A Positive Tinel Sign as Predictor of Pain Relief or Sensory Recovery after Decompression of Chronic Tibial Nerve Compression in Patients with Diabetic Neuropathy

Abstract

Predictive ability of a positive Tinel sign over the tibial nerve in the tarsal was evaluated as a prognostic sign in determining sensory outcomes after distal tibial neurolysis in diabetics with chronic nerve compression at this location. Outcomes were evaluated with a visual analog score (VAS) for pain and measurements of the cutaneous pressure threshold/two-point discrimination. A multicenter prospective study enrolled 628 patients who had a positive Tinel sign. Of these patients, 465 (74%) had VAS >5. Each patient had a release of the tarsal tunnel and a neurolysis of the medial and lateral plantar and calcaneal tunnels. Subsequent, contralateral, identical surgery was done in 211 of the patients (152 of which had a VAS >5). Mean VAS score decreased from 8.5 to 2.0 (p <0.001) at 6 months, and remained at this level for 3.5 years. Sensibility improved from a loss of protective sensation to recovery of some two-point discrimination during this same time period. It is concluded that a positive Tinel sign over the tibial nerve at the tarsal tunnel in a diabetic patient with chronic nerve compression at this location predicts significant relief of pain and improvement in plantar sensibility.

The Positive Effect of Neurolysis on Diabetic Patients with Compressed Nerves of the Lower Extremities

“…Both RCTs are currently recruiting participants and are expected to be completed by mid-2013. Of the 10 relevant observational studies, 4 were listed as prospective 8,15,18,19 and 6 as retrospective. 10,13,14,16,17,20 These 10 clinical series were found to have a mean clinical relevance score of 70% and a mean methodological quality score of 50% (Table 4).…”

“…None of the included studies based their diagnosis of nerve compression on magnetic resonance neurography findings. Five studies 14,15,17–19 for a total of 745 patients used the Pressure-Specified Sensory Device, whereas 1 study 13 for a total of 26 patients used the Disk-Criminator device to assess the degree of sensory impairment. One study 16 including 12 patients assessed sensory impairment with both devices.…”

Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence?

“…This positive Tinel sign is common in DSPN and correlates strongly with the Michigan Neuropathy Screening Instrument [16]. Pain relief after ND is found in 80% if Tinel’s sign at anatomic entrapment sites is positive, but only 50% if negative [15,16,36]. …”

“…Again, the critique is not dispositive. Tinel’s sign has proven clinically useful as a predictor of ND benefit [15,16]. …”

“…The risk of hospitalization for foot infection in diabetes, at 0.6%/yr in a registry of 628 ND cases with painful DSPN [15], is much lower after ND than the 2.4%/yr reported by Lavery et al [54]. …”