Earthquake generated proximal tibial nerve compression treated by surgery

Abstract

Purpose This article reports on nine cases of proximal tibial nerve compression by the soleal tendinous arch caused by unsuitable treatment of acute compartment syndrome (ACS). Also, we report the clinical results of neurolysis and analyse the cause of this special type of neurological compression. Methods There were nine extremities in nine patients included in the study. All patients were among the victims of the Wenchuan earthquake in 2008. All patients had a previous lower extremity ACS. Pain level, numbness in the sole, muscle strength of the flexor hallucis longus and Tinel's sign were evaluated pre-and post-operatively. Each proximal tibial nerve compression was subjected to neurolysis with division of the soleal tendinous arch. Results At a mean follow-up of 22 months, eight patients (87 %) with weakness of the flexor hallucis longus showed improvement in flexor strength and seven patients (78 %) exhibited improved sensory function in the sole. All patients experienced pain relief. Subjective pain was reduced from an average score of 2.7 to 0.7 based on a visual analogue scale. Physical examination for Tinel's sign revealed all patients experienced relief of radiating pain, but two patients still retained a positive Tinel's sign (mild) over the soleal tendinous arch. In summary, four patients were highly satisfied, four were satisfied and one was neither satisfied nor dissatisfied with functional recovery after neurolysis. Conclusions Unsuitable treatment of lower extremity ACS can lead to tibial nerve compression beneath the soleal tendinous arch. Neurolysis may improve pain and sensory and motor function.

Tibial nerve compression due to osteochondroma of the fibular head: A case report

“…Complete surgical neurolysis is a critical treatment modality for tibial nerve compression caused by space-occupying lesions. [ 13 ] On the contrary, most cases associated with isolated osteochondroma are treated using conservative methods with periodic monitoring. [ 3 ] However, surgical excision is performed when the tumor size presents an aesthetic problem, if there is a pathological fracture, if symptoms of nerve or vascular compression appear, if there is limitation in the movement of joints, and if exacerbation of the tumor is suspected.…”

Vascular entrapment neuropathy of the tibial nerve within the gastrocnemius muscle

“…[2,4] is same phenomenon could be caused by any other source of impingement such as space-occupying lesions, compartment syndromes, or other morphologic variants. [2,7] For instance, in a 2013 study by Tang et al, they evaluated the effects of acute compartment syndrome and subsequent proximal tibial nerve compression by the soleus tendinous arch. [7] However, vascular compression is not typically high on the differential diagnosis.…”

“…[2,7] For instance, in a 2013 study by Tang et al, they evaluated the effects of acute compartment syndrome and subsequent proximal tibial nerve compression by the soleus tendinous arch. [7] However, vascular compression is not typically high on the differential diagnosis. Unlike the trigeminal and facial nerves where vascular compression is a common and well-studied phenomenon, the same is not true with the tibial nerve.…”

“…Unlike the trigeminal and facial nerves where vascular compression is a common and well-studied phenomenon, the same is not true with the tibial nerve. [2,[6][7][8] It seems logical that neuropathy secondary to close vascular proximity could occur at various locations in the body, especially given the tendency of nerves to travel adjacent to arterial and venous structures within the same space.…”

Prognostic Accuracy of Blood Cell Count Ratios in Predicting Adverse Outcomes in Crush Syndrome Patients

“…In contrast to other types of catastrophic events, an earthquake is characterized by the signi cant dissipation of energy it involves [3]. It is primarily mechanical energy; therefore, most victims suffer crush injuries [4]. Furthermore, collapsed buildings prolong extrication time and increase the severity of crush injuries.…”