DOCSLIB.ORG

Tunnel Syndrome

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Tunnel Syndrome J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.48.10.999 on 1 October 1985. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry 1985;48: 999-1003 The near-nerve sensory nerve conduction in tarsal tunnel syndrome SHIN J OH, HYUN S KIM, BASHIRUDDIN K AHMAD From the Department ofNeurology, University ofAlabama at Birmingham, Birmingham, Alabama, USA SUMMARY The near-nerve sensory nerve conduction in the medial and lateral plantar nerves was studied in 25 cases of tarsal tunnel syndrome. Sensory nerve conduction was abnormal in 24 cases (96%) The most common abnormalities were slow nerve conduction velocities and dispersion phenomenon (prolonged duration of compound nerve action potentials). These two elec- trophysiological abnormalities are indicative of a focal segmental demyelination as the primary pathological process in tarsal tunnel syndrome. In 1979, we published a method of obtaining sen- simultaneously. Each interdigital nerve was stimulated sory nerve conductions in the medial and lateral separately by placing the interdigital stimulating electrodes plantar nerves using the surface electrode, which between the toes. Stimulus duration used was 0-05-0-1 ms. was able to confirm the diagnosis of tarsal tunnel Supramaximal stimulation was assured by increasing it Protected by copyright. syndrome in 90% of cases.' For the past 25-30% beyond the maximal stimulation intensity when four years the CNAP was observed on each stimulus. The supramax- we have used the near-nerve needle sensory nerve imal stimulation intensity was usually at least three times conduction technique in diagnosis of this disorder. the sensory threshold level and above 60 mA for a stimulus We report here our experience with this technique. of 0-05 ms. Thus, these stimulus parameters were used when the CNAP was not observed on each stimulus. In Materials and me every case, at least 2 digital or interdigital nerves in the medial plantar nerve and one digital or interdigital nerve in The technique of the near-nerve needle sensory nerve the lateral plantar nerve were tested. conduction in the digital and interdigital nerves of the foot 64 to 256 stimuli were averaged with a signal averager in was described in detail in a previous report.2 Sensory com- each recording. When no recognisable and constant poten- pound nerve action potentials (CNAPs) were recorded tial was noted after 256 stimuli had been averaged in three orthodromically using the near-nerve needle and signal recordings, we concluded that there was no CNAP. Surface averaging techniques. The active needle recording elec- skin temperature under the arched portion of the medial trode was inserted close to the medial plantar fascicle near plantar surface of the foot was controlled at 32°C using a the posterior tibial nerve in the ankle behind the medial skin temperature control unit. Latency was measured from maileolus above the flexor retinaculum. This site was cho- the stimulus onset to the first positive peak for the max- sen with the aid of a surface stimulating electrode. The imum nerve conduction velocity (NCV), to the highest adequacy of the needle position was determined by negative peak for the negative peak NCV, and to the last http://jnnp.bmj.com/ stimulating the nerve through the active electrode. When negative peak of the potential for the minimum NCV. the great toe (digit I) was contracting minimally with less Conduction velocity was calculated by dividing the dis- than 3 mA for a stimulus of 0-05 ms duration, the needle tance by the latency. Distance was measured by caliper. was considered to be adequately positioned. The reference The amplitude was measured from peak to peak. The dura- needle electrode was placed subcutaneously at the same tion was measured from the onset of the first positive peak level as the active electrode at a transverse distance 3- to the baseline return of the last component of the poten- 4 cm. The I and V digital nerves were stimulated with ring tials. electrodes and various interdigital nerves with interdigital When the NCVs and the duration of CNAP in patients stimulating surface electrodes which were specially deviated by more than 2 standard deviations from the on October 6, 2021 by guest. designed to stimulate two branches of the interdigital nerve normal mean values, they were considered abnormal. Address for reprint requests: Shin J Oh, MD, Department of Abnormally prolonged duration of CNAP is termed "dis- Neurology, University of Alabama at Birmingham, University persion phenomenon". When the amplitude of CNAP was Station, Birmingham, Alabama 35294, USA. lower than the lowest normal range, it was considered abnormal. Received 7 December 1984 and in revised form 1 March 1985. The motor terminal latency of the medial and lateral Accepted 8 March 1985. plantar nerves was determined following the method pre- 999 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.48.10.999 on 1 October 1985. Downloaded from 1000 Oh, Kim, Ahmad Table 1 Sensory nerve conduction abnormalities in 25 had bilateral tarsal tunnel syndrome. The ages of patients cases oftarsal tunnel syndrome ranged from 14 to 69 years. Clinically, medial plantar neuropathy was diagnosed in 10 patients, lateral plantar Plantar nerve Medial Lateral neuropathy in two, and calcarine neuropathy in one. None Normal 1* 1 of the patients had any motor weakness or wasting of the Abnormal 24 13 intrinsic foot muscles. Absent potential 2 6 In all cases, subjective burning and tingling paraesthesia Slow NCV 16 4 Maximum 13 3 over the medial or lateral plantar nerve territory was pres- Negative peak 14 3 ent. For the diagnosis of tarsal tunnel syndrome, objective Minimum 10 1 sensory impairment over the medial or lateral plantar Dispersion 14 5 nerve territory and a positive Tiners sign on these nerves Low amplitude 10 5 at the ankle were present in 20 cases; subjective symptoms *Number of cases and a Tiners sign in three cases; and subjective symptoms and objective sensory impairment in two cases. Lumbar radiculopathy and peripheral neuropathy were viously described.' 6 The distance between the recording ruled out by neurological and electrophysiological evalua- electrodes and the stimulating electrodes was kept con- tions when clinically indicated. stant: 10 cm in the medial and 12 cm in the lateral plantar nerve. Results Twenty-five cases of tarsal tunnel syndrome were diag- nosed in 21 patients, 11 male and 10 female. Four patients Among the 25 cases of tarsal tunnel syndrome, , 34.8 34.9 ii' A H I Protected by copyright. iI~~~~~~~~~~~~~~~~~r III-IV |f I .r^ 40.9 40-0 , 34 *6 34 2 A II eV / '-"' 39.8 IV-V I ., II 34.92u349V {I I X 2ms http://jnnp.bmj.com/ 1I-111i V .I1 I i 40.8 |1 -36.0 42.9 2 ms on October 6, 2021 by guest. Fig 1 Normal maximum and negative-peak nerve conduction velocity (NCV) in a 29-year-old normal control. Roman numerals indicate digital and interdigital nerves. Numbers under the compound nerve action potentials (CNAP) represent maximum NCVs and numbers above the CNAPs represent negative-peak NCVs respectively. Two ,uV calibration for the I and 1-1I interdigital nerves and I p4V calibration for all other nerves. J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.48.10.999 on 1 October 1985. Downloaded from The near-nerve sensory nerve conduction in tarsal tunnel syndrome 1001 26.1 23 3 - I -. , lII I-Iv ,r -2 .I 30.7 27.8 24.6 24.7 I-II _-> X Iv-v 30.2 31. 31.1 23 8 _ 25.0 _'Ilk b -X 1-I1 1 ,UV 3.26 28.9 Iim Protected by copyright. 2 ms 3266 Fig 2 Slow maximum and negative-peak NCVs in medial plantar nerve and normal maximum and negative-peak NCVs in lateral plantar nerve in a case oftarsal tunnel syndrome. abnormal sensory nerve conduction was observed in Mean values of the various nerve conduction 24 (96%): abnormal sensory nerve conduction in parameters are presented in table 2. Maximum and the medial plantar nerve in 24 cases and in the lat- negative-peak NCVs and duration of CNAP in the eral plantar nerve in 13 cases (table 1). Thus, diag- various interdigital nerves in tarsal tunnel syndrome nosis was confirmed electrophysiologicaily in 96% are significantly different from normal values. How- of the cases of tarsal tunnel syndrome. ever, the amplitudes of CNAP are only significantly In 18 cases, various combinations of sensory con- lower than normal values in the I digital and I-II duction abnormalities (for example, slow NCV and interdigital nerves. Slowing in minimum NCVs is dispersion phenomenon) were noted. In seven cases, barely significant in the I, II-III, and V nerves. (p < a single sensory nerve conduction abnormality was 0-05) noted: low amplitude in three, slow negative-peak Terminal latency of the plantar nerves was pro- NCV in two, dispersion phenomenon in two, and longed in only four of 24 tested cases (17%): one in absent CNAPs in two. the medial plantar nerve (<5.38 ms) and three in http://jnnp.bmj.com/ Slow nerve conduction velocities (NCVs) and dis- the lateral plantar nerve (<6-26 ms) Mean terminal persion phenomenon were the most prominent latencies were 4-00 + 0-77 (SD) ms (vs. normal, abnormalities (figures 1-3). In 12 cases, slowing was 4-10 0.64) in the medial plantar nerve and 4-81 _ observed both in maximum and negative-peak 1-06 ms (vs. normal, 4 70 0.78) in the lateral NCVs. In two cases, negative-peak NCV alone was plantar nerve. The amplitude of the compound slow, emphasising the value of the negative-peak muscle action potential was abnormally low in one NCV.
Load more

Recommended publications
  • Piriformis Syndrome Is Overdiagnosed 11 Robert A
    American Association of Neuromuscular & Electrodiagnostic Medicine AANEM CROSSFIRE: CONTROVERSIES IN NEUROMUSCULAR AND ELECTRODIAGNOSTIC MEDICINE Loren M. Fishman, MD, B.Phil Robert A.Werner, MD, MS Scott J. Primack, DO Willam S. Pease, MD Ernest W. Johnson, MD Lawrence R. Robinson, MD 2005 AANEM COURSE F AANEM 52ND Annual Scientific Meeting Monterey, California CROSSFIRE: Controversies in Neuromuscular and Electrodiagnostic Medicine Loren M. Fishman, MD, B.Phil Robert A.Werner, MD, MS Scott J. Primack, DO Willam S. Pease, MD Ernest W. Johnson, MD Lawrence R. Robinson, MD 2005 COURSE F AANEM 52nd Annual Scientific Meeting Monterey, California AANEM Copyright © September 2005 American Association of Neuromuscular & Electrodiagnostic Medicine 421 First Avenue SW, Suite 300 East Rochester, MN 55902 PRINTED BY JOHNSON PRINTING COMPANY, INC. ii CROSSFIRE: Controversies in Neuromuscular and Electrodiagnostic Medicine Faculty Loren M. Fishman, MD, B.Phil Scott J. Primack, DO Assistant Clinical Professor Co-director Department of Physical Medicine and Rehabilitation Colorado Rehabilitation and Occupational Medicine Columbia College of Physicians and Surgeons Denver, Colorado New York City, New York Dr. Primack completed his residency at the Rehabilitation Institute of Dr. Fishman is a specialist in low back pain and sciatica, electrodiagnosis, Chicago in 1992. He then spent 6 months with Dr. Larry Mack at the functional assessment, and cognitive rehabilitation. Over the last 20 years, University of Washington. Dr. Mack, in conjunction with the Shoulder he has lectured frequently and contributed over 55 publications. His most and Elbow Service at the University of Washington, performed some of the recent work, Relief is in the Stretch: End Back Pain Through Yoga, and the original research utilizing musculoskeletal ultrasound in order to diagnose earlier book, Back Talk, both written with Carol Ardman, were published shoulder pathology.
    [Show full text]
  • Sensory Conduction in Medial and Lateral Plantar Nerves
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.51.2.188 on 1 February 1988. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry 1988;51:188-191 Sensory conduction in medial and lateral plantar nerves S N PONSFORD From the Department of Clinical Neurophysiology, Walsgrave Hospital, Coventry, UK SUMMARY A simple and reliable method of recording medial and lateral plantar nerve sensory action potentials is described. Potentials are recorded with surface electrodes at the ankle using surface electrodes stimulating orthodromically at the sole. The normal values obtained are higher in amplitude than those obtained by the method described by Guiloff and Sherratt and are detectable in older subjects aged over 80 years. The procedure is valuable in the diagnosis of early peripheral neuropathy, mononeuritig multiplex; tarsal tunnel syndrome and in differentiation between pre and post ganglionic L5 SI lesions. The value of medial plantar sensory action potential EL53051 applied to the sole just lateral to the first meta-guest. Protected by copyright. (SAP) recording in the diagnosis of peripheral neuro- tarsal, the anode level with metatarsophalangeal joint, the pathy and investigation of root or individual nerve cathode thus overlying the first common digital nerve sub- lesions involving the leg or foot was clearly estab- serving contiguous surfaces ofthe great and second toes. For the lateral plantar, the stimulator was placed between the lished by Guiloff and Sherratt.1 However, their fourth and fifth metatarsals, the anode-again level with the method of stimulating at the big toe and recording at metatarsophalangeal joint, overlying the fourth common the ankle gives potentials of relatively small ampli- digital nerve supplying contiguous surfaces of the fourth and tude (mean amplitude 2-3 pv, range 0-8- 1).
    [Show full text]
  • Ultrasound of Medial Tarsal Tunnel by Lisa Howell
    Ultrasound of Medial Tarsal Tunnel by Lisa Howell Medial Tarsal Tunnel Syndrome Medial Tarsal Tunnel Syndrome (Posterior Tibial Neuralgia) is a compression neuropathy Occurs when Posterior Tibial Nerve (PTN) and / or its branches are entrapped within Tarsal Tunnel of Medial ankle Proximal syndrome compression main trunk of PTN, affects entire foot Distal syndrome compression of divisional branches of PTN Medial TTS: -More complex than carpal tunnel syndrome in wrist -Diagnosis and treatment of TTS depends on cause, and severity -Pain typically radiates down medial ankle to heel and/or plantar aspect of foot -Symptoms occur whilst standing, during exercise, and at night when patient is at rest [Ref: 1, 6] Anatomy Medial Ankle Medial Tarsal Tunnel MTT Fibro-osseous tunnel of medial ankle, posterior and inferior to medial malleolus (MM) Tendons of medial ankle Tibialis posterior (PTT), Flexor digitorum longus (FDL), and Flexor hallucis longus (FHL) Ligaments of medial ankle Deltoid ligament is fan shaped, and originates at MM It is divided into a deep and superficial layers Deep layer : Anterior tibiotalar lig, and Posterior tibiotalar lig Superficial layer: Tibionavicular lig, Tibiospring lig, and Tibiocalcaneal lig Neurovascular bundle Posterior tibial nerve (PTN), Posterior tibial artery (PTA), and Posterior tibial veins (PTV) [Ref : 1,6 ] Anatomy of PTN Posterior Tibial Nerve (PTN) branch of Sciatic nerve divides at medial ankle into three branches : ● Medial Calcaneal Nerve ● Medial Plantar Nerve ● Lateral Plantar Nerve Proximal Medial Tarsal Tunnel Flexor Retinaculum (FR) forms the roof of prox MTT Medial Calcaneal nerve (MCN) first branch of PTN MCN superficial to Abductor Hallucis muscle (AHM) Innervates posterior medial part of calcaneus, and posterior fat pad of foot Distal Medial Tarsal Tunnel Lateral Plantar nerve (LPN), and Medial Plantar nerve (MPN) are the terminal branches of PTN [Ref: 1,6] Frank.H.Netter, MD.
    [Show full text]
  • Tarsal Tunnel Syndrome: a Still Challenge Condition
    Rev Bras Neurol. 55(1):12-17, 2019 TARSAL TUNNEL SYNDROME: A STILL CHALLENGE CONDITION SÍNDROME DO TÚNEL DO TARSO: UMA CONDIÇÃO AINDA DESAFIADORA Celmir de Oliveira Vilaça1,2, Bruno Pessoa3, Janaína de Moraes Silva4, Victor Hugo Bastos5, Diandra Martins5, Silmar Teixeira6, Victor Marinho6, Rossano Fiorelli7, Vanessa de Albuquerque Dinoa8; Marco Orsini7, 9 ABSTRACT RESUMO Tarsal tunnel syndrome is a rare, under diagnosed and often confu- A Síndrome do túnel do tarso é uma rara e subdiagnosticada neuro- sed neuropathy with other clinical entities. There is a lack of popula- patia geralmente confundida com outras entidades clínicas. Há falta tion studies on this disease. Herein, we performed a non-systematic de estudos populacionais sobre a doença. Assim sendo, realizamos review of articles between January 1992 and February 2018. Althou- uma revisão da literatura de artigos entre Janeiro de 1992 e fevereiro gh with a less complex anatomy comparing to the carpal tunnel, the de 2018. Apesar de possuir uma anatomia de menor complexidade tarsal tunnel is source of pain and some other conditions. Treatment comparada ao túnel do carpo, o túnel do tarso é origem de dor e involves conservative measures such as analgesics and physical the- algumas outras condições. O tratamento envolve medidas conserva- rapy rehabilitation or surgical procedures in case of conservative doras como analgésicos e terapia de reabilitação ou procedimentos treatment failure. Randomized control studies are lack and manda- cirúrgicos, em caso de falha do tratamento conservador. Estudos ran- tory for uncover the best modality of treatment for this condition. domizados são escassos e necessários para descoberta da melhor modalidade de tratamento desta condição.
    [Show full text]
  • Tarsal Tunnel Syndrome
    MICHAEL J. BAKER, D.P.M. JASON D. GRAY, D.P.M. GREGORY W. BOAKE, D.P.M JESSICA R TAULMAN, D.P.M BFS BUSINESS OFFICE P O BOX 330. Tarsal Tunnel Syndrome Fortville, IN 46040-0330 Tel 317.863.2556 Fax 317.203.0420 Tarsal tunnel syndrome is an entrapment neuropathy (pressure on nerve) of the tibial nerve as it courses through the inside COMMUNITY FOOT & ANKLE CENTER aspect of the foot and ankle. 1221 Medical Arts Blvd. Anderson, IN 46011 Tel 765.641.0001 Symptoms. Pain, numbness, burning and electrical sensations Fax 765.641.0003 may occur along the course of the nerve, which includes the EAST FOOT & inside of the ankle, heel, arch and bottom of foot. Symptoms are ANKLE CENTER usually worsened with increased activity such as walking or 161B Washington Point Dr. Indianapolis, IN 46229 exercise. Prolonged standing in one place may also be an Tel 317.898.6624 aggravating factor. Fax 317.898.6636 FOOT & ANKLE AT WESTVIEW HOSPITAL 3520 Guion Rd., Ste 102 Indianapolis, IN 46222 Tel 317.920.3240 Fax 317.920.3243 MARION FOOT CENTER 330 N. Wabash Ave, Ste 460A Marion, IN 46952 Tel 765.664.1413 Fax 765.965.6530 BAKER FOOT SOLUTIONS SATILLITE FOOT CLINICS BROWNSBURG Tel 317.920.3240 Causes. There are a variety of factors that may cause tarsal Fax 317.920.3243 tunnel syndrome. These may include repetitive stress with GEIST FAMILY PRACTICE activities, flat feet, and excess weight. Additionally, any lesion Tel 317.898.6624 Fax 317.898.6636 that occupies space within the tarsal tunnel region may cause NEW CASTLE pressure on the nerve and subsequent symptoms.
    [Show full text]
  • Focal Entrapment Neuropathies in Diabetes
    Reviews/Commentaries/Position Statements REVIEW ARTICLE Focal Entrapment Neuropathies in Diabetes 1 1 AARON VINIK, MD, PHD LAWRENCE COLEN, MD millimeters]) is a risk factor (8,9). It used 1 2 ANAHIT MEHRABYAN, MD ANDREW BOULTON, MD to be associated with work-related injury, but now seems to be common in people in sedentary positions and is probably re- lated to the use of keyboards and type- MONONEURITIS AND because the treatment may be surgical (2) writers (dentists are particularly prone) ENTRAPMENT SYNDROMES — (Table 1). (10). As a corollary, recent data (3) in 514 Peripheral neuropathies in diabetes are a patients with CTS suggest that there is a diverse group of syndromes, not all of CARPAL TUNNEL threefold risk of having diabetes com- which are the common distal symmetric SYNDROME — Carpal tunnel syn- pared with a normal control group. If rec- polyneuropathy. The focal and multifocal drome (CTS) is the most common entrap- ognized, the diagnosis can be confirmed neuropathies are confined to the distribu- ment neuropathy encountered in diabetic by electrophysiological studies. Therapy tion of single or multiple peripheral patients and occurs as a result of median is simple, with diuretics, splints, local ste- nerves and their involvement is referred nerve compression under the transverse roids, and rest or ultimately surgical re- to as mononeuropathy or mononeuritis carpal ligament. It occurs thrice as fre- lease (11). The unaware physician seldom multiplex. quently in a diabetic population com- realizes that symptoms may spread to the Mononeuropathies are due to vasculitis pared with a normal healthy population whole hand or arm in CTS, and the signs and subsequent ischemia or infarction of (3,4).
    [Show full text]
  • ICD9 & ICD10 Neuromuscular Codes
    ICD-9-CM and ICD-10-CM NEUROMUSCULAR DIAGNOSIS CODES ICD-9-CM ICD-10-CM Focal Neuropathy Mononeuropathy G56.00 Carpal tunnel syndrome, unspecified Carpal tunnel syndrome 354.00 G56.00 upper limb Other lesions of median nerve, Other median nerve lesion 354.10 G56.10 unspecified upper limb Lesion of ulnar nerve, unspecified Lesion of ulnar nerve 354.20 G56.20 upper limb Lesion of radial nerve, unspecified Lesion of radial nerve 354.30 G56.30 upper limb Lesion of sciatic nerve, unspecified Sciatic nerve lesion (Piriformis syndrome) 355.00 G57.00 lower limb Meralgia paresthetica, unspecified Meralgia paresthetica 355.10 G57.10 lower limb Lesion of lateral popiteal nerve, Peroneal nerve (lesion of lateral popiteal nerve) 355.30 G57.30 unspecified lower limb Tarsal tunnel syndrome, unspecified Tarsal tunnel syndrome 355.50 G57.50 lower limb Plexus Brachial plexus lesion 353.00 Brachial plexus disorders G54.0 Brachial neuralgia (or radiculitis NOS) 723.40 Radiculopathy, cervical region M54.12 Radiculopathy, cervicothoracic region M54.13 Thoracic outlet syndrome (Thoracic root Thoracic root disorders, not elsewhere 353.00 G54.3 lesions, not elsewhere classified) classified Lumbosacral plexus lesion 353.10 Lumbosacral plexus disorders G54.1 Neuralgic amyotrophy 353.50 Neuralgic amyotrophy G54.5 Root Cervical radiculopathy (Intervertebral disc Cervical disc disorder with myelopathy, 722.71 M50.00 disorder with myelopathy, cervical region) unspecified cervical region Lumbosacral root lesions (Degeneration of Other intervertebral disc degeneration,
    [Show full text]
  • Lower Extremity Focal Neuropathies
    LOWER EXTREMITY FOCAL NEUROPATHIES Lower Extremity Focal Neuropathies Arturo A. Leis, MD S.H. Subramony, MD Vettaikorumakankav Vedanarayanan, MD, MBBS Mark A. Ross, MD AANEM 59th Annual Meeting Orlando, Florida Copyright © September 2012 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 Printed by Johnson Printing Company, Inc. 1 Please be aware that some of the medical devices or pharmaceuticals discussed in this handout may not be cleared by the FDA or cleared by the FDA for the specific use described by the authors and are “off-label” (i.e., a use not described on the product’s label). “Off-label” devices or pharmaceuticals may be used if, in the judgment of the treating physician, such use is medically indicated to treat a patient’s condition. Information regarding the FDA clearance status of a particular device or pharmaceutical may be obtained by reading the product’s package labeling, by contacting a sales representative or legal counsel of the manufacturer of the device or pharmaceutical, or by contacting the FDA at 1-800-638-2041. 2 LOWER EXTREMITY FOCAL NEUROPATHIES Lower Extremity Focal Neuropathies Table of Contents Course Committees & Course Objectives 4 Faculty 5 Basic and Special Nerve Conduction Studies of the Lower Limbs 7 Arturo A. Leis, MD Common Peroneal Neuropathy and Foot Drop 19 S.H. Subramony, MD Mononeuropathies Affecting Tibial Nerve and its Branches 23 Vettaikorumakankav Vedanarayanan, MD, MBBS Femoral, Obturator, and Lateral Femoral Cutaneous Neuropathies 27 Mark A. Ross, MD CME Questions 33 No one involved in the planning of this CME activity had any relevant financial relationships to disclose.
    [Show full text]
  • Tarsal Tunnel Syndrome Masked by Painful Diabetic Polyneuropathy
    CASE REPORT – OPEN ACCESS International Journal of Surgery Case Reports 15 (2015) 103–106 CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector Contents lists available at ScienceDirect International Journal of Surgery Case Reports journa l homepage: www.casereports.com Tarsal tunnel syndrome masked by painful diabetic polyneuropathy a,∗ b c Tugrul Ormeci , Mahir Mahirogulları , Fikret Aysal a Medipol University, Faculty of Medicine, Department of Radiology, Istanbul,˙ Turkey b Medipol University, Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul,˙ Turkey c Medipol University, Faculty of Medicine, Department of Neurology, Istanbul,˙ Turkey a r a t b i c l e i n f o s t r a c t Article history: INTRODUCTION: Various causes influence the etiology of tarsal tunnel syndrome including systemic Received 3 July 2015 diseases with progressive neuropathy, such as diabetes. Received in revised form 5 August 2015 PRESENTATION OF CASE: We describe a 52-year-old male patient with complaints of numbness, burning Accepted 21 August 2015 sensation and pain in both feet. The laboratory results showed that the patient had uncontrolled diabetes, Available online 28 August 2015 and the EMG showed distal symmetrical sensory-motor neuropathy and nerve entrapment at the right. Ultrasonography and MRI showed the cyst in relation to medial plantar nerve, and edema- moderate Keywords: atrophy were observed at the distal muscles of the foot. Tarsal tunnel syndrome DISCUSSION: Foot neuropathy in diabetic patients is a complex process. So, in planning the initial treat- Diabetic polyneuropathy Pain ment, medical or surgical therapy is selected based on the location and type of the pathology.
    [Show full text]
  • Foot and Ankle Disorders Capturing Motion with Ultrasound
    VISIT THE AANEM MARKETPLACE AT WWW.AANEM.ORG FOR NEW PRODUCTS AMERICAN ASSOCIATION OF NEUROMUSCULAR & ELECTRODIAGNOSTIC MEDICINE Foot and Ankle Disorders Capturing Moti on With Ultrasound: Blood, Muscle, Needle, and Nerve Photo by Michael D. Stubblefi eld, MD Foot and Ankle Nerve Disorders Tracy A. Park, MD David R. Del Toro, MD Atul T. Patel, MD, MHSA Jeffrey A. Mann, MD AANEM 58th Annual Meeting San Francisco, California Copyright © September 2011 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 Printed by Johnson’s Printing Company, Inc. 1 Please be aware that some of the medical devices or pharmaceuticals discussed in this handout may not be cleared by the FDA or cleared by the FDA for the specific use described by the authors and are “off-label” (i.e., a use not described on the product’s label). “Off-label” devices or pharmaceuticals may be used if, in the judgment of the treating physician, such use is medically indicated to treat a patient’s condition. Information regarding the FDA clearance status of a particular device or pharmaceutical may be obtained by reading the product’s package labeling, by contacting a sales representative or legal counsel of the manufacturer of the device or pharmaceutical, or by contacting the FDA at 1-800-638-2041. 2 Foot and Ankle Nerve Disorders Table of Contents Course Objectives & Course Committee 4 Faculty 5 Tarsal Tunnel Syndromes 7 Tracy A. Park, MD First Branch Lateral Plantar Neuropathy: “Baxter’s Neuropathy” 17 David R. Del Toro, MD Foot Pain Related to Peroneal (Fibular) Nerve Entrapments (Deep and Superficial) and Digital Neuromas 25 Atul T.
    [Show full text]
  • Tibial Nerve Block: Supramalleolar Or Retromalleolar Approach? a Randomized Trial in 110 Participants
    International Journal of Environmental Research and Public Health Article Tibial Nerve Block: Supramalleolar or Retromalleolar Approach? A Randomized Trial in 110 Participants María Benimeli-Fenollar 1,* , José M. Montiel-Company 2 , José M. Almerich-Silla 2 , Rosa Cibrián 3 and Cecili Macián-Romero 1 1 Department of Nursing, University of Valencia, c/Jaume Roig s/n, 46010 Valencia, Spain; [email protected] 2 Department of Stomatology, University of Valencia, c/Gascó Oliag, 1, 46010 Valencia, Spain; [email protected] (J.M.M.-C.); [email protected] (J.M.A.-S.) 3 Department of Physiology, University of Valencia, c/Blasco Ibánez, 15, 46010 Valencia, Spain; [email protected] * Correspondence: [email protected] Received: 26 April 2020; Accepted: 23 May 2020; Published: 29 May 2020 Abstract: Of the five nerves that innervate the foot, the one in which anesthetic blocking presents the greatest difficulty is the tibial nerve. The aim of this clinical trial was to establish a protocol for two tibial nerve block anesthetic techniques to later compare the anesthetic efficiency of retromalleolar blocking and supramalleolar blocking in order to ascertain whether the supramalleolar approach achieved a higher effective blocking rate. A total of 110 tibial nerve blocks were performed. Location of the injection site was based on a prior ultrasound assessment of the tibial nerve. The block administered was 3 mL of 2% mepivacaine. The two anesthetic techniques under study provided very similar clinical results. The tibial nerve success rate was 81.8% for the retromalleolar technique and 78.2% for the supramalleolar technique.
    [Show full text]
  • SŁOWNIK ANATOMICZNY (ANGIELSKO–Łacinsłownik Anatomiczny (Angielsko-Łacińsko-Polski)´ SKO–POLSKI)
    ANATOMY WORDS (ENGLISH–LATIN–POLISH) SŁOWNIK ANATOMICZNY (ANGIELSKO–ŁACINSłownik anatomiczny (angielsko-łacińsko-polski)´ SKO–POLSKI) English – Je˛zyk angielski Latin – Łacina Polish – Je˛zyk polski Arteries – Te˛tnice accessory obturator artery arteria obturatoria accessoria tętnica zasłonowa dodatkowa acetabular branch ramus acetabularis gałąź panewkowa anterior basal segmental artery arteria segmentalis basalis anterior pulmonis tętnica segmentowa podstawna przednia (dextri et sinistri) płuca (prawego i lewego) anterior cecal artery arteria caecalis anterior tętnica kątnicza przednia anterior cerebral artery arteria cerebri anterior tętnica przednia mózgu anterior choroidal artery arteria choroidea anterior tętnica naczyniówkowa przednia anterior ciliary arteries arteriae ciliares anteriores tętnice rzęskowe przednie anterior circumflex humeral artery arteria circumflexa humeri anterior tętnica okalająca ramię przednia anterior communicating artery arteria communicans anterior tętnica łącząca przednia anterior conjunctival artery arteria conjunctivalis anterior tętnica spojówkowa przednia anterior ethmoidal artery arteria ethmoidalis anterior tętnica sitowa przednia anterior inferior cerebellar artery arteria anterior inferior cerebelli tętnica dolna przednia móżdżku anterior interosseous artery arteria interossea anterior tętnica międzykostna przednia anterior labial branches of deep external rami labiales anteriores arteriae pudendae gałęzie wargowe przednie tętnicy sromowej pudendal artery externae profundae zewnętrznej głębokiej
    [Show full text]