Dr Vanessa Sammons

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NEUROSURGEON Dr Vanessa Sammons Dr Vanessa Sammons MBBS (Hons) MPhil FRACS Surgeons, the international Association of Women Surgeons, and is a Neurosurgeon at Gosford Private Hospital, treating all the American Society of Peripheral Nerve Surgery. Dr Sammons neurosurgical conditions, but with a particular interest in Peripheral is also a mother of two. Nerve Surgery. Dr Sammons prides herself on providing Conditions Dr Sammons manages include: personalised patient care and utilising her skills to achieve the best • Nerve entrapments (including, but not limited to carpal tunnel outcome possible. syndrome, ulnar neuropathy, common peroneal neuropathy, Dr Sammons attended the University of Sydney, graduating tarsal tunnel syndrome, meralgia paraesthetica) with honours, also being awarded the Hinder Memorial Prize for • Nerve and brachial plexus injuries Surgery. Prior to Neurosurgery training, Dr Sammons completed • Thoracic outlet syndrome a Master of Philosophy in Advanced Medicine, researching brain • Nerve tumours (including schwannomas and neurofibromas) arteriovenous malformations. • Spinal cord and spinal nerve root compression Dr Sammons completed her training at several Sydney hospitals • Spinal cord and brain tumours including, Royal Prince Alfred Hospital, St George Hospital, Prince • Spinal degenerative conditions of Wales Hospital, Liverpool Hospital, Royal North Shore Hospital • Chiari malformations and Sydney Children’s Hospital. After the award of Fellowship to • Hydrocephalus the Royal Australasian College of Surgeons as a Neurosurgeon, Dr Sammons travelled to Foothills Medical Centre in Calgary, • Trigeminal neuralgia Canada where she undertook subspecialty training in Peripheral • Hemifacial spasm Nerve Surgery under the mentorship of Dr Rajiv Midha, a world Referrals: renowned Peripheral Nerve Surgeon. For referrals to Dr Sammons, please contact Central Coast During training Dr Sammons was the elected trainee representative Neurosciences at Suite 202, Level 1, 200 Central Coast to the Training Board of the Neurosurgical Society of Australasia. Highway, Erina on: She is a member of the Neurosurgical Society of Australasia, the Women in Surgery Section of the Royal Australasian College of T: 02 9436 1818 E: [email protected] Burrabil Avenue, North Gosford NSW 2250 T: 4324 7111 / gosfordprivate.com.au.

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Ultrasound-Guided Treatment of Peripheral Entrapment Mononeuropathies John W
AANEM MONOGRAPH ULTRASOUND-GUIDED TREATMENT OF PERIPHERAL ENTRAPMENT MONONEUROPATHIES JOHN W. NORBURY, MD,1 and LEVON N. NAZARIAN, MD2 1 Department of Physical Medicine and Rehabilitation, The Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville North Carolina 27834, USA 2 Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA Accepted 13 May 2019 ABSTRACT: The advent of high-resolution neuromuscular ultrasound high-resolution linear-array transducers has allowed neu- (US) has provided a useful tool for conservative treatment of periph- romuscular US to emerge as a powerful tool for the diag- eral entrapment mononeuropathies. US-guided interventions require 2–6 careful coordination of transducer and needle movement along with a nosis of peripheral entrapment mononeuropathies. detailed understanding of sonoanatomy. Preprocedural planning and US-guided treatment of entrapment mononeuropathies positioning can be helpful in performing these interventions. Cortico- has also greatly expanded in recent years. Technical steroid injections, aspiration of ganglia, hydrodissection, and minimally invasive procedures can be useful nonsurgical treatments for aspects of performing therapeutic US-guided proce- mononeuropathies refractory to conservative care. Technical aspects dures and the current state of the science regarding US- as well as the current understanding of the indications and efﬁcacy of guided treatment for common peripheral entrapment these procedures for common entrapment mononeuropathies are reviewed in this study. mononeuropathies are reviewed and discussed in this Muscle Nerve 60: 222–231, 2019 monograph. The expansion of high-resolution linear-array trans- TYPES OF ULTRASOUND-GUIDED INTERVENTIONS ducers has allowed neuromuscular ultrasound (US) Corticosteroid Injections. Corticosteroids suppress 7–9 to emerge as a powerful tool for the diagnosis and treat- proinﬂammatory cytokines.
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Meralgia Paraesthetica
Meralgia Paraesthetica Meralgia paraesthetica is numbness or pain in the outer thigh not caused by injury to the thigh, but by injury to a nerve that extends from the thigh to the spinal column. This chronic neurological disorder involves a single nerve—the lateral cutaneous nerve of the thigh. The lateral femoral cutaneous nerve most often becomes injured by entrapment or compression where it passes between the upper front hip bone (ilium) and the inguinal ligament near the attachment at the ASIS. Signs and symptoms Pain on the outer side of the thigh, occasionally extending to the outer side of the knee, usually constant. A burning sensation, tingling, or numbness in the same area Multiple bee-sting like pains in the affected area Occasionally, aching in the groin area or pain spreading across the buttocks Usually more sensitive to light touch than to firm pressure Hyper sensitivity to heat (warm water from shower feels like it is burning the area) Treatments Wearing looser clothing and suspenders rather than belts Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammatory pain Pain killers if pain level limits motion and prevents sleep Reducing physical activity in relation to pain level. Acute pain may require absolute bed rest MP can occur in any age group but is most frequently reported in middle-age persons and is generally regarded as uncommon. The incidence rate of MP reported in Holland in 2004 was 4.3 per 10,000 persons. There is no consensus about sex predominance, but in 1 study evaluating 150 MP cases, a higher incidence was reported in men.
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Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2014; 18: 2766-2771 Peripheral neuropathy in obstetrics: efficacy and safety of α-lipoic acid supplementation M. COSTANTINO, C. GUARALDI 1, D. COSTANTINO 2, S. DE GRAZIA 3, V. UNFER 3 Chemistry and Pharmaceutical Technologies, University of Ferrara, Ferrara, Italy 1Obstetrics and Gynaecology Unit, Ospedale di Valdagno (VI), Italy 2Female Health Centre, Azienda USL, Ferrara, Italy 3A.G.UN.CO. Ostetric and Gynecological Center, Rome, Italy Abstract. – OBJECTIVE : Neuropathic pain more prone to the development of neuropathic during pregnancy is a common condition due to syndromes. First and foremost, the physical the physical changes and compression around changes caused by the enlargement of the uterus pregnancy and childbirth that make pregnant women more prone to develop several medical and the development of the foetus cause postural conditions such as carpal tunnel syndrome, sci - changes and nutation of the pelvic girdle that fa - atica, meralgia paraesthetica and other nerve en - cilitate the development of low back pain and en - trapment syndromes. Most of the treatments trapment neuropathies. The mutation of the usually performed to counteract neuropathic pelvic girdle is favoured during pregnancy also pain are contraindicated in pregnancy so that, by the presence of high concentrations of relaxin, the management of these highly invalidating conditions remains an issue in the clinical prac - which is produced from the tenth week of gesta - tice. We aimed to review the efficacy and safety tion and causes a laxity in the joints not only in of alpha lipoic acid supplementation in the treat - the pelvis, but also on a vertebral level, which ment of neuropathic pain.
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Diagnosis of the of the Extremities
Postgrad Med J: first published as 10.1136/pgmj.22.251.255 on 1 September 1946. Downloaded from DIAGNOSIS OF THE COMMON FORMS OF NERVE INJURY OF THE EXTREMITIES By COLIN EDWARDS, M.B., B.S., M.R.C.P., D.P.M. History-taking is the first step in diagnosis and panying diminution or loss of reflexes. In the it is useful to know how varied the causes of peri- absence of an external wound or contusion near the pheral nerve injuries can be. Otherwise the true nerve concerned these muscle changes may be the nature of a traumatic lesion sometimes may not only guide. be suspected. Look first at the most peripheral muscles and The commoner ones are the result of:- particularly those which move the hands and feet. (I) Cutting and laceration. If these are normal (indicating an intact nerve (2) Stretching, which may be sudden (e.g. supply) it is uncommon, although not impossible, stretching of the sciatic by jumping upon the for muscles to be involved whose supply leaves extended foot) causing fibre rupture and those same nerves at a more proximal level. And haemorrhage, or prolonged (e.g. lying with the proximal involvement with normal peripheral arm extended for hours above the head) muscles only occurs close to the actual spot where ischaemia. causing the nerve is injured. The state of innervation of Contusion. the muscles moving the hands and feet gives no (3) to that of the limb (4) Concussion (including that produced by a guide, however, girdle muscles,Protected by copyright. "near miss" when a missile passes through as they are supplied by comparatively short nerves neighbouring tissues without touching the nerve).
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Peripheral Neuropathy in Older People Peripheral Neuropathies Are Common in Older People
Pain 47 Peripheral neuropathy in older people Peripheral neuropathies are common in older people. Although the ageing process itself may play a part, there are multiple other causes. Peripheral neuropathy interferes with normal daily activities and leads to increased risk of falls, injury and poor quality of life. Management of peripheral neuropathy ofen needs a multidisciplinary team approach. Siyum Strait, Specialist Registrar Acute Medicine, Great Western Hospital, Swindon Pippa Medcalf, Consultant Physician, Gloucester Royal Hospital, Great Western Road, Gloucestershire Email [email protected] Peripheral neuropathy is one involvement, time course, type of (eg. diabetic distal symmetrical pattern of damage to the peripheral defcit or nature of the underlying polyneuropathy), purely nervous system.1 Physical signs of pathology.8 (Box 1) motor (eg. acute motor axonal peripheral neuropathy are common The patterns of nerve neuropathy), mixed motor and in older people.2 Recognition involvement that occur include sensory (eg. Charcot-Marie-Tooth of these deficits is particularly mononeuropathy, multiple disease) and autonomic. important because peripheral mononeuropathy (mononeuritis Te responsible pathology may neuropathy may contribute to the multiplex), symmetrical be axonal, demyelinating or mixed vulnerability to falls that is common polyneuropathy, radiculopathy and axonal and demyelinating. in this age group.3,4 More than 30% polyradiculoneuropathy. Peripheral neuropathies of all of patients aged over 65 years will Mononeuropathy refers to groups may involve large nerve fall at least once per year.5 involvement of major nerve trunks, fbres, small nerve fbre or both. Peripheral neuropathy singly or multiply. Radiculopathy Large nerve fibres are long, commonly causes impairment refers to involvement of nerve myelinated and enable fast of proprioception and balance, roots, again singly or multiply.
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Bypassing the Challenges of Lower-Limb ELECTROMYOGRAPHY by Using Ultrasonography: Anatomus-II
J Rehabil Med 2013; 45: 604–605 LETTER TO THE EDITOR BYPASSING THE CHALLENGES OF LOWER-LIMB ELECTROMYOGRAPHY BY USING ULTRASONOGRAPHY: ANATOMUS-II Electrodiagnostic studies are the gold-standard evaluation real-time imaging tool, whereby it is practical for the physician tools for peripheral nerve entrapment syndromes. However, to scan several peripheral nerves immediately after medical/ although they can indirectly localize the site of injury (through physical examination of the patient. In addition, in the afore- physiological data), they cannot provide morphological confir- mentioned challenging cases, it becomes a powerful diagnostic mation as do other imaging methods (1). Furthermore, during tool rather than merely an adjunct to electrodiagnostics. With lower limb diagnostics in particular, electrophysiologists may ultrasound, one can morphologically confirm entrapment, un- encounter various challenges concerning certain entrapment cover the underlying cause of injury, precisely guide onward syndromes, e.g. meralgia paraesthetica, tarsal tunnel syn- intervention (injection/surgery), and follow up the injury (1). drome, Morton’s neuroma. In addition, technical difficulties Thus, having organized study of the upper limb in 2012 (6), during sensory evaluations with surface electrodes (even with in a similar workshop in 2013 we studied the lower limb nerves near-nerve needle techniques) may overwhelm the diagnostics in parallel sessions using cadavers and ultrasound (Fig. 1). (2–5). In this case, ultrasound appears to be a very convenient, This time we included in-depth electrophysiological discussion Fig. 1. Anatomical dissections and their corresponding ultrasound images for (A, B) lateral femoral cutaneous, (C, E) superficial and (D, F) deep peroneal nerves. (A) Lateral femoral cutaneous nerve is shown distal to its bifurcation in the inguinal region lateral to the femoral nerve and vessels.
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Meralgia Paresthetica Caused by Entrapment of the Lateral Femoral Subcutaneous Nerve at the Fascia Lata of the Thigh : a Case Report and Literature Review
248 CASE REPORT Meralgia paresthetica caused by entrapment of the lateral femoral subcutaneous nerve at the fascia lata of the thigh : a case report and literature review Yasuyuki Omichi1, Ichiro Tonogai2, Shinsuke Kaji1, Teruaki Sangawa1, and Koichi Sairyo2 1Department of Orthopedics, Shikokuchuo Hospital, Ehime, Japan, 2Department of Orthopedics, Tokushima University, Tokushima, Japan Abstract : Meralgia paresthetica (MP) causes tingling, stinging or a burning sensation in the anterolateral part of the thigh, usually as a result of entrapment of the lateral femoral cutaneous nerve (LFCN) at the inguinal liga- ment (IL) due to mechanical or iatrogenic injury. However, there are few reports on MP caused by entrapment of the LFCN at a more distal site from the IL. We report here a rare case of MP caused by entrapment of the LFCN at the fascia lata of the thigh level. A 23-year-old man felt numbness and sharp pain at the anterolateral aspects of both thighs soon after direct repair surgery for L5 isthmic spondylolisthesis. Although his symptoms were re- lieved a few days later, numbness and sharp pain in the right thigh recurred 6 months after the surgery. A diag- nosis of MP was made, and decompression of the LFCN was performed because conservative treatment for MP was inadequate. Intraoperatively, it was noted that the LFCN was entrapped underneath the fascia lata of the thigh, not at the IL level. His symptoms disappeared after LFCN was released. This case demonstrates that it is necessary to consider the possibility of entrapment of the LFCN at the fascia lata at the thigh level in MP.
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Aetiology of Neuropathic Pain (NP) Along with Role of Gabapentinoids
ISSN: 2474 - 9206 Review Article Journal of Anesthesia & Pain Medicine Aetiology of Neuropathic Pain (NP) Along with Role of Gabapentinoids Like Pregabalin and Gabapentin in Treating the Excruciating Pain Besides Other Newer Alternatives-a Systematic Review Kulvinder Kochar Kaur1*, Gautam Allahbadia2 and Mandeep Singh3 1Scientific Director Centre for Human Reproduction 721, G.T.B. Nagar Jalandhar-144001 Punjab, India * 2 Corresponding author Scientific Director Ex-Rotunda-A Centre for Human reproduction Kulvinder Kochar Kaur, Scientific Director Centre for Human Reproduction 672, Kalpak Garden, Perry Cross Road, Near Otter’s Club, Bandra 721, G.T.B. Nagar Jalandhar-144001 Punjab, India (W)-400040 Mumbai, India 3Neurology Consultant Neurologist Swami Satyanand Hospital Submitted: 29 Jan 2020; Accepted: 13 Feb 2020; Published: 20 Feb 2020 near Nawi Kachehri, Baradri, Ladowali road, Jalandhar, Punjab, India Abstract Neuropathic pain (NP) by definition is a problem that involves the somatosensory system either as a manifestation as disease or as a lesion. Lot of differing causes either of central/peripheral origin can stimulate NP and that might affect life’s quality badly. Worldwide prevalence of NP varies from 6.9-10% with spinal cord injury (SCI) explaining 40% of them. The 2nd commonest cause is diabetic peripheral neuropathy (DPN) that accounts for 22-28% of type 2 diabetes mellitus (T2DM). After having reviewed thoroughly how to manage diabetic neuropathic pain here we decided to conduct a systematic review on varying causes of NP and
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Entrapment Neuropathies of the Lower Extremities
ACU Sağlık Bil Derg 2017(4):185-191 DERLEME / REVIEW Fiziksel Tıp ve Rehabilitasyon / Physical Medicine and Rehabilitation Entrapment Neuropathies of The Lower Extremities Meral Bayramoğlu1 1Acıbadem Mehmet Ali Aydınlar ABSTRACT University Faculty of Medicine, Department of Physical Medicine and Peripheral nerves of the lower extremities might be compressed on their course where the anatomic configuration Rehabilitation, Istanbul, Turkey puts them in a vulnerable position. Neuropathic states can also be the result of any kind of trauma which directly injures the nerves or leads to a state of inflammation around the nerves. A wide variety of etiologies, as well as clinical presentations, may lead to diagnostic challenges for the clinician. The main symptom of a peripheral neuropathy is paresthesia. This could be accompanied by pain and numbness depending on the severity of the compression. The lumbosacral plexus, which arises from the ventral rami of the L1-S3 roots, serves the lower extremities. There are par- Meral Bayramoğlu, Prof. Dr. ticular anatomic sites where the nerves are more vulnerable. A clear identification of the anatomic course, and motor and sensory distribution of each nerve arising from the lumbosacral plexus, is critical in localizing the injury and plan- ning the optimal treatment. Electrodiagnostic studies help localize the site of the lesion, give a clue about the severity and potential recovery, and help differentiate any plexopathy and/or radiculopathy. Imaging studies, mostly magnetic imaging, can be ordered to help confirm the entrapment or exclude other pathologies. Most, but not all, of the cases can be treated by conservative measures. Common entrapments of the lower extremities, namely, meralgia paresthe- tica, femoral, obturator, sciatic, peroneal and tibial neuropathies will be discussed in this review.
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Simvastatin-Induced Meralgia Paresthetica
J Am Board Fam Med: first published as 10.3122/jabfm.2011.04.100229 on 7 July 2011. Downloaded from BRIEF REPORT Simvastatin-Induced Meralgia Paresthetica Menahem Sasson, MD, and Shvartzman Pesach, MD 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) cause mainly muscular adverse effects. During the last 20 years there has been solid evidence of peripheral neuropathy caused by st- atins, with a risk of one in 10,000 patients treated for 1 year. Meralgia paresthetica is an entrapment neuropathy occasionally encountered by primary care physicians. To date there has been no report of entrapment neuropathy that could have been caused or aggravated by statins. This case report presents meralgia paresthetica aggravated by simvastatin use that disappeared after simvastatin cessation. (J Am Board Fam Med 2011;24:469–473.) Keywords: Case Report, Entrapment Neuropathy, Meralgia Paresthetica, Peripheral Neuropathy, Simvastatin Meralgia paresthetica (MP) is an entrapment neu- present an entrapment neuropathy syndrome that ropathy of the lateral femoral cutaneous nerve. It is seems to be induced or aggravated by simvastatin. characterized by a localized paresthesia and numb- ness on the anterolateral aspect of the thigh.1 Its reported incidence is 0.43 per 10,000 person-pri- Case mary care years per a computerized registration A 58-year-old white man who was born in Kurdish copyright. network of a Dutch population study between 1990 Iran and currently working as a bus driver pre- to 1998.2 Before this, an incidence of 3 cases in sented with a burning pain along the lateral aspect 10,000 general clinic patients was reported.3 of his right thigh for the past 2 months that wors- 3-hydroxy-3-methylglutaryl coenzyme A reduc- ened when he stood erect.
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Effectiveness of Ultrasound-Guided
EFFECTIVENESS OF ULTRASOUND-GUIDED CORTICOSTEROID INJECTION AND ALCOHOL NEUROLYSIS IN THE TREATMENT OF MERALGIA PARESTHETICA DURING A 28-MONTH FOLLOW-UP PERIOD: A RETROSPECTIVE COHORT STUDY Ozge¨ Yapıcı1 and Meri¸cU˘gurlar2 1Marmara University School of Medicine 2Silivri Anadolu Private Hospital June 2, 2021 Abstract Abstract Objectives Meralgia paresthetica is a very rare sensory mononeuropathy of the lateral femoral cutaneous nerve (LFCN). The purpose of this study was to evaluate the outcomes and compare the results of ultrasound-guided corticosteroid injection and ultrasound-guided alcohol neurolysis in the treatment of meralgia paresthetica. Methods We performed a retrospective clinical study of 26 patients with a diagnosis of marelgia paresthetica with a duration of [?]10 months. The patients were divided into 2 groups, with the Group 1 receiving ultrasound-guided local corticosteroid injection and Group 2 receiving ultrasound- guided alcohol neurolysis to the entrapment site of the LFCN. Results The mean age of the patients in Group 1 was 42.2 years and in Group 2 was 40.8 years. The mean follow-up period of Group 1 was 28.7 months and Group 2 was 28.4 months. At the end of the follow-up period 9 patients in Group 1 and 10 patients in Group 2 declared full pain relief and improvement in cutaneous sensitivity. Conclusion Once meralgia paresthetica has persisted corticosteroid injection and alcohol neurolysis are both eﬀective methods. Although the recurrence rates are higher in corticosteroid injection, both treatment methods decreased the pain and improved the patients’ satisfaction and long-term curative eﬀect. EFFECTIVENESS OF ULTRASOUND-GUIDED CORTICOSTEROID INJECTION AND ALCOHOL NEUROLYSIS IN THE TREATMENT OF MERALGIA PARESTHETICA DUR- ING A 28-MONTH FOLLOW-UP PERIOD: A RETROSPECTIVE COHORT STUDY Abstract Objectives Meralgia paresthetica is a very rare sensory mononeuropathy of the lateral femoral cutaneous nerve (LFCN).
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Nerve Lesions and Entrapment Neuropathies of the Lower Limb
Nerve lesions and entrapment neuropathies of the lower limb CHAPTER CONTENTS The effects of pressure on the peripheral nerves of leg and Introduction . e313 foot are discussed in this chapter. Sciatic .nerve . e313 Sciatic nerve Lateral .cutaneous .nerve . e313 Femoral .nerve . e315 Neurocompression syndromes of the sciatic nerve are not Saphenous .nerve . e315 common. Some believe that the nerve can become compressed Common .peroneal .nerve . e315 between the fibres of the piriformis muscle (the piriformis syndrome2). Deep .peroneal .nerve . e316 If the nerve becomes damaged or is chronically irritated, Superficial .peroneal .nerve . e317 serious deafferentation pain can result and occurs in circum- stances in which the sciatic nerve is locally bruised or has Tibial .nerve . e317 undergone damage after local injection of irritating substances. Plantar .nerves . e318 Continuous and burning pain, independent of posture, is then felt in the sensory distribution of the nerve. Local pressure on the nerve can increase the pain considerably.3–4 Introduction Lateral cutaneous nerve The main symptom of pressure on nerves is paraesthesia. Depending on the level of the compression, paraesthesia is Entrapment of the lateral cutaneous femoral nerve is not accompanied by pain and numbness. The combination of these uncommon and results in meralgia paraesthetica. three symptoms and their interrelation are of importance in The lateral cutaneous nerve is sensory only. It originates at localizing the site of compression.1 L2 and runs retroperitoneally to emerge at the outer edge of Pressure on the distal spinal cord induces painless pins and the psoas and then crosses the iliacus muscle at the lateral needles in both feet, soon followed by numbness, incoordina- border of the pelvis, which it follows to the anterior superior tion and abnormal reflexes.
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