Clinico-radiological review of peripheral entrapment neuropathies – Part 2 Lower limb

Abstract

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.

Imaging in peripheral neuropathy: Ultrasound and MRI

“…[10] Both US and MRI enable localization of the site of the pathology, identify the cause and extent of nerve involvement and visualize changes in the innervated muscles. [11,12] Together, US and MRI are instrumental in facilitating diagnosis and management of patients with peripheral neuropathies.…”

Ultrasound of the Lateral Femoral Cutaneous Nerve: A Review of the Literature and Pictorial Essay

“…33 Moreover, US may also guide cryoneuroablation and radiofrequency ablation. 3,35 Surgery may be proposed when conservative treatments fail. 31,36,37 Conclusion US is the first modality-and usually sufficient-to diagnose MP and to guide its treatment.…”

Nerve entrapment syndromes of the lower limb: a pictorial review

“…The lumbosacral plexus provides motor and sensory innervation to the pelvis and lower limb [ 18 ]. It is comprised of the lumbar plexus and the sacral plexus.…”

“…The sciatic nerve arises from the anterior divisions of the L4 to S3 nerve roots and leaves the pelvis through the greater sciatic foramen at the inferior border of the piriformis muscle [ 1 , 18 ]. It provides motor supply to the biceps femoris, semitendinosus, semimembranosus and the hamstring portion of the adductor magnus.…”

“…The tibial nerve is accompanied in the tarsal tunnel by the tibialis posterior, flexor digitorum longus and flexor hallucis longus tendons, and the posterior tibial vein and artery. The tibial nerve then divides into the medial calcaneal nerve and the lateral and medial plantar nerves at the distal tarsal tunnel [ 1 , 18 ]. The tibial nerve provides sensory supply to the posterolateral leg and, via the medial and lateral plantar nerves, to the sole of the foot.…”