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Zavaroni S, Tristano I, Casamenti V, Colonna V, Cereti M, Mamone M, Prencipe U, Sanzone F, Murgia M, Masala S, Beccacece A, Vetrano M, Vulpiani MC, Bemporad J. Ultrasound-based neuropathy diagnosis in COVID-19 patients in post-intensive care rehabilitation settings. A retrospective observational study. Arch Phys Med Rehabil 2023:S0003-9993(23)00101-6. [PMID: 36854349 PMCID: PMC9968491 DOI: 10.1016/j.apmr.2023.02.002] [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] [Received: 08/03/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES using ultrasound scanning to examine the correlation between increase of Common Fibular Nerve's (CFN) Cross Sectional Area (CSA) and functional impairment of foot dorsiflexor muscles as an early sign of peripheral neuropathy. DESIGN retrospective observational study. SETTING in-patient rehabilitation unit between November 2020 and July 2021. PARTICIPANTS 26 inpatients who underwent prolonged hospitilization in ICU'S and were diagnosed with CRYMINE after SARS-COV-2 infection. Physical examination and ultrasound scanning of the CFN and EMG/ENG were carried out on each patient. INTERVENTIONS not applicable MAIN OUTCOME MEASURE(S): CFN's CSA at the peroneal head. RESULTS we verified a significant increase in the CSA of the CFN measured at the peroneal head in more than 90% of the nerves tested. A cut off value of CFN's CSA of 0,20 cm was used to identify pathological nerves. No correlations with other variables (BMI, ICU days) were found. CONCLUSION US scanning of the CFN appears to be an early and specific test in the evaluation of CPN's abnormalities in post COVID-19 patients. US scanning is a reproducible, cost effective, safe and easily administered bedside tool to diagnose a loss of motor function when abnormalities in peripheral nerves are present.
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Affiliation(s)
- Susanna Zavaroni
- University of Rome "La Sapienza", S. Andrea Hospital, via di Grottarossa 1035/1039, Roma, Italy
| | - Isabella Tristano
- University of Rome "La Sapienza", Policlinico Umberto I, viale Regina Elena 328, Roma, Italy
| | - Vittoria Casamenti
- University of Rome "La Sapienza", S. Andrea Hospital, via di Grottarossa 1035/1039, Roma, Italy
| | - Vincenzo Colonna
- University of Rome "La Sapienza", S. Andrea Hospital, via di Grottarossa 1035/1039, Roma, Italy
| | - Margherita Cereti
- Ospedale Privato Accreditato "Sol Et Salus" Spa Rimini, Viale San Salvador 204, Torre Pedrera 47922 RN, Italy
| | - Maria Mamone
- Ospedale Privato Accreditato "Sol Et Salus" Spa Rimini, Viale San Salvador 204, Torre Pedrera 47922 RN, Italy
| | - Umberto Prencipe
- Ospedale Privato Accreditato "Sol Et Salus" Spa Rimini, Viale San Salvador 204, Torre Pedrera 47922 RN, Italy
| | - Fernando Sanzone
- Ospedale Privato Accreditato "Sol Et Salus" Spa Rimini, Viale San Salvador 204, Torre Pedrera 47922 RN, Italy
| | - Massimiliano Murgia
- University of Rome "La Sapienza", Policlinico Umberto I, viale Regina Elena 328, Roma, Italy
| | | | - Alessia Beccacece
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense 292, 00149 Roma, Italy
| | - Mario Vetrano
- University of Rome "La Sapienza", S. Andrea Hospital, via di Grottarossa 1035/1039, Roma, Italy
| | - Maria Chiara Vulpiani
- University of Rome "La Sapienza", S. Andrea Hospital, via di Grottarossa 1035/1039, Roma, Italy
| | - Jonathan Bemporad
- Ospedale Privato Accreditato "Sol Et Salus" Spa Rimini, Viale San Salvador 204, Torre Pedrera 47922 RN, Italy.
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Su T, Jiang YF, Hou ZC, Zhao YQ, Chen W, Hu YL, Guo QW, Jiang D, Jiao C. The L-shaped tunnel technique showed favourable outcomes similar to those of the Y-graft technique in anatomic lateral ankle ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:2166-2173. [PMID: 35217882 DOI: 10.1007/s00167-022-06880-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/13/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To compare the mid- to long-term clinical and radiological outcomes of the confluent L-shaped tunnel technique with the Y-graft technique for anatomic lateral ankle ligament reconstruction. METHODS This retrospective study involved 41 patients who underwent lateral ankle ligament reconstruction between 2013 and 2018. Based on the tunnel direction and tendon fixation method at the fibula side, patients were divided into two groups, with 17 patients in the L-shaped tunnel group and 24 patients in the Y-graft group. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner score, and Karlsson score were evaluated and compared preoperatively and at follow-up. Anterior talar translation and talar tilt at stress radiographs, postoperative sprain recurrence, range of motion (ROM) restriction, sensory disturbance, etc., were also collected and compared. RESULTS The mean follow-up times were 72 and 42 months for the L-shaped group and Y-graft group, respectively. The median VAS pain score, Tegner score, AOFAS score, Karlsson score significantly improved from a preoperative level in both groups (all with p < 0.01). No significant difference was found between the two groups regarding the changes from preoperatively to postoperatively except for the VAS pain score reduction (1.58 ± 1.58 in the L-shaped group vs. 2.53 ± 1.29 in the Y-graft group, p = 0.035). The incidence of flexion-extension ROM restriction (≥ 5°) was significantly higher in the Y-graft group (41.2%) than in the L-shaped group (12.5%) (p = 0.035). CONCLUSIONS Both the confluent L-shaped tunnel technique and the Y-graft technique significantly improved symptoms, ankle function, and radiographic outcomes in patients with chronic lateral ankle instability (CLAI) at mid- to long-term follow-up. The confluent L-shaped tunnel technique resulted in lower rates of flexion-extension ROM restriction, while the Y-graft technique showed better VAS pain reduction. This result could provide further evidence for the surgical treatment of CLAI. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Yan-Fang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Zong-Chen Hou
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Yu-Qing Zhao
- Department of Radiology, Peking University Third Hospital, No. 49 North Garden Road, Beijing, China
| | - Wen Chen
- Department of Radiology, Peking University Third Hospital, No. 49 North Garden Road, Beijing, China
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China.
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China.
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Becciolini M, Pivec C, Riegler G. Ultrasound Imaging of the Deep Peroneal Nerve. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:821-838. [PMID: 32881065 DOI: 10.1002/jum.15455] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/14/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
Ultrasound is considered an excellent imaging modality to evaluate the nerves of the limbs. The deep peroneal nerve (DPN) is one of the terminal branches of the common peroneal nerve. The DPN may be affected by various disorders, which may be clinically challenging to show. This Pictorial Essay reviews the normal ultrasound anatomy of the DPN and presents disorders that may involve the nerve and its main branches along its course, from proximal to distal.
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Affiliation(s)
- Marco Becciolini
- Misericordia di Pistoia, Pistoia, Italy
- Scuola Siumb di Ecografia Muscolo-Scheletrica, Pisa, Italy
| | | | - Georg Riegler
- Private Ultrasound Center Graz, Lassnitzhoehe, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
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Relvas-Silva M, Pinho AR, Lopes JG, Lixa J, Leite MJ, Sousa AN, Veludo V, Madeira D, Pereira P. Anatomy of the superficial peroneal nerve: Can we predict nerve location and minimize iatrogenic lesion? Morphologie 2021; 105:204-209. [PMID: 33642180 DOI: 10.1016/j.morpho.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE OF THE STUDY Knowledge of anatomical variations of the superficial peroneal nerve (SPN) may minimize iatrogenic insults. The aim of the investigation was to perform an anatomical description of the SPN. MATERIALS AND METHODS Twenty-three embalmed cadaver lower limbs were dissected. RESULTS The SPN emerged from the crural fascia about 6.3±7.7mm anteromedial to the anterior border of the fibula and 26.8±12.6mm anteromedial and 113.6±43.9mm superior to the tip of the lateral malleolus. The median point of bifurcation into two terminal branches was 13.0mm anteromedial to the anterior border of the fibula and 34.9±14.7mm anteromedial and 81.0±69.0mm superior to the tip of the lateral malleolus. The SPN was found between 5.76% and 7.70% of the individual's height proximal to the tip of the lateral malleolus, with an unpredictable branching pattern over the intermalleolar line. CONCLUSION A lateral ankle approach over the posterolateral surface of the fibula (posterior to the tip of the lateral malleolus) minimizes the risk of iatrogenic nerve lesion.
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Affiliation(s)
- M Relvas-Silva
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Portugal.
| | - A R Pinho
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Portugal
| | - J G Lopes
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Portugal
| | - J Lixa
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Portugal
| | - M J Leite
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Portugal
| | - A N Sousa
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Portugal
| | - V Veludo
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Portugal
| | - D Madeira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto - Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - P Pereira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto - Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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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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Abstract
Nerve imaging is an important component in the assessment of patients presenting with suspected peripheral nerve pathology. Although magnetic resonance neurography and ultrasound are the most commonly utilized techniques, several promising new modalities are on the horizon. Nerve imaging is useful in localizing the nerve injury, determining the severity, providing prognostic information, helping establish the diagnosis, and helping guide surgical decision making. The focus of this article is imaging of damaged nerves, focusing on nerve injuries and entrapment neuropathies.
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Affiliation(s)
- David A Purger
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences, 213 Quarry Road, MC 5979, Palo Alto, CA 94304, USA
| | - Nicholas F Hug
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sandip Biswal
- Department of Radiology, Stanford University, 300 Pasteur Drive, S-068B, Stanford, CA 94305, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University, 300 Pasteur Drive, R293, Stanford, CA 94305, USA.
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