454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Purpose of Review Meralgia paresthetica (MP) is a condition characterized by paresthesias, neuropathic pain, and alterations in sensorium of the anterolateral thigh secondary to impingement of the lateral femoral cutaneous nerve (LFCN). MP is generally diagnosed by clinical history and is often a diagnosis of exclusion. When diagnosis remains a challenge, diagnostic modalities such as ultrasound, MRI, electromyography, and nerve conduction studies have been utilized as an adjunct. This review summarizes the most recent medical literature regarding MP, its pathophysiology, presentation, and current treatment options. Recent Findings Treatment options for patients with MP range from lifestyle modifications and conservative management to surgical procedures. Initial management is often conservative with symptoms managed with medications. When conservative management fails, the next step is regional blocks followed by surgical management. The conflicting data for treatment options for MP highlight how the evidence available does not point to a single approach that's universally effective for treating all patients with MP. Summary Despite the apparent success at treating MP with regional blocks and surgical interventions, much remains to be known about the dosing, frequency, and optimal interventions due to the inconclusive results of current studies. Further research including randomized controlled trials are needed to better understand the most optimal treatment options for MP including studies with a larger number of participants.
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Affiliation(s)
| | - Edgar Remotti
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Deandra Uju Momah
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Emily Zhang
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Daniel D Swanson
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | - Rosa Kim
- Georgetown University Hospital, Department of General Surgery, Medstar, Washington, DC
| | | | - Alan D Kaye
- Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA
| | - Christopher L Robinson
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
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Garg SP, Hassan AM, Patel A, Ketheeswaran S, Galiano RD, Ko JH. A systematic review of nerve grafting, end-to-end repair, and nerve transfer for obturator nerve injuries. Int J Gynecol Cancer 2022; 32:ijgc-2022-003565. [PMID: 35948366 DOI: 10.1136/ijgc-2022-003565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Obturator nerve injury can occur as a complication of gynecologic surgeries, occurring most frequently in patients with endometriosis and genitourinary malignancies. The resulting injury causes paresthesia and major weakness in adduction and atrophy of the adductor group of lower extremity muscles. The objective of this study was to conduct a systematic review and meta-analysis of the effectiveness of end-to-end repair, nerve grafting, and nerve transfer in improving motor function in patients with obturator nerve injury. METHODS PubMed, Cochrane, Medline, and Embase libraries were searched from May 1994 to August 2020 according to the PRISMA guidelines for articles that present functional outcomes after obturator nerve injury in patients treated with nerve grafting, end-to-end repair, or nerve transfer. RESULTS A total of 25 patients from 22 studies were included in the study, 15 of whom were treated with end-to-end repair (60%), nine with nerve grafting (36%), and one with nerve transfer (4%). Of the 15 patients with transection data, two had incomplete (13%) and 13 had complete (87%) nerve transections. The patients underwent pelvic lymphadenectomy (n=24) and radical cystectomy (n=1) operations. The mean Medical Research Council (MRC) score was 2.95±1.7 immediately after treatment and 4.77±0.6 at the final follow-up. All patients achieved good outcomes (MRC ≥3) at the final follow-up. The mean MRC score for end-to-end repair (n=15), nerve grafting (n=9), and nerve transfer (n=1) was 4.8±0.6, 4.7±0.8, and 5, respectively. Patients with end-to-end repair had higher immediate post-operative strength than those treated with nerve grafting (p=0.03) and tended to achieve full functional recovery after shorter periods of time (rho=-0.65, p=0.049). Other parameters did not correlate with MRC. CONCLUSION End-to-end repair, nerve grafting, and nerve transfer are equally effective in restoring function in patients with obturator nerve injury. However, patients treated with end-to-end repair had higher immediate post-operative strength than those treated with nerve grafting.
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Affiliation(s)
- Stuti P Garg
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abbas M Hassan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anooj Patel
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Robert D Galiano
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jason H Ko
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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7
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Diaz WD, Moreland G, Barkley L. Nerve Entrapment Syndrome: Chronic Lower Leg Pain in Athletes. Curr Sports Med Rep 2022; 21:263-264. [PMID: 35946843 DOI: 10.1249/jsr.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Wuilly D Diaz
- Charles R. Drew University of Medicine & Science, Los Angeles, CA
| | - George Moreland
- Charles R. Drew University of Medicine & Science, Los Angeles, CA
| | - Lisa Barkley
- Department of Family Medicine, Charles R. Drew University of Medicine & Science, Los Angeles, CA
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Brand P, Cejas CP, Rivero AD. Childhood focal compressive mononeuropathies during the COVID-19 pandemic in Buenos Aires, Argentina. Muscle Nerve 2022; 65:590-593. [PMID: 35083751 PMCID: PMC9015344 DOI: 10.1002/mus.27507] [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: 06/28/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 11/20/2022]
Abstract
Introduction/Aims Focal peripheral neuropathies are infrequently seen in pediatric patients. The COVID‐19 pandemic has disrupted normal life for many people, including complete lockdowns and school closing for long periods of time in many countries, which prompted children to stay at home. Our aim is to assess whether there has been an increased incidence of focal compressive peripheral neuropathies in the pediatric population during COVID‐19–associated lockdown. Methods Clinical, electrophysiological, and imaging characteristics were reviewed for patients referred to the electrodiagnostic (EDx) laboratory with suspicion of a focal neuropathy. The incidence of focal compressive peripheral neuropathies seen during the period of March to September 2020 was compared with the same time period in 2019. Results An increased incidence of focal neuropathies was seen in 2020 (31%) compared with 2019 (6.8%). During 2020, 7 fibular (peroneal) mononeuropathies and 2 ulnar neuropathies were diagnosed. Most patients with focal neuropathies were underweight and acknowledged prolonged screen time periods. Electrophysiological findings consisted of mostly demyelinating lesions with an overall good clinical outcome. Discussion In this study we raise awareness about a possible increased incidence of focal compressive peripheral neuropathies in children during COVID‐19–associated lockdown, which may be prevented with changing positions during sedentary activities.
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Abstract
Carpal tunnel syndrome, ulnar neuropathy at the elbow, and peroneal neuropathy are the most common mononeuropathies; however, other individual nerves may also be injured by various processes. These uncommon mononeuropathies may be less readily diagnosed owing to unfamiliarity with the presentations and vague symptoms. Electrodiagnostic studies are essential in the evaluation of uncommon mononeuropathies and can assist in localization and prognostication. However, they can also be challenging; stimulation at the proximal sites is difficult and well-validated reference values are not available. This article reviews the electrodiagnostic assessment of several uncommon upper and lower extremities mononeuropathies.
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Affiliation(s)
- Ghazala Hayat
- Saint Louis University School of Medicine, Saint Louis, MO, USA.
| | - Jeffrey S Calvin
- Department of Neurology, Saint Louis University School of Medicine, Saint Louis, MO, USA
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10
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The Importance of Sacral Neuroanatomy in Pain Syndromes and Procedures. Neuromodulation 2021. [DOI: 10.5812/ipmn.116625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
: The neural plexus exists in different parts of the body. The sacral plexus is the lowest neural network in the body that is responsible for sensory and motor innervation to a large part of the body. The sacral plexus or sacral nerve roots may be damaged by diseases, such as disc herniation, spinal canal stenosis, and cancer or iatrogenic injuries during surgery or interventional pain procedures (open spinal surgeries, hip surgeries, percutaneous endoscopic disc decompression, trans-sacral epiduroscopic laser decompression, …). Patients with sacral nerve damage may experience a variety of symptoms, including low back pain radiating to the legs, sensory disturbance in the buttocks or legs, motor weakness in the legs, bladder or bowel dysfunction (urinary retention/incontinence, defecation’s problems), or sexual dysfunction. Therefore, complete familiarity with the anatomy of the sacral plexus is very important. In this article, we tried to review the anatomy of the sacral plexus and sensory or motor innervations of each terminal branch of the sacral plexus. Also, the clinical importance of these nerves in the development of pain syndromes and diagnostic and therapeutic methods for damage to the terminal branches of the sacral plexus were investigated.
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Lower Extremity Injury While Undergoing Urology Procedures in the Trendelenburg with Lithotomy Position: Three Case Reports. J Perianesth Nurs 2021; 36:214-218. [PMID: 33926806 DOI: 10.1016/j.jopan.2020.08.010] [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: 04/11/2020] [Revised: 06/28/2020] [Accepted: 08/23/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To report and discuss the incidence of severe lower extremity injuries associated with robotic procedures in Trendelenburg with lithotomy position. DESIGN AND METHODS A case study method was used to describe three cases of patients who underwent robotically assisted urological procedures in Trendelenburg with lithotomy position and developed serious lower extremities injuries resulting in fasciotomies. Furthermore, a literature review was conducted to evaluate risk factors and possible interventions for the prevention of similar injuries. FINDINGS Case analysis revealed multifactorial causes, including patient comorbidities, long surgical procedures, and blood pressure decreases below the baseline for more than 30 minutes. The severity of lower extremity injury associated with lithotomy position may be underestimated. The etiology of peripheral nerve injury can be attributed to patient comorbidities, positioning, and surgical conditions. Injury prevention should include careful patient and procedural risk assessment, staff education, and communication strategies. CONCLUSIONS Extreme Trendelenburg with lithotomy position for longer periods can lead to serious lower extremities injuries. Preanesthetic screening and multidisciplinary team discussions for additional precautions for high-risk patients are crucial interventions to decrease incidence and severity of lower extremities injuries.
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Zhang Y, He X, Li J, Ye J, Han W, Zhou S, Zhu J, Wang G, Chen X. An MRI study of the tibial nerve in the ankle canal and its branches: a method of multiplanar reformation with 3D-FIESTA-C sequences. BMC Med Imaging 2021; 21:51. [PMID: 33731040 PMCID: PMC7968234 DOI: 10.1186/s12880-021-00582-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 03/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background The visualization of the tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and it is also useful for clinical observation and surgical planning. The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reformation (MPR) display of the tibial nerve and its branches in the ankle canal. Methods The subjects were 20 healthy volunteers (40 ankles), aged 22–50 years, with no history of ankle joint disease. The 3D-FIESTA-C sequence was used in the 3.0 T magnetic resonance equipment for imaging. During scanning, each foot was at an angle of 90° to the tibia. The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through MPR. Results Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few bifurcation points (42.5%) were located at the proximal end of the ankle canal, and none of them were found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve was on the line between the tip of the medial malleolus and the calcaneus, and it’s angle ranged between 6° and 35°. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than two medial calcaneal nerve innervations. Conclusion The 3D-FIESTA-C MPR can display the morphological features and positions of the tibial nerve and its branches and the bifurcation point’s projection position can be marked on the body surface. This method not only benefited the imaging diagnosis of the tibial nerve and branch-related lesions in the ankle canal, but it also provided a good imaging basis to plan a clinical operation of the ankle canal and avoid surgical injury.
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Affiliation(s)
- Yan Zhang
- Department of Radiology, Shandong Mental Health Center, Shandong, 250014, China
| | - Xucheng He
- Department of Radiology, Third Medical Centre of Chinese PLA General Hospital, Beijing, 100039, China
| | - Juan Li
- Department of Urology, Third Medical Centre of Chinese PLA General Hospital, Beijing, 100039, China
| | - Ju Ye
- Department of Radiology, Third Medical Centre of Chinese PLA General Hospital, Beijing, 100039, China
| | - Wenjuan Han
- Department of Radiology, Third Medical Centre of Chinese PLA General Hospital, Beijing, 100039, China
| | - Shanshan Zhou
- Department of Radiology, Third Medical Centre of Chinese PLA General Hospital, Beijing, 100039, China
| | - Jianzhong Zhu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, 271000, China
| | - Guisheng Wang
- Department of Radiology, Third Medical Centre of Chinese PLA General Hospital, Beijing, 100039, China.
| | - Xiaoxia Chen
- Department of Radiology, Third Medical Centre of Chinese PLA General Hospital, Beijing, 100039, China.
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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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14
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The conservative treatment of longstanding adductor-related groin pain syndrome: a critical and systematic review. Biol Sport 2020; 38:45-63. [PMID: 33795914 PMCID: PMC7996386 DOI: 10.5114/biolsport.2020.97669] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/12/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
Longstanding (chronic) adductor-related groin pain syndrome is a widely common problem for athletes in many sports activities which often drastically reduces player activity and performance. The first choice in therapeutic treatment is conservative therapy. The objective of this study is to provide a systematic review regarding conservative treatment for longstanding adductor-related groin pain syndrome present in literature today. Furthermore, this study aims to give a critical vision of the current state of the art of the considered topic. After screening 234 articles, 19 studies following the inclusion criteria were included and summarized in this current systematic review and seven different types of therapeutic interventions were described. Compression clothing therapy, manual therapy together with strengthening exercise and prolotherapy were the therapeutic interventions which showed both the greatest level of strength of evidence (Moderate) and grade of recommendation (D). The remaining four types of therapeutic interventions i.e.: corticoid injection, platelet rich plasma therapy, intra-tissue percutaneous electrolysis and pulse-dose radiofrequency, showed both lower levels of strength of evidence (Conflicting) and grade of recommendation (C). In conclusion the literature available on the conservative treatment for longstanding adductor-related groin pain syndrome is limited and characterized by a low level of evidence. Therefore, our recommendation is to refer only to the few studies with higher level of evidence and at the same time to encourage further research in this area. The intervention showing the greater level of strength of evidence, and the greater grade of recommendation are compression clothing therapy, manual therapy and strengthening exercise, and prolotherapy. Other therapeutic interventions such as intra-tissue percutaneous electrolysis and pulse-dose radiofrequency seem promising but require further studies to confirm their efficacy.
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15
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Hanyu-Deutmeyer A, Pritzlaff SG. Peripheral Nerve Stimulation for the 21st Century: Sural, Superficial Peroneal, and Tibial Nerves. PAIN MEDICINE 2020; 21:S64-S67. [PMID: 32804232 DOI: 10.1093/pm/pnaa202] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Peripheral nerve stimulation (PNS) of the lower extremity has progressed significantly over the last decade. From the proof of concept that ultrasound-guided, percutaneous implantation was possible to advances in waveforms, the field has been rapidly evolving. While most nerves in the lower extremity can be PNS targets, consideration must be given to the ergonomics of pulse generator placement, patient comfort, and avoidance of lead migration. For this paper, we examine some of the conditions amenable to lower extremity PNS, review the evidence and history behind PNS for these conditions, and describe approaches for the tibial, sural, and superficial peroneal nerves. METHODS A literature search was conducted using PubMed. Search terms used were "peripheral nerve stimulation," "lower extremity entrapment neuropathies," "sural nerve," "superficial peroneal nerve," "tibial nerve," and "tarsal tunnel syndrome." Emphasis was placed on randomized controlled studies, anatomical dissections, and comprehensive review articles. Approaches to nerves and ultrasound images were based on anecdotal PNS cases from an experienced implanter (SP). CONCLUSIONS The development of ultrasound as a viable method of image guidance for percutaneous peripheral nerve stimulation has led to an exponential growth in the field. Lower extremity percutaneous lead placement is both feasible and an appropriate treatment modality for certain pain conditions.
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Affiliation(s)
- Aaron Hanyu-Deutmeyer
- Division of Pain Medicine, Department Anesthesiology and Pain Medicine, University of California, Davis, California, USA
| | - Scott G Pritzlaff
- Division of Pain Medicine, Department Anesthesiology and Pain Medicine, University of California, Davis, California, USA
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16
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Song B, Marathe A, Chi B, Jayaram P. Hydrodissection as a therapeutic and diagnostic modality in treating peroneal nerve compression. Proc (Bayl Univ Med Cent) 2020; 33:465-466. [PMID: 32675990 DOI: 10.1080/08998280.2020.1758006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/12/2020] [Accepted: 04/16/2020] [Indexed: 01/16/2023] Open
Abstract
A 51-year-old man presented with pain in the region of his left patellar tendon and fibular head. He had previously undergone three L5 epidural steroid injections and physical therapy without relief. Prior magnetic resonance imaging was significant only for fat pad impingement, and electromyography and nerve conduction studies were negative. Ultrasound demonstrated an enlarged peroneal nerve suggestive of peroneal nerve entrapment. Three ultrasound-guided hydrodissection procedures offered symptomatic improvement and identified an area posterior to the fibular head that was unable to be hydrodissected, indicating scar tissue causing peroneal nerve compression. The patient was referred for peroneal nerve decompression at the area of entrapment with complete symptom relief. This case is unique in describing the ability of hydrodissection to identify nerve compression not visualized with other diagnostic tests.
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Affiliation(s)
- Bo Song
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of MedicineHoustonTexas.,Baylor College of MedicineHoustonTexas
| | | | - Bradley Chi
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of MedicineHoustonTexas.,Baylor College of MedicineHoustonTexas
| | - Prathap Jayaram
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of MedicineHoustonTexas.,Baylor College of MedicineHoustonTexas
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17
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Acute bilateral foot drop in a chronic alcoholic patient. Turk J Phys Med Rehabil 2019; 65:87-92. [PMID: 31453549 DOI: 10.5606/tftrd.2019.2244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/16/2018] [Indexed: 11/21/2022] Open
Abstract
Peroneal palsy is compression neuropathy of the peroneal nerve, which presents with foot drop. Patients with unilateral peroneal nerve palsy are frequently encountered in clinical practice. Although bilateral peroneal nerve palsy is rare, bilateral foot drop due to peroneal nerve palsy is much less common. The main complaint is often walking difficulty due to weakened ankle dorsiflexor muscles. Medical history and physical examination are always a part of the diagnosis, and the most useful method is electroneuromyography to evaluate the degree of the lesion. In this report, we present a 52-year-old male unconscious patient with chronic alcoholism admitted with acute bilateral foot drop and discuss clinical assessment, diagnosis, and treatment planning of this rare case of peroneal palsy after lying in the prone position in the light of literature data.
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18
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Wilson C, Yaacoub AP, Bakare A, Bo N, Aasar A, Barbaro NM. Peroneal nerve decompression: institutional review and meta-analysis to identify prognostic associations with favorable and unfavorable surgical outcomes. J Neurosurg Spine 2019; 30:714-721. [PMID: 30738397 DOI: 10.3171/2018.10.spine18626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A common cause of peroneal neuropathy is compression near the fibular head. Studies demonstrate excellent outcomes after decompression but include few cases (range 15-60 patients). Consequently, attempts to define predictors of good outcomes are limited. Here, the authors combine their institutional outcomes with those in the literature to identify predictors of good outcomes after peroneal nerve decompression. METHODS The authors searched their institutional electronic medical records to identify all peroneal nerve decompressions performed in the period between December 1, 2012, and September 30, 2016, and created an IRB-approved database. They also conducted a MEDLINE and literature search to identify articles discussing surgical decompression. All data were combined by meta-analysis to identify the factors associated with a favorable outcome, which was defined as improvement in preoperative symptoms. Patients were analyzed in the aggregate and by presentation (pain, paresthesias, weakness, foot drop). The factors evaluated included age, sex, body mass index, diabetes, smoking status, previous knee or lumbar spine surgery, preoperative symptom duration, and etiology. A meta-analysis was completed for any factor evaluated in at least three data sets. RESULTS Twenty-one institutional cases had sufficient data for review. The follow-up among this group was long: median 29 months, range 12-52 months. On aggregate analysis of the data, only diabetes was significantly associated with unfavorable outcomes after decompression (p = 0.05). A trend toward worse outcomes was seen in smokers presenting with pain (p = 0.06). Outcomes were not affected by presentation.An additional 115 cases in the literature had extractable data for meta-analysis, and other associations were seen. Preoperative symptom duration longer than 12 months was associated with unfavorable outcomes (OR 0.23, 95% CI 0.08-0.65). Patients presenting with paresthesias or hypesthesia demonstrated a trend toward more unfavorable outcomes when operated on more than 6 months after symptom onset (OR 0.37, 95% CI 0.13-1.06). Even after the meta-analysis, outcomes did not vary with an advanced age (OR 0.70, 95% CI 0.24-1.98) or with patient sex (OR 1.13, 95% CI 0.42-3.06). CONCLUSIONS The authors provide their institutional data in combination with published data regarding outcomes after peroneal nerve decompression. Outcomes are typically favorable and generally unaffected by the type of symptoms preoperatively, especially if the patient is nondiabetic and preoperative symptom duration is less than 12 months. Patients with paresthesias may benefit from surgery within 6 months after onset. Smoking may adversely affect surgical outcomes. Finally, an advanced age does not adversely affect outcomes, and older patients should be considered for surgery.
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19
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Karvat J, Kakihata CMM, Vieira L, Silva JLDC, Ribeiro LDFC, Brancalhão RMC, Bertolini GRF. Analysis of the muscle tissue of Wistar rats submitted to the sciatic nerve compression model and cryotherapy. ACTA ACUST UNITED AC 2018; 16:eAO4206. [PMID: 30231143 PMCID: PMC6178854 DOI: 10.1590/s1679-45082018ao4206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/26/2017] [Indexed: 11/21/2022]
Abstract
Objective: To evaluate the effects of right sciatic nerve compression and cryotherapy on muscle tissue. Methods: We used 42 male Wistar rats, subdivided in the following Groups Control, Injury 3, Injury 8 and Injury 15 submitted to nerve compression and euthanized in the 3rd, 8th and 15th day after surgery. The Cryotherapy Injury 3 was entailed treatment with cryotherapy by immersion of the animal in recipient for 20 minutes during 1 day, then animals were euthanized at the 3rd day after surgery, and the Cryotherapy Injury 8 and the Cryotherapy Injury 15 was treated for 6 days, and euthanized at the 8th and 15th day after surgery. Functional evaluation was performed by the grasping strength of the right pelvic limb. The right tibialis anterior muscles were evaluated for mass, smaller diameter and cross-sectional area. In the Cryotherapy Injury 8 and the Cryotherapy Injury 15 groups, the hydroxyproline was dosed in the right soles. Results: In the compression there was a significant difference in the Injury Groups compared with the Control Group (p<0.05). In the smaller diameter, the compression in Control Group was higher than Injury 8 (p=0.0094), Injury 15 (p=0.002) and Cryotherapy Injury 15 (p<0.001) groups. The comparison between groups with euthanasia in the same post-operative period, a significant difference (p=0.0363) was seen in day 8th after surgery, and this result in Cryotherapy Injury Group was greater than Injury Group. In the fiber area, Control Group was also higher than the Injury 8 (p=0.0018), the Injury 15 (p<0.001) and the Cryotherapy Injury 15 (p<0.001). In hydroxyproline, no significant difference was seen between groups. Conclusion: Nerve damage resulted in decreased muscle strength and trophism, the cryotherapy delayed hypotrophy, but this effect did not persist after cessation of treatment.
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Affiliation(s)
- Jhenifer Karvat
- Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil
| | | | - Lizyana Vieira
- Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil
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20
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Abstract
PURPOSE OF REVIEW This article addresses relevant peripheral neuroanatomy, clinical presentations, and diagnostic findings in common entrapment neuropathies involving the median, ulnar, radial, and fibular (peroneal) nerves. RECENT FINDINGS Entrapment neuropathies are a common issue in general neurology practice. Early diagnosis and effective management of entrapment mononeuropathies are essential in preserving limb function and maintaining patient quality of life. Median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, radial neuropathy at the spiral groove, and fibular neuropathy at the fibular head are among the most frequently encountered entrapment mononeuropathies. Electrodiagnostic studies and peripheral nerve ultrasound are employed to help confirm the clinical diagnosis of nerve compression or entrapment and to provide precise localization for nerve injury. Peripheral nerve ultrasound demonstrates nerve enlargement at or near sites of compression. SUMMARY Entrapment neuropathies are commonly encountered in clinical practice. Accurate diagnosis and effective management require knowledge of peripheral neuroanatomy and recognition of key clinical symptoms and findings. Clinical diagnoses may be confirmed by diagnostic testing with electrodiagnostic studies and peripheral nerve ultrasound.
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21
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Gaut D, Cone BD, Gregson AL, Agopian VG. Gastrointestinal Mucormycosis After Orthotopic Liver Transplantation Presenting as Femoral Nerve Palsy: A Case Report and Review of the Literature. Transplant Proc 2017; 49:1608-1614. [PMID: 28755897 DOI: 10.1016/j.transproceed.2017.03.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/19/2017] [Accepted: 03/30/2017] [Indexed: 02/07/2023]
Abstract
Mucormycosis has emerged as a major threat to transplant recipients with high morbidity and mortality. This infection most commonly presents with rhino-sino-orbital localization. Gastrointestinal mucormycosis is uncommon, with presenting symptoms usually abdominal in nature. Here, we describe the case of a liver transplant recipient who developed gastrointestinal mucormycosis with an initial manifestation of femoral nerve palsy, ultimately resulting in fungal dissemination and patient demise. This case highlights the challenges in making a timely diagnosis of mucormycosis, particularly in immunocompromised patients.
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Affiliation(s)
- D Gaut
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
| | - B D Cone
- Deparment of Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - A L Gregson
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - V G Agopian
- Division of Liver and Pancreas Transplant Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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An unexpected side effect: Wartenberg syndrome related to the use of splint during carpal tunnel syndrome treatment. Turk J Phys Med Rehabil 2017; 64:83-86. [PMID: 31453494 DOI: 10.5606/tftrd.2018.1186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/02/2017] [Indexed: 11/21/2022] Open
Abstract
Isolated superficial radial neuropathy is a sensorial mononeuropathy and a rare clinical condition. In case of trapping of the sensorial branch of the radial nerve, symptoms such as burning type pain at proximal forearm and hand dorsoradial, hypoesthesia, numbness and tingling at hand dorsum and thumb radial side are observed. Muscular weakness and trophic changes are not seen, and electrophysiological assessment revealed normal motor nerve conduction values. Therefore, hand motor functions are not affected. The etiology of the isolated superficial radial nerve neuropathy is often associated with repeated use of wrist watches, forearm fractures, use of handcuffs, repetitive activities. In this report, we present a 59-year-old female case of isolated superficial radial nerve neuropathy diagnosed by electrophysiological evaluation who was treated for two months with carpal tunnel syndrome with altered symptoms and increased numbness. This is the first case of superficial radial nerve neuropathy following the splint use in the literature.
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23
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Lee SH, Shin KJ, Gil YC, Ha TJ, Koh KS, Song WC. Anatomy of the lateral femoral cutaneous nerve relevant to clinical findings in meralgia paresthetica. Muscle Nerve 2017; 55:646-650. [DOI: 10.1002/mus.25382] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Shin-hyo Lee
- Department of Anatomy, Research Institute of Medical Science; Konkuk University School of Medicine; 120 Neungdong-ro Gwangjin-gu Seoul 05029 Republic of Korea
| | - Kang-jae Shin
- Department of Anatomy, Research Institute of Medical Science; Konkuk University School of Medicine; 120 Neungdong-ro Gwangjin-gu Seoul 05029 Republic of Korea
| | - Young-chun Gil
- Department of Anatomy, Research Institute of Medical Science; Konkuk University School of Medicine; 120 Neungdong-ro Gwangjin-gu Seoul 05029 Republic of Korea
| | - Tae-jun Ha
- Department of Anatomy, Research Institute of Medical Science; Konkuk University School of Medicine; 120 Neungdong-ro Gwangjin-gu Seoul 05029 Republic of Korea
| | - Ki-seok Koh
- Department of Anatomy, Research Institute of Medical Science; Konkuk University School of Medicine; 120 Neungdong-ro Gwangjin-gu Seoul 05029 Republic of Korea
| | - Wu-chul Song
- Department of Anatomy, Research Institute of Medical Science; Konkuk University School of Medicine; 120 Neungdong-ro Gwangjin-gu Seoul 05029 Republic of Korea
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Monteleone G, Stevanato G. Entrapment of the sciatic nerve at the linea aspera: A case report and literature review. Surg Neurol Int 2016; 7:89. [PMID: 27857853 PMCID: PMC5093878 DOI: 10.4103/2152-7806.192633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/31/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Nontraumatic, non-neoplastic sciatic nerve entrapment at the level of the thigh is extremely rare. In its course, in proximity of the linea aspera, the nerve is exposed to unexpected neuropathic syndromes associated with bone disorders. CASE DESCRIPTION A 67-year-old woman presented with a painful, neuropathic syndrome of the sciatic nerve, not resulting from any trauma and persisting for approximately 2 years. Imaging studies of the thigh showed a delimited zone of hyperostosis in the proximal third of the femoral diaphysis. The symptoms dramatically resolved after the patient underwent neurolysis of the tract of the nerve adjoining to the linea aspera. At the clinical checkup 2 years later, the patient remained free of pain. CONCLUSION The diagnosis of sciatic nerve entrapment at the linea aspera may present considerable difficulties. The clinical history and physical examination sometimes motivate the exploration and neurolysis of the nerve at this site.
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Affiliation(s)
- Giovanni Monteleone
- Department of Biomedicine and Preventative Medicine, Faculty of Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
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25
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Poppler LH, Groves AP, Sacks G, Bansal A, Davidge KM, Sledge JA, Tymkew H, Yan Y, Hasak JM, Potter P, Mackinnon SE. Subclinical Peroneal Neuropathy: A Common, Unrecognized, and Preventable Finding Associated With a Recent History of Falling in Hospitalized Patients. Ann Fam Med 2016; 14:526-533. [PMID: 28376439 PMCID: PMC5389395 DOI: 10.1370/afm.1973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 06/02/2016] [Accepted: 06/15/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Identification of modifiable risk factors for falling is paramount in reducing the incidence and morbidity of falling. Peroneal neuropathy with an overt foot drop is a known risk factor for falling, but research into subclinical peroneal neuropathy (SCPN) resulting from compression at the fibular head is lacking. The purpose of our study was to determine the prevalence of SCPN in hospitalized patients and establish whether it is associated with a recent history of falling. METHODS We conducted a cross-sectional study of 100 medical inpatients at a large academic tertiary care hospital in St Louis, Missouri. General medical inpatients deemed at moderate to high risk for falling were enrolled in the summer of 2013. Patients were examined for findings that suggest peroneal neuropathy, fall risk, and a history of falling. Multivariate logistic regression was used to correlate SCPN with fall risk and a history of falls in the past year. RESULTS The mean patient age was 53 years (SD = 13 years), and 59 patients (59%) were female. Thirty-one patients had examination findings consistent with SCPN. After accounting for various confounding variables within a multivariate logistic regression model, patients with SCPN were 4.7 times (95% CI, 1.4-15.9) more likely to report having fallen 1 or more times in the past year. CONCLUSIONS Subclinical peroneal neuropathy is common in medical inpatients and is associated with a recent history of falling. Preventing or identifying SCPN in hospitalized patients provides an opportunity to modify activity and therapy, potentially reducing risk.
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Affiliation(s)
- Louis H Poppler
- Division of Plastic & Reconstructive Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Andrew P Groves
- Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Gina Sacks
- Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Anchal Bansal
- Washington University in St Louis School of Medicine, St Louis, Missouri
| | | | | | | | - Yan Yan
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Jessica M Hasak
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | | | - Susan E Mackinnon
- Division of Plastic & Reconstructive Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
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Kakihata CMM, Malanotte JA, Karvat J, Brancalhão RMC, de Fátima Chasko Ribeiro L, Bertolini GRF. The morphological and functional effects of exercise in the aquatic environment, performed before and/or after sciatic nerve compression in Wistar rats. J Exerc Rehabil 2016; 12:393-400. [PMID: 27807516 PMCID: PMC5091053 DOI: 10.12965/jer.1632670.335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/27/2016] [Indexed: 12/30/2022] Open
Abstract
The aim of this study was to evaluate the effects of exercise in the aquatic environment, performed before and/or after sciatic nerve compression in Wistar rats on morphological and functional parameters. Twenty-five Wistar rats were divided into the following groups: control (C), lesion (L), trained+lesion (TL), lesion+exercise (LE), and training+lesion+exercise (TLE), who underwent right sciatic nerve compression on day 21 of the experiment. The TL and TLE groups were submitted to a jumping exercise in a water environment for 20 days prior to injury and the LE and TLE groups after injury. The functional analysis was carried out using the sciatic functional index (SFI). On the last day of the experiment, the right sciatic nerves were collected, processed and analysed according to morphology and morphometry. The C group showed higher SFI in relation to the other groups. In the morphometric analysis, in comparison to C, all groups showed a decrease in the diameter of the injured nerve fibre, the myelin sheath and an increase in the percentage of connective tissue. There was a decrease in axon diameter in L, TL, and LE groups and a decrease in the density of nerve fibres in the TL and LE groups. The exercise did not affect functional recovery. However, the exercise prior to the injury improved morphology of the nervous tissue, and when performed pre- and postinjury, there was also an improvement in nerve regeneration, but this was not the case with exercise performed after the injury demonstrating worse results.
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Affiliation(s)
| | | | - Jhenifer Karvat
- Universidade Estadual do Oeste do Paraná, Cascavel, Brazil; Universidade Federal de Santa Catarina, Florianópolis, Brazil
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27
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Yablon CM, Hammer MR, Morag Y, Brandon CJ, Fessell DP, Jacobson JA. US of the Peripheral Nerves of the Lower Extremity: A Landmark Approach. Radiographics 2016; 36:464-78. [PMID: 26871986 DOI: 10.1148/rg.2016150120] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ultrasonography (US) is commonly used to assess the peripheral nerves of the lower extremity because of its many advantages over magnetic resonance (MR) imaging. The most obvious advantages over MR imaging are superior soft-tissue resolution, low cost, portability, lack of magnetic susceptibility artifact, and the ability to image patients who cannot undergo MR imaging. US has been shown to have equal specificity and greater sensitivity than MR imaging in the evaluation of peripheral nerves. Additional benefits are the capability of real-time and dynamic imaging, and the ability to scan an entire extremity quickly without the need for a patient to lie motionless for long periods of time, as with MR imaging. Any abnormal findings can be easily compared against the contralateral side. Published literature has shown that US has clinical utility in patients suspected of having peripheral nerve disease: US can be used to guide diagnostic and therapeutic decisions, as well as help confirm electrodiagnostic findings. Common indications for lower extremity peripheral nerve US are the evaluation for injury due to penetrating trauma, entrapment by scar tissue, or tumor. To confidently perform US of the peripheral nerves of the lower extremity, it is important to gain a thorough knowledge of anatomic landmarks and the course of each nerve. Readers who may not be familiar with US will be introduced to the basics of scanning the peripheral nerves of the lower extremity. Important anatomic landmarks and common sites of injury and entrapment will be reviewed.
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Affiliation(s)
- Corrie M Yablon
- From the Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109 (C.M.Y., Y.M., C.J.B., D.P.F., J.A.J.); and the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (M.R.H.)
| | - Matthew R Hammer
- From the Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109 (C.M.Y., Y.M., C.J.B., D.P.F., J.A.J.); and the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (M.R.H.)
| | - Yoav Morag
- From the Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109 (C.M.Y., Y.M., C.J.B., D.P.F., J.A.J.); and the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (M.R.H.)
| | - Catherine J Brandon
- From the Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109 (C.M.Y., Y.M., C.J.B., D.P.F., J.A.J.); and the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (M.R.H.)
| | - David P Fessell
- From the Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109 (C.M.Y., Y.M., C.J.B., D.P.F., J.A.J.); and the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (M.R.H.)
| | - Jon A Jacobson
- From the Department of Radiology, University of Michigan Medical Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109 (C.M.Y., Y.M., C.J.B., D.P.F., J.A.J.); and the Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (M.R.H.)
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28
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Bonasia DE, Rosso F, Cottino U, Rossi R. Exercise-induced leg pain. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:73-84. [PMID: 29264244 PMCID: PMC5730650 DOI: 10.1016/j.asmart.2015.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/11/2015] [Accepted: 03/27/2015] [Indexed: 12/03/2022]
Abstract
Exercise-induced leg pain is a common condition in athletes and in people involved in recreational sports. The diagnosis is not always straightforward: many conditions may cause exercise-induced leg pain. The aim of the present review is to provide a complete discussion of the most common pathologies related to this condition. Particular attention is dedicated to the history and the physical examination, which are fundamental for requesting the correct diagnostic tests or imaging techniques necessary for a precise diagnosis.
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Affiliation(s)
- Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Città della Salute e della Scienza, Torino, Italy
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
| | - Umberto Cottino
- Department of Orthopaedics and Traumatology, University of Torino, Torino, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
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29
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Neufeld EA, Shen PY, Nidecker AE, Runner G, Bateni C, Tse G, Chin C. MR Imaging of the Lumbosacral Plexus: A Review of Techniques and Pathologies. J Neuroimaging 2015; 25:691-703. [PMID: 25940664 DOI: 10.1111/jon.12253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 11/29/2022] Open
Abstract
The lumbosacral plexus is a complex anatomic area that serves as the conduit of innervation and sensory information to and from the lower extremities. It is formed by the ventral rami of the lumbar and sacral spine which then combine into larger nerves serving the pelvis and lower extremities. It can be a source of severe disability and morbidity for patients when afflicted with pathology. Patients may experience motor weakness, sensory loss, and/or debilitating pain. Primary neurologic processes can affect the lumbosacral plexus in both genetic and acquired conditions and typically affect the plexus and nerves symmetrically. Additionally, its unique relationship to the pelvic musculature and viscera render it vulnerable to trauma, infection, and malignancy. Such conditions are typically proceeded by a known history of trauma or established pelvic malignancy or infection. Magnetic resonance imaging is an invaluable tool for evaluation of the lumbosacral plexus due to its anatomic detail and sensitivity to pathologic changes. It can identify the cause for disability, indicate prognosis for improvement, and be a tool for delivery of interventions. Knowledge of proper MR protocols and imaging features is key for appropriate and timely diagnosis. Here we discuss the relevant anatomy of the lumbosacral plexus, appropriate imaging techniques for its evaluation, and discuss the variety of pathologies that may afflict it.
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Affiliation(s)
- Ethan A Neufeld
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Peter Yi Shen
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Anna E Nidecker
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Gabriel Runner
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Cyrus Bateni
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Gary Tse
- University of California Davis Medical Center, Department of Radiology, 4860 Y Street Suite 3100, Sacramento, CA, 95817
| | - Cynthia Chin
- University of California San Francisco Medical Center, Department of Radiology, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628
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An Uncommon Case of Bilateral Peroneal Nerve Palsy following Delivery: A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2014; 2014:746480. [PMID: 25180116 PMCID: PMC4142536 DOI: 10.1155/2014/746480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/22/2014] [Indexed: 11/17/2022] Open
Abstract
Peroneal nerve palsy is an infrequent but potential complication of childbirth. Bilateral peroneal palsy is particularly rare following delivery with few reported cases. A 38-year-old gravida 1, para 0 underwent a prolonged second stage of labor, was diagnosed with an arrest of descent, and subsequently underwent an uncomplicated primary cesarean section. The patient was diagnosed with bilateral peroneal neuropathy four days after delivery. By two months postpartum, her foot drop had improved by 85% and the remainder of her symptoms resolved. Awareness of the risks of a peroneal neuropathy as well as implementation of preventive measures is important for members of the delivery team. Regional anesthesia during labor is a risk factor for the development of a peroneal neuropathy.
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31
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Sole JS, Pingree MJ, Spinner RJ, Murthy NS, Sellon JL. Saphenous neuropathy secondary to extraneural ganglion cyst 15 years after reconstruction of the anterior cruciate ligament. PM R 2014; 6:451-5. [PMID: 24507555 DOI: 10.1016/j.pmrj.2013.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/01/2013] [Accepted: 11/03/2013] [Indexed: 10/25/2022]
Abstract
This case report describes a 43-year-old woman with a previous anterior cruciate ligament reconstruction and medial meniscectomy who presented with right knee dysesthesias radiating into her medial ankle with associated allodynia. An extensive work-up was pursued, without a definitive diagnosis found or improvement in the patient's symptoms. Eventually, she was referred to Pain Medicine for an ultrasound-guided saphenous nerve (SN) block, where a scan before the injection revealed a large cyst anteromedial to the sartorius in the expected location of the SN. Magnetic resonance imaging and surgical pathology confirmed a juxta-articular ganglion cyst compressing the main SN, just above the take-off of the infrapatellar branch. The cyst was successfully resected, with improvement noted in the patient's neuropathic symptoms postoperatively. Saphenous neuropathy is a rare condition, and to our knowledge this case is the first reported of saphenous neuropathy caused by a knee joint capsule-derived ganglion cyst.
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Affiliation(s)
- Joshua S Sole
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First Street SW, Rochester, MN 55901(∗).
| | - Matthew J Pingree
- Department of Physical Medicine and Rehabilitation, and Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN(†)
| | - Robert J Spinner
- Departments of Neurologic Surgery and Orthopedic Surgery, Mayo Clinic, Rochester, MN(‡)
| | - Naveen S Murthy
- Department of Radiology, Musculoskeletal Division, Mayo Clinic, Rochester, MN(§)
| | - Jacob L Sellon
- Department of Physical Medicine and Rehabilitation, Sports Medicine Center, Mayo Clinic, Rochester, MN(‖)
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32
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Gologan RE, Walter V, Röhl H. [Peripheral nerve lesions of the lower leg due to tibiofibular ganglion]. DER NERVENARZT 2014; 85:749-52. [PMID: 24441848 DOI: 10.1007/s00115-013-3966-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cystic formations around the knee are a common object of orthopedic treatment. When associated with neurological or vascular deficits further diagnostic imaging is required. This case study demonstrates the appearance of an intramuscular ganglion causing drop foot, arising from the tibio-fibular joint.
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Affiliation(s)
- R E Gologan
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland,
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