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Obana KK, Trofa DP, Ahmad CS, Levine WN, Popkin CA. Surfer's neurapraxia - an uncommon surfing injury of the saphenous nerve. PHYSICIAN SPORTSMED 2024:1-5. [PMID: 38975984 DOI: 10.1080/00913847.2024.2375961] [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: 04/16/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
Surfer's neurapraxia is a rare surfing injury of the saphenous nerve secondary to persistent compression of the saphenous nerve along the medial thigh by the surfboard when paddling prone and while sitting upright on the board waiting for a wave. Symptoms may be nonspecific and consist of pain in the medial thigh with or without radiation along the saphenous nerve distribution (medial leg, medial ankle, medial arch of the foot). The saphenous nerve tension test can be utilized to reproduce the symptoms of surfer's neurapraxia. Treatment consists of conservative management while refractory cases may benefit from injection with local anesthetic. The authors propose the Obana Plan (WATER) for prevention of surfer's neurapraxia, consisting of Wetsuits, Abduction, Timing, Exercise, and Rest. Overall, surfer's neurapraxia is a benign condition that can be prevented and managed conservatively.
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Affiliation(s)
- Kyle K Obana
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - David P Trofa
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - Christopher S Ahmad
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - Charles A Popkin
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
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Lecigne R, Dubreil PX, Berton E, Ropars M, Dalili D, Guillin R. Anatomical basis for ultrasound-guided infiltration of the saphenous nerve in the subsartorial canal. J Ultrasound 2022; 25:429-434. [PMID: 34195927 PMCID: PMC9402865 DOI: 10.1007/s40477-021-00604-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022] Open
Abstract
The present work is aimed studying the visibility and position of the vasto-adductor membrane with ultrasonography and demonstrating that injection performed under this membrane allows to infiltrate the saphenous nerve. It was analyzed with ultrasonography in four cadaveric subjects and in 13 volunteers. This membrane was clearly visible and methylene blue was located underneath it after injection in all cadaveric subjects. This study demonstrates that it can be used as a reliable anatomic landmark when performing an injection for both regional anesthesia and in the treatment of saphenous nerve tunnel syndrome.
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Affiliation(s)
- Romain Lecigne
- Radiology Department, Hôpital Sud, CHU Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France.
| | - Pierre-Xavier Dubreil
- Radiology Department, Hôpital Sud, CHU Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Eric Berton
- Anatomy Department, Faculté de Médecine de Rennes, Université Rennes 1, 35000, Rennes, France
| | - Mickaël Ropars
- Orthopaedic Surgery Department, Hôpital Pontchaillou, 2 Rue Henri le Guilloux, 35000, Rennes, France
| | - Danoob Dalili
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Raphaël Guillin
- Radiology Department, Hôpital Sud, CHU Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France
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Haraguchi T, Kume S, Jimbo K, Gotoh M, Shiba N, Okawa T. Saphenous Nerve Entrapment Neuropathy After Closed Tibial Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00017. [PMID: 33835945 DOI: 10.2106/jbjs.cc.20.00670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 43-year-old man who underwent intramedullary nailing for a closed tibial fracture developed saphenous nerve entrapment neuropathy. He developed severe medial leg pain, which was worse on walking or standing, 2 years postoperatively. Surgical neurolysis resulted in complete pain relief and functional recovery of the limb without recurrence of symptoms. CONCLUSION Clinicians should consider several etiologies in the diagnostic evaluation of a patient with chronic pain after limb trauma. If a patient complains of lower extremity pain after intramedullary fixation of closed fractures of the tibial shaft, the possibility of saphenous nerve entrapment neuropathy should be considered.
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Affiliation(s)
- Toshiaki Haraguchi
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan.,Department of Orthopedic Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Shinichiro Kume
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Kotaro Jimbo
- Department of Orthopedic Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takahiro Okawa
- Department of Orthopedic Surgery, Kurume University Medical Center, Kurume, Fukuoka, Japan
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Guild GN, Galindo RP, Marino J, Cushner FD, Scuderi GR. Periarticular regional analgesia in total knee arthroplasty: a review of the neuroanatomy and injection technique. Orthop Clin North Am 2015; 46:1-8. [PMID: 25435030 DOI: 10.1016/j.ocl.2014.09.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Postoperative pain control after total knee arthroplasty may be insufficient, resulting in insomnia, antalgic ambulation, and difficulty with rehabilitation. Current strategies, including the use of femoral nerve catheters, may control pain but have been associated with falls, motor blockade, and quadriceps inhibition. Periarticular infiltration using the appropriate technique and knowledge of intraarticular knee anatomy may increase pain control and maximize rehabilitation.
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Affiliation(s)
- George N Guild
- Department of Orthopaedics, Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, Lenox Hill Hospital, Northshore LIJ Health System, 210 E 64th Street, New York, NY 10065, USA.
| | - Rubin P Galindo
- Department of Orthopaedics, Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, Lenox Hill Hospital, Northshore LIJ Health System, 210 E 64th Street, New York, NY 10065, USA
| | - Joseph Marino
- Department of Anesthesia, Northshore LIJ Health System, 210 E 64th Street, New York, NY 10065, USA
| | - Fred D Cushner
- Department of Orthopedic Surgery, Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, Lenox Hill Hospital, Northshore LIJ Health System, 210 E 64th Street, New York, NY 10065, USA
| | - Giles R Scuderi
- Department of Orthopedic Surgery, Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, Lenox Hill Hospital, Northshore LIJ Health System, 210 E 64th Street, New York, NY 10065, USA
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Settergren R. Conservative management of a saphenous nerve entrapment in a female ultra-marathon runner. J Bodyw Mov Ther 2013; 17:297-301. [PMID: 23768272 DOI: 10.1016/j.jbmt.2012.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 10/09/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
Abstract
Entrapment of the saphenous nerve is a frequently overlooked cause of medial knee pain. Delayed or misdiagnosis is a result of a lack of detailed reporting of the vastoadductor membrane, and by direct visualization of the entrapment only being accomplished at the time of surgical decompression. To date there are no documented conservative interventions discussed in the literature. This is a case of diagnosis and conservative resolution of a spontaneous saphenous nerve entrapment in a competitive female ultra-marathon runner. In-office Active Release Technique(®) combined with an at-home rehabilitative exercise program relieved the patient's subjective pain and paresthesia with two treatments provided over a one week period of time.
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Affiliation(s)
- Roy Settergren
- National University of Health Science, MS Advanced Clinical Practice Program, 200 E. Roosevelt Rd., Lombard, IL 60148, USA.
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Abstract
Peripheral nerve entrapments are frequent. They usually appear in anatomical tunnels such as the carpal tunnel. Nerve compressions may be due to external pressure such as the fibular nerve at the fibular head. Malignant or benign tumors may also damage the nerve. For each nerve from the upper and lower limbs, detailed clinical, electrophysiological, imaging, and therapeutic aspects are described. In the upper limbs, carpal tunnel syndrome and ulnar neuropathy at the elbow are the most frequent manifestations; the radial nerve is less frequently involved. Other nerves may occasionally be damaged and these are described also. In the lower limbs, the fibular nerve is most frequently involved, usually at the fibular head by external compression. Other nerves may also be involved and are therefore described. The clinical and electrophysiological examination are very important for the diagnosis, but imaging is also of great use. Treatments available for each nerve disease are discussed.
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Affiliation(s)
- P Bouche
- Department of Clinical Neurophysiology Salpêtrière Hospital, Paris, France.
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Damarey B, Demondion X, Wavreille G, Pansini V, Balbi V, Cotten A. Imaging of the nerves of the knee region. Eur J Radiol 2013; 82:27-37. [DOI: 10.1016/j.ejrad.2011.04.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/29/2011] [Indexed: 01/11/2023]
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Abstract
Saphenous neuritis is a painful condition caused by either irritation or compression at the adductor canal or elsewhere along the course of the saphenous nerve. The condition also may be associated with surgical or nonsurgical trauma to the nerve, especially at the medial or anterior aspect of the knee. Saphenous neuritis can imitate other pathology around the knee, particularly a medial meniscal tear or osteoarthritis. Unrecognized saphenous neuritis can confuse the patient's clinical picture, complicate treatment, and compromise results. As an isolated entity, saphenous neuritis may appear in conjunction with other common problems, such as osteoarthritis and patellofemoral pain syndrome, and it can have an indolent and protracted course. Its clinical appearance is characterized by allodynia along the course of the saphenous nerve. The diagnosis is confirmed by relief of symptoms after injection of the affected area with local anesthetic. Initial treatment can include non-surgical symptomatic care, treatment of associated pathology, and diagnostic or therapeutic injections of local anesthetic. In recalcitrant cases, surgical decompression and neurectomy are potential options. The key to treatment is prompt recognition; palpation of the saphenous nerve should be part of every routine examination of the knee.
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