DOCSLIB.ORG

Failed Tarsal Tunnel Release

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Failed Tarsal Tunnel Release Failed Tarsal Tunnel Release Ellianne Nasser, DPM, FACFAS, CWS Podiatry Associate, Department of Orthopaedics Geisinger Health System Assistant Program Director, Podiatric Medicine and Surgery Residency Geisinger Community Medical Center Success Rates/Timing of Procedure • Success rates 44%-96% • Continued compression intraneural fibrosis muscle atrophy and irreparable nerve damage • Better outcomes with symptoms < 1 year • Sammarco/Chang 75 TTR • Results favorable if symptoms < 1 year • Babba et al 34 TTR • 61% relief of symptoms after TTR with “longstanding symptoms” • Turan et al 18 TTR Technique Pearls/Pitfalls • Bleeding wound dehiscence and post-op scarring • Drop tourniquet • Consider drain • Evacuate seroma/hematoma in timely fashion • Correct Etiology • Minimal manipulation of nerve Failed Tarsal Tunnel Release No relief? Relief with recurrence? No Improvement – Double Crush Syndrome • Systemic disease • Radiculopathy/Plexopathy • Proximal tibial nerve compression Proximal Tibial Nerve Compression • Soleal Sling Syndrome • Severe POP calf 9cm distal to popliteal crease • Conduction block btwn stimulation at knee and ankle No Improvement- Incomplete Release Lamm et al 2007 No Improvement: Etiology not Addressed • Space occupying lesions • Hindfoot deformity • Varicosities • Neurilemoma • Hypertrophic flexor retinaculum • Post-traumatic fibrosis • Low-lying muscle belly Etiology: Schwannoma Preoperative Imaging Etiology: Ganglion Preoperative Imaging/Workup No Improvement: Incorrect Diagnosis No Improvement: Intrinsic Nerve Pathology Peripheral Nerve Stimulation Temporary Relief with Recurrence: Adhesive Neuritis • Relief 2-4 months then return of symptoms • Post-op joint motion scarring • Nerve adhesions prevent gliding traction neuritis/pain • Risk factors • Tender, hypertrophic scar, decreased joint mobility Revision Decompression with Nerve Wrap Conclusions • Meticulous surgical technique • Address etiology • When it fails… References • Baba H, Wada M, Annen S, Azuchi M, Imura S, Tomita K. The tarsal tunnel syndrome: evaluation of surgical results using multivariate analysis. Int Orthop. 1997;21:67-71. • Bezerra MJC, Leite JAD, Neto JE, Romero S. Endoscopic release of the tarsal tunnel: a suggested surgical approach. Acta Ortop Bras. 2005;13(1): 46-48. • Day III FN, Naples JJ. Endoscopic tarsal tunnel release: update 96. J Foot Ankle Surg. 1996;35(3):225-229. • Day III FN, Naples JJ. Tarsal tunnel syndrome: an endoscopic approach with 4- to 28-month follow-up. J Foot Ankle Surg. 1994;33(3):244-248. • Ducic I, Endara M, Quadri H. Minimally invasive peripheral nerve surgery: a short scar technique. Microsurgery. 2010; 622-626. • Ducic I, Felder J. Tibial nerve decompression: reliable exposure using shorter incisions. Microsurgery. 2012;32:533-538. • Easley ME, Schon LC. Peripheral nerve vein wrapping for intractable lower extremity pain. Foot Ankle Int. 2000;21:492-500. • El Shazly O, El Shazly A, Desouky A, El Zohiery AK, Sakr HM. Anatomical bases of endoscopic tarsal tunnel release: anatomical and ultra-sonographic study with a preliminary case report. Surg Radiol Anat. 2011;33:929-936. • Franson J, Baravarian B. Tarsal tunnel syndrome: a compression neuropathy involving four distinct tunnels. Clin Pod Med Surg. 2006;23:597-609. • Gkotsoulis EN, Simonson DC, Roukis TS. Outcomes and safety of endoscopic tarsal tunnel decompression: a systematic review. Foot Ankle Spec. 2013;7(1):57-60. • Gould JS. Tarsal tunnel syndrome. Foot Ankle Clin N Am. 2011;16:275-286. • Gould JS. The failed tarsal tunnel release. Foot Ankle Clin N Am. 2011;16:287-293. • Jolly GP. Tarsal tunnel syndrome: can a minimally invasive release be advantageous? Podiatry Today. 2009;3(22). • Krishnan KG. Endoscopic decompression of the tarsal tunnel. Tech Foot Ankle Surg. 2010;9(2):52-57. • Krishnan KG, Pinzer T, Schackert G. A novel endoscopic technique in treating single nerve entrapment syndromes with special attention to ulnar nerve transposition and tarsal tunnel release: clinical application. Neurosurgery. 2006;59(1):89-100. • Lamm BM, Paley D, Testani M, Herzenberg JE. Tarsal tunnel decompression in leg lengthening and deformity correction at the foot and ankle. J Foot Ankle Surg. 2007, 43(6): 201-206. • Pfeiffer WH, Cracchiolo A. Clinical results after tarsal tunnel decompression. J Bone Joint Surg. 1994;76-A:1222-1230. • Raikin SM, Minnich JM. Failed tarsal tunnel syndrome surgery. Foot Ankle Clin N Am. 2003;8:159-174. • Sagi HC, Papp S, Dipasquale T. The effect of suture pattern and tension on cutaneous blood flow as assessed by laser Doppler flowmetry in a pig model. J Orthop Trauma. 2008;22:171-175. • Sammarco GJ, Chang L. Outcome of surgical treatment of tarsal tunnel syndrome. Foot Ankle Int. 2003;24:125-131. • Schon LC, Easley ME. Chronic Pain. In: Myerson, MS, editor. Foot and ankle disorders. Philadelphia: WB Saunders; 2000. p. 851-881. • Turan I, Rivero-Melian C, Guntner P, Rolf C. Tarsal tunnel syndrome: outcome of surgery in longstanding cases. Clin Orthop Relat Res. 1997;343:151-156. • Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973;2:359-362. • Williams EH, Rosson GD, Hagan RR, Hashemi SS, Dellon AL. Soleal sling syndrome (proximal tibial nerve compression): results of surgical decompression. Plast Reconstr Surg. 2012;129:454-462. • Williams EH, Williams CG, Rosson GD, Dellon LA. Anatomic site for proximal tibial nerve compression: a cadaver study. Ann Plast Surg. 2009;62:322-325..
Load more

Recommended publications
  • Dr Peter Heppner Consultant Neurosurgeon Auckland City Hospital Starship Childrens Hospital Ascot Hospital
    Dr Peter Heppner Consultant Neurosurgeon Auckland City Hospital Starship Childrens Hospital Ascot Hospital 14:00 - 14:55 WS #55: Case Studies on Managing Cervical Radiculopathy 15:05 - 16:00 WS #67: Case Studies on Managing Cervical Radiculopathy (Repeated) Case Studies on Managing Cervical Radiculopathy: Peter Heppner Neurosurgeon Auckland City Hospital Starship Childrens Hospital Ascot Private Hospital www.neurosurgeon.org.nz DISCLOSURES I have no actual or potential conflict of interest in relation to this presentation WHAT ARE THE TAKE HOME POINTS? Evidence relating to cervical radiculopathy management is poor Natural history is generally very good In the absence of red flags, initial management with analgesia and physiotherapy appropriate NRIs can be a useful therapeutic and diagnostic tool Surgery ideally considered between 3-6 months from onset Either anterior or posterior surgical approaches can be selected depending on specifics of the case CASE 1 58 yr old lady 2 weeks radiating left arm pain (?after pilates) Taking paracetamol and NSAID Mild parasthesia in thumb Neuro exam normal Neck Disability Index 28% (mild) Clinically: Mild C6 radiculopathy of short duration CERVICAL RADICULOPATHY Radiating arm pain in a nerve distribution due to mechanical compression/chemical irritation of the nerve root Referred pain to inter-scapular and lateral neck common Weakness usually mild Pain or parasthesia non-dermatomal in almost half of patients Reduced reflex best predictor of imaging findings>motor weakness>sensory
    [Show full text]
  • Carpal Tunnel Syndrome: a Review of the Recent Literature I
    The Open Orthopaedics Journal, 2012, 6, (Suppl 1: M8) 69-76 69 Open Access Carpal Tunnel Syndrome: A Review of the Recent Literature I. Ibrahim*,1, W.S. Khan1, N. Goddard2 and P. Smitham1 1University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK 2 Department of Trauma & Orthopaedics, Royal Free Hospital, Pond Street, London, NW3 2QG, UK Abstract: Carpal Tunnel Syndrome (CTS) remains a puzzling and disabling condition present in 3.8% of the general population. CTS is the most well-known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in CTS. The clinical presentation and risk factors associated with CTS are discussed in this paper. Also, the various methods of diagnosis are explored; including nerve conduction studies, ultrasound, and magnetic resonance imaging. Keywords: Carpal tunnel syndrome, median nerve, entrapment neuropathy, pathophysiology, diagnosis. WHAT IS CARPAL TUNNEL SYNDROME? EPIDEMIOLOGY First described by Paget in 1854 [1], Carpal Tunnel CTS is the most frequent entrapment neuropathy [2], Syndrome (CTS) remains a puzzling and disabling condition believed to be present in 3.8% of the general population [14]. 1 commonly presented to Rheumatologists and Orthopaedic in every 5 subjects who complains of symptoms such as pain, Hand clinicians. It is a compressive neuropathy, which is numbness and a tingling sensation in the hands is expected to defined as a mononeuropathy or radiculopathy caused by have CTS based on clinical examination and electrophysio- mechanical distortion produced by a compressive force [2].
    [Show full text]
  • A Historical Approach to Hereditary Spastic Paraplegia
    r e v u e n e u r o l o g i q u e 1 7 6 ( 2 0 2 0 ) 2 2 5 – 2 3 4 Available online at ScienceDirect www.sciencedirect.com History of Neurology A historical approach to hereditary spastic paraplegia O. Walusinski Private practice, 20, rue de Chartres, 28160 Brou, France i n f o a r t i c l e a b s t r a c t Article history: Hereditary spastic paraplegia (HSP) is a group of rare neurological disorders, characterised Received 12 August 2019 by their extreme heterogeneity in both their clinical manifestations and genetic origins. Received in revised form Although Charles-Prosper Ollivier d’Angers (1796–1845) sketched out a suggestive descrip- 25 November 2019 tion in 1827, it was Heinrich Erb (1840–1921) who described the clinical picture, in 1875, for Accepted 26 November 2019 ‘‘spastic spinal paralysis’’. Jean-Martin Charcot (1825–1893) began teaching the disorder as a Available online 3 January 2020 clinical entity this same year. Adolf von Stru¨mpell (1853–1925) recognised its hereditary nature in 1880 and Maurice Lorrain (1867–1956) gained posthumous fame for adding his Keywords: name to that of Stru¨mpell and forming the eponym after his 1898 thesis, the first review Hereditary spastic paraplegia covering twenty-nine affected families. He benefited from the knowledge accumulated over Weakness a dozen years on this pathology by his teacher, Fulgence Raymond (1844–1910). Here I Motor neuron disease present a history across two centuries, leading to the clinical, anatomopathological, and Neurodegeneration genetic description of hereditary spastic paraplegia which today enables a better unders- Stru¨mpell-Lorrain syndrome tanding of the causative cellular dysfunctions and makes it possible to envisage effective History of neurology treatment.
    [Show full text]
  • 101-Carpal Tunnel Syndrome
    Focus on CME at the University of Calgary Carpal Tunnel Syndrome The non-idiopathic causes of carpal tunnel syndrome (CTS) involve intrinsic and extrinsic conditions responsible for nerve compression. To establish a work-related association, there should be a history of excessive or unusual hand use of a nature known to be associated with CTS prior to the onset of symptoms. By Ron Gorsché, MD, MMedSc (Occupational Health), CCFP arpal tunnel syndrome (CTS) is responsible about CTS and it is among the most controversial C for the most time lost in the workplace, yet of disorders. This article focuses on how recent lit- there is little consensus regarding work as a erature has contributed to the theories of patho- causative factor of the syndrome. Little is known physiology and pathogenesis of CTS, and pro- vides clinicians with a more scientific approach Dr. Gorsché is clinical associate pro- to causative factors and treatment. fessor, departments of family medi- cine and community health sciences, faculty of medicine, University of Historical Perspectives Calgary, and director, Work-Related In 1860, Paget reported the first cases of median Upper Limb Disorders Research nerve compression of the wrist — one case attrib- Unit, Calgary, Alberta. He is also uted the disorder to a tight band wrapped around active staff, High River General the wrist and the other cited complications asso- Hospital, High River, Alberta. ciated with a fractured distal radius.1 In 1941, The Canadian Journal of CME / October 2001 101 Carpal Tunnel Syndrome Woltman first postulated the possibility of nerve toms of CTS. This approach works well for the compression within the carpal tunnel as a cause of clinician attempting to explain the syndrome to a “median neuritis,” after reporting 12 cases associ- patient, but requires further classification for epi- ated with acromegaly.2 demiological study.
    [Show full text]
  • POLYNEURITIS by G
    413 Postgrad Med J: first published as 10.1136/pgmj.35.405.413 on 1 July 1959. Downloaded from POLYNEURITIS By G. S. GRAVESON, M.A., M.D., F.R.C.P. Consultant Neurologist, Wessex Regional Hospital Board (From the Southampton General Hospital) Diseases affecting the lower motor and sensory acid and vitamin B.I2. Thiamine is a constituent neurones, diffusely and usually symmetrically, are of the coenzyme cocarboxylase, which is necessary grouped together under the title polyneuritis. The for the oxidation of pyruvic acid formed in the term is imprecise, for many of these diseases affect metabolism of glucose by nerve cells. It is also structures other than peripheral nerves, e.g. concerned in the synthesis of acetylocholine in spinal nerve cells, roots and muscles, and few of nerve fibres. Its deficiency, therefore, results in them are really inflammatory disorders. To over- neuronal degeneration and the accumulation of an come this inaccuracy, such terms as polyradiculo- excess of pyruvate in the blood. This may be neuropathy and neuromyopathy have been coined present in the fasting state or it may be brought but the older word still serves, with better out by a loading dose of glucose. Joiner, McArdle euphony perhaps, provided it is used merely in and Thompson (1950) describe the use of such aProtected by copyright. the sense of a condition in which lesions of peri- 'pyruvate metabolism test ' in the investigation of pheral nerves occur. Its retention may be ad- cases of polyneuritis. Lack of thiamine may be a visable, too, until such time as the pathogenesis of contributory factor in the polyneuritis of chronic the various types of the disease have been more alcoholism and in those cases which complicate fully elucidated.
    [Show full text]
  • SARS-Cov-2 Infection and Guillain-Barré Syndrome
    pathogens Review SARS-CoV-2 Infection and Guillain-Barré Syndrome Huda Makhluf 1,* and Henry Madany 2 1 Department of Mathematics and Natural Sciences, National University, La Jolla, CA 92037, USA 2 Public Health, University of California, Irvine, CA 92697, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-858-642-8488 Abstract: Severe acute respiratory syndrome coronavirus strain 2 (SARS-CoV-2) is a beta-coronavirus that emerged as a global threat and caused a pandemic following its first outbreak in Wuhan, China, in late 2019. SARS-CoV-2 causes COVID-19, a disease ranging from relatively mild to severe illness. Older people and those with many serious underlying medical conditions such as diabetes, heart or lung conditions are at higher risk for developing severe complications from COVID-19 illness. SARS-CoV-2 infections of adults can lead to neurological complications ranging from headaches, loss of taste and smell, to Guillain–Barré syndrome, an autoimmune disease characterized by neurological deficits. Herein we attempt to describe the neurological manifestations of SARS-CoV2 infection with a special focus on Guillain-Barré syndrome. Keywords: SARS-CoV-2; COVID-19; Guillain-Barré Syndrome 1. Introduction Citation: Makhluf, H.; Madany, H. SARS-CoV-2 Infection and SARS-CoV-2 is an enveloped, positive-stranded RNA virus belonging to the Coron- Guillain-Barré Syndrome. Pathogens aviridae family and Betacoronavirus genus. SARS-CoV-2 and the related SARS-CoV-1 and 2021, 10, 936. https://doi.org/ MERS-CoV share several characteristics including severe disease outcomes. SARS-CoV-2 10.3390/pathogens10080936 has a ~30 Kb genome encoding 29 proteins, with four structural proteins (envelope, mem- brane, nucleocapsid, and spike), 16 nonstructural proteins, and nine accessory proteins.
    [Show full text]
  • Peripheral Neuropathy (Peripheral Neuritis) with Bronchiectasis by J
    Thorax: first published as 10.1136/thx.13.1.59 on 1 March 1958. Downloaded from Thorax (1958), 13, 59. PERIPHERAL NEUROPATHY (PERIPHERAL NEURITIS) WITH BRONCHIECTASIS BY J. E. CAUGHEY, R. F. WILSON, AND JOHN BORRIE From the Departments of Medicine and Surgery, Medical School, Otago University, New Zealand (RECEIVED FOR PUBLICATION OCTOBER 21, 1957) The ill-defined group of conditions comprising ground. The feet and ankles were " oddly stiff and the syndrome of peripheral or multiple neuritis led tight" all the time but most of all on movement. Walshe (1946) to ask for a more precise definition. The ankles, but not the knees, felt weak. At the age of 9 years she had severe pneumonia Elkington (1952) pointed out the advantages of complicated by left basal empyema for which three the new term " peripheral neuropathy," as it avoids drainage operations were performed during nine weeks the suggestion that all the lesions are inflammatory in hospital. A chronic loose paroxysmal cough per- in origin. Haymaker and Kernohan (1949), in a sisted thereafter, commonly productive of muco- comprehensive study of peripheral neuropathy, purulent sputum, more profuse and purulent during found that the clinical picture may range from frequently recurring and prolonged colds, and at the slight lesion with peripheral weakness and times blood-stained. She had frequent attacks of mild paraesthesiae to a grave ascending fatal neuronitis pleural pain. Her ill-health seriously interrupted her involving the central nervous system as seen in education. She was comparatively well in her early adult years, but after marriage she again had increas- the so-called Landry syndrome.
    [Show full text]
  • Inflammation and Neuropathic Attacks in Hereditary Brachial Plexus Neuropathy C J Klein,Pjbdyck, S M Friedenberg, T M Burns, a J Windebank, P J Dyck
    45 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.73.1.45 on 1 July 2002. Downloaded from PAPER Inflammation and neuropathic attacks in hereditary brachial plexus neuropathy C J Klein,PJBDyck, S M Friedenberg, T M Burns, A J Windebank, P J Dyck ............................................................................................................................. J Neurol Neurosurg Psychiatry 2002;73:45–50 Objective: To study the role of mechanical, infectious, and inflammatory factors inducing neuropathic attacks in hereditary brachial plexus neuropathy (HBPN), an autosomal dominant disorder character- ised by attacks of pain and weakness, atrophy, and sensory alterations of the shoulder girdle and upper limb muscles. Methods: Four patients from separate kindreds with HBPN were evaluated. Upper extremity nerve See end of article for biopsies were obtained during attacks from a person of each kindred. In situ hybridisation for common authors’ affiliations viruses in nerve tissue and genetic testing for a hereditary tendency to pressure palsies (HNPP; tomacu- ....................... lous neuropathy) were undertaken. Two patients treated with intravenous methyl prednisolone had Correspondence to: serial clinical and electrophysiological examinations. One patient was followed prospectively through Dr Christopher J Klein, pregnancy and during the development of a stereotypic attack after elective caesarean delivery. Mayo Clinic, 200 First Results: Upper extremity nerve biopsies in two patients showed prominent perivascular inflammatory Street SW, Rochester, infiltrates with vessel wall disruption. Nerve in situ hybridisation for viruses was negative. There were Minnesota 55905, USA; no tomaculous nerve changes. In two patients intravenous methyl prednisolone ameliorated symptoms [email protected] (largely pain), but with tapering of steroid dose, signs and symptoms worsened. Elective caesarean Received delivery did not prevent a typical postpartum attack.
    [Show full text]
  • Pediatric MS and Other Demyelinating Disorders in Childhood Current Understanding, Diagnosis and Management 24
    Pediatric MS and other demyelinating disorders in childhood Current understanding, diagnosis and management 24 Contents Pediatric MS from the perspective of both the 4 child and the family Biological reasons why children develop MS 4 Genetic and environmental risk factors for 5 pediatric MS Clinical features and outcome 6 Cognition and mood 6 MRI features 7 Conventional first-line treatment and general 7 management Escalation and emerging treatments 9 Defining MS in childhood and differentiating it 9 from mimics Acute disseminated encephalomyelitis (ADEM) 10 Acute transverse myelitis (ATM) 10 Optic neuritis 11 Neuromyelitis optica (NMO) 11 Acquired demyelinating syndrome (ADS) 12 References and further reading 13 Contributors The articles summarised in this publication are taken from a 2016 Neurology journal supplement, written by the International Pediatric MS Study Group. We gratefully acknowledge the editorial contribution of Dr Rosalind Kalb. Funders Associazione Italiana Sclerosi Multipla, Deutsche Multiple Sklerose Gesellschaft Bundesverband, MS Cure Fund, National MS Society (USA), Schweizerische Multiple Sklerose Gesellschaft/Société suisse de la Sclérose en plaques, Scleroseforeningen, Stichting MS Research. 34 Pediatric MS and other demyelinating disorders in childhood: Current understanding, diagnosis and management The understanding of multiple sclerosis (MS) and other demyelinating disorders in childhood has advanced considerably in the last ten years. This publication accompanies a series of articles written by subject experts that highlight the advances, unanswered questions and new challenges in understanding, diagnosis and management. It provides a short summary of the key points from each article, and a list of resources and further reading where you can find links to the full articles, all of which are available open access (free).
    [Show full text]
  • Evaluating the Patient with Suspected Radiculopathy
    EVALUATINGEVALUATING THETHE PATIENTPATIENT WITHWITH SUSPECTEDSUSPECTED RADICULOPATHYRADICULOPATHY Timothy R. Dillingham, M.D., M.S Professor and Chair, Department of Physical Medicine and Rehabilitation The Medical College of Wisconsin. RadiculopathiesRadiculopathies PathophysiologicalPathophysiological processesprocesses affectingaffecting thethe nervenerve rootsroots VeryVery commoncommon reasonreason forfor EDXEDX referralreferral CAUSESCAUSES OFOF RADICULOPATHYRADICULOPATHY HNPHNP RadiculiitisRadiculiitis SpinalSpinal StenosisStenosis SpondylolisthesisSpondylolisthesis InfectionInfection TumorTumor FacetFacet SynovialSynovial CystCyst Diseases:Diseases: Diabetes,Diabetes, AIDPAIDP MUSCULOSKELETALMUSCULOSKELETAL DISORDERSDISORDERS :: UPPERUPPER LIMBLIMB ShoulderShoulder BursitisBursitis LateralLateral EpicondylitisEpicondylitis DequervainsDequervains TriggerTrigger fingerfinger FibrositisFibrositis FibromyalgiaFibromyalgia // regionalregional painpain syndromesyndrome NEUROLOGICALNEUROLOGICAL CONDITIONSCONDITIONS MIMICKINGMIMICKING CERVICALCERVICAL RADICULOPATHYRADICULOPATHY Entrapment/CompressionEntrapment/Compression neuropathiesneuropathies –– Median,Median, Radial,Radial, andand UlnarUlnar BrachialBrachial NeuritisNeuritis MultifocalMultifocal MotorMotor NeuropathyNeuropathy NeedNeed ExtensiveExtensive EDXEDX studystudy toto R/OR/O otherother conditionsconditions MUSCULOSKELETALMUSCULOSKELETAL DISORDERSDISORDERS :: LOWERLOWER LIMBLIMB HipHip arthritisarthritis TrochantericTrochanteric BursitisBursitis IlliotibialIlliotibial BandBand
    [Show full text]
  • Hereditary Spastic Paraplegia by Edwin R
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.13.2.134 on 1 May 1950. Downloaded from J. Neurol. Neurosurg. Psychiat., 1950, 13, 134. HEREDITARY SPASTIC PARAPLEGIA BY EDWIN R. BICKERSTAFF From the Department ofNeurology, United Birmingham Hospitals The family under consideration in this paper has from Germany. Families are described in the been studied in detail, not only because its members central and southern American journals, others provide many examples of a disease which is very from the UJnited States, and isolated reports came rare in this country, but also because the differing from Russia and Japan. In Great Britain, how- clinical picture appearing in certain members of the ever, the disease appears to be rare, and indeed, family may contribute to the better understanding of despite an intensive search, Bell and Carmichael the hereditary disorders ofthe central nervous system, (1939) were able to find one family only amongst and their possible inter-relationship. The tendency the records of the last 25 years at the National for the members ofthis family to remain in the same Hospital, Queen Square, London, and the Maida part of the same city, even after marriage, has made Vale Hospital, London. (If one holds to strict it possible to examine the majority of the living diagnostic criteria, the disease is less common in members, and clinical details have been obtained other countries than appears, for it would seem, Protected by copyright. concerning several who have died. as Bell and Carmichael (1939) observe, that the It is evident that the disease is widespread through- major justification for the clinical differentiation of out three generations, and possibly four, and that this condition from the spastic ataxias is the absence alongside examples of the fully developed syndrome, of any form of ataxia-a rule not always observed.) there are numerous early or abortive cases.
    [Show full text]
  • Review a Brief History of Sciatica
    Spinal Cord (2007) 45, 592–596 & 2007 International Spinal Cord Society All rights reserved 1362-4393/07 $30.00 www.nature.com/sc Review A brief history of sciatica JMS Pearce*,1 1Department of Neurology, Hull Royal Infirmary and Hull York Medical School, UK Study design: Historical review. Objectives: Appraise history of concept of sciatica. Setting: Europe. Methods: Selected, original quotations and a historical review. Results: Evolution of ideas fromhip disorders, through interstitial neuritis. Conclusion: Current concepts of discogenic sciatica. Sponsorship: None. Spinal Cord (2007) 45, 592–596; doi:10.1038/sj.sc.3102080; published online 5 June 2007 Keywords: sciatica; intervertebral disc; disc prolapse Introduction Using selected, original quotations and a historical Hippocrates was allegedly, the first physician to use review, this paper attempts to appraise the several steps the term‘sciatica’, deriving fromthe Greek ischios, hip. leading to modern concepts of the ubiquitous sciatica. Pain in the pelvis and leg was generally called sciatica Pain in sciatic distribution was known and recorded and attributed to a diseased or subluxated hip: by ancient Greek and Roman physicians, but was commonly attributed to diseases of the hip joint. After protracted attacks of sciatica, when the head Although graphic descriptions abounded, it was not of the bone [femur] alternately escapes from and until Cotugno’s experiments of 1764 that leg pain returns into the cavity, an accumulation of synovia of ‘nervous’ origin was distinguished frompain of occurs.3 ‘arthritic’ origin. In the nineteenth century, disc diseases including prolapse were recognised, but not related to Hippocrates noticed symptoms which were more sciatica until Lase` gue described his sign to indicate frequent in summer and autumn.
    [Show full text]