Vascular entrapment neuropathy of the tibial nerve within the gastrocnemius muscle

Abstract

Background: Vascular compression is an extremely rare cause of mononeuropathy and compression of selective tibial nerve branches is an additionally a rare finding and makes diagnosis difficult. Case Description: Here within, we describe the case of a 41-year-old male who presented with isolated mononeuropathy of the medial gastrocnemius (MG) branch of the tibial nerve presented as persistent fasciculations and atrophy. After electromyography and clinical evaluation, surgical exploration was recommended. A vascular bundle was found to be compressing the MG branch of the tibial nerve and thus was ligated to decompress the nerve. Postoperatively, all fasciculations improved and muscle atrophied improved. Conclusion: Vascular compression resulting in mononeuropathy of the peripheral nerves is a rare clinical entity. Clinicians should include these etiologies on their differential when considering surgical exploration of mononeuropathies.

A bilateral gastrocnemius tertius coexisting with a unilateral two-headed plantaris muscle

“…In cases of GM aberrant heads and their neural supply (TN thin branches), the available space in the popliteal fossa is decreased between adjacent structures, and vascular entrapment neuropathy of the TN may occur within the GM. Such chronic cases of neuropathy may also present with GM atrophy [14]. Differential diagnosis of entrapment neuropathy or vasculopathy cases includes a range of conditions, such as intraneural ganglion cyst affecting the sciatic nerve lower divisions, adventitial cyst in the PA, thrombophlebitic syndrome due to lower extremity deep vein thrombosis, synovial sarcoma in the knee joint, popliteal entrapment syndrome, posterior compartment syndrome in the lower leg, PA aneurysm, and Baker cyst [5,6,15].…”

Gastrocnemius Fascial Tear With Soleus Vascular Leash Leading to Tibial Neuritis: A Case Report

“… 7 Vascular disorders have also been reported to physically restrict the tibial nerve. 3 , 6 Additionally, muscle swelling from injury can also lead to an accumulation of connective tissue fluids that may progress to compartment syndrome. 8 Furthermore, exercise-induced compartment syndrome is a rare clinical diagnosis that can have long-term ramifications if not diagnosed in a timely fashion.…”