Proximal peripheral nerve entrapment syndromes in the lower extremity

Kashuk, K B

doi:10.7547/87507315-67-8-529

Cited by 23 publications

(7 citation statements)

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“…Most of the articles related to lower extremity nerve compressions do not mention this possible nerve compression site [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Earthquake generated proximal tibial nerve compression treated by surgery

Tang¹,

He²,

Chen³

et al. 2013

International Orthopaedics (SICOT)

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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.

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“…Most of the articles related to lower extremity nerve compressions do not mention this possible nerve compression site [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Earthquake generated proximal tibial nerve compression treated by surgery

Tang¹,

He²,

Chen³

et al. 2013

International Orthopaedics (SICOT)

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“…An entrapment neuropathy is defined as a pressure-induced segmental injury to a peripheral nerve due to an anatomical compression or pathological process. [34] The defining criteria of an entrapment, according to Kashuk,[5] include altered transmission because of mechanical irritation from impingement of near structures. Many nerve entrapments occur at sites where the nerve travels through a canal, channel, or tunnel, but they also occur because of trauma or scar “strangulation” of the nerve.…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone versus hyaluronidase as an adjuvant to local anesthetics in the ultrasound-guided hydrodissection of the median nerve for the treatment of carpal tunnel syndrome patients

Alsaeid

2019

Anesth Essays Res

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Background:Carpal tunnel syndrome (CTS) is one of the most common focal entrapment neuropathies. Although the exact etiology remains unclear, high-pressure-related intracarpal tunnel compression of the median nerve (MN), progressing ischemia, and mechanical strangulation are common mechanisms. The therapeutic managements for CTS depend on the disease severity, varying from a conservative treatment to surgical interventions. Conservative treatment is helpful for most of the patients with mild-to-moderate CTS. Hydrodissection is a minimally invasive procedure of injecting solutions into some anatomical spaces to facilitate dissection and adhesiolysis. Steroids as an anti-inflammatory drugs are used to treat chronic pain conditions. Hyaluronidase as an adhesolysis agent can also be used for epidural injections with local anesthetics (LAs) and steroids for control of chronic back pain.Aim of the Study:This study was carried out to compare the efficacy of hyaluronidase versus dexamethasone as adjuvants to the mixture of LAs in ultrasound (US)-guided hydrodissection of the median nerve in mild to moderate cases of carpal tunnel syndrome.Settings and Design:This study was a prospective randomized controlled double-blinded clinical study.Methods:40 patients aged from 20 to 60 years old with clinical, electrophysiologic, and ultrasonographic evidence of mild to moderate CTS were included in this study. Each patient was assessed at the baseline (prior to injection) and at 1 week, 1 month, 3 months, and 6 months intervals after injection: (1) The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) which is a frequently used patient-based questionnaire for measurement of CTS. primary outcome. (2) Median motor and sensory nerve conduction studies (NCS) secondary outcome. (3) Median nerve ultrasonography. The ultrasound examination included measurement of the median nerve cross-sectional area (CSA) at the distal wrist crease (DWC). Also, the median nerve echogenicity, mobility, and vascularity at the DWC were assessed by US. Secondary outcome. All outcome assessments were assessed by single investigator who was blinded to the study details. All patients received US guided hydrodissection of the median nerve at the distal wrist crease. The selected patients were randomly allocated into 2 groups containing 20 patients each according to the study drugs; Group (D) received 5 mL (3 mL plain bupivacaine 0.5% and 2 mL (8 mg) dexamethasone), and Group (H) received 5 mL (3 mL plain bupivacaine 0.5% and 2 mL normal saline containing 300 international units (IU) hyaluronidase. Ultrasound-guided intracarpal injection using ultrasonography (Sono Scape A5; Shinzhen, China) with a 10-18-MHZ linear array transducer was performed by the same physician who was not aware of study groups, the MN was observed at the inlet of the carpal tunnel, 3 ml of solution was injected via the in-plane ulnar approach, to detach the MN from the transverse carpal ligament and an additional 2 ml was injected to separate the MN from underlying flexor tendons. All pa...

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“…Entrapment neuropathies are the most prevalent type of peripheral neuropathy (Schmid et al, 2018) and can have profound physical, psychological, and economic impacts on patients (Toussaint et al, 2010). The defining criteria of an entrapment, according to Kashuk (1977), include altered transmission due to mechanical irritation related to anatomical neighbor impingement. Nerve entrapment is broadly defined as compression or entrapment of a nerve as it passes through an anatomical structure such as a fibroosseous tunnel or fascial opening (Flanigan and DiGiovanni, 2011) or below a thickened overlying retinaculum (Toussaint et al, 2010) that represents a fascial reinforcement (Stecco et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Fascial entrapment neuropathy

2019

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Entrapment neuropathies are debilitating clinical conditions, creating significant morbidity in the upper and lower extremities in terms of pain, sensory abnormalities, and motor weakness, becoming a challenge to diagnose and treat. Because entrapments can have multiple origins, a misinterpretation of anatomy during examination can lead to incorrect diagnosis and treatment. This review addresses understanding of the anatomy of fascia that can play an important role in this syndrome. There is a specific microenvironment around the nerve composed of connective tissues that include deep fascia, intermuscular septa, epineurium, and perineurium. The microenvironmental modifications can be translated into change in mobility with consequence decreasing of the independency of the nerve from the surrounding structures lading to entrapments and “internal stretch lesion.” The entrapments reported in this article reinforce the importance of fascia tissue in generating common symptoms that pose more difficult diagnostic challenges and may often be confused with more common clinical conditions. Clin. Anat. 32:883–890, 2019. © 2019 Wiley Periodicals, Inc.

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Proximal peripheral nerve entrapment syndromes in the lower extremity

Cited by 23 publications

References 0 publications

Earthquake generated proximal tibial nerve compression treated by surgery

Earthquake generated proximal tibial nerve compression treated by surgery

Dexamethasone versus hyaluronidase as an adjuvant to local anesthetics in the ultrasound-guided hydrodissection of the median nerve for the treatment of carpal tunnel syndrome patients

Fascial entrapment neuropathy

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