22. Ankle Block

Total Page：16

File Type：pdf, Size：1020Kb

22. ANKLE BLOCK INTRODUCTION AND AnatoMY Five peripheral nerves supply the foot: the tibial nerve, the deep peroneal nerve, the superficial peroneal nerve, the sural nerve, and the saphenous nerve. All cross the ankle and are derived from the sciatic nerve except for the saphenous nerve, which is derived from the femoral nerve. The tibial and deep peroneal nerves supply deep structures of the foot and therefore must be blocked beneath the deep fascia of the ankle. The remaining nerves supply sensory innervation to the skin and can be blocked superficially (Figure 22-1). The ankle block works very well for foot and toe surgery and facilitates early ambulation. Figure 22-1 79 22 ANKLE BLOCK 12 PROCEDURE Landmarks Tibial Nerve. This nerve is located posterior to the Figure 22-5 posterior tibial artery at the level of the medial malleolus. Palpate the artery and insert the needle passing posterior to the artery. A nerve stimulator can be used to help localize the nerve. The needle will typically contact the medial malleolus; after this contact occurs, slightly withdraw the needle. Inject 3 to 5 mL of local anesthetic (Figure 22-2). Figure 22-3 Deep Peroneal Nerve. This nerve runs lateral to the dorsalis pedis artery at the level of the foot. Figure 22-5 Palpate the artery and insert the needle lateral Saphenous Nerve. Inject a subcutaneous wheal of to the artery. If bone is contacted, withdraw the local anesthetic (5 mL), directing it posteriorly from needle slightly before injecting 2 to 4 mL of local the tibial ridge to the medial malleolus (Figure anesthetic (Figure 22-3). 22-5). Sural Nerve. Insert the needle between the Achilles Superficial Peroneal Nerve. Inject a subcutaneous tendon and the lateral malleolus, and subcutane- wheal of local anesthetic (5 mL) from the anterior ously infiltrate 5 mL of local anesthetic along this border of the tibia to the lateral malleolus (Figure course (Figure 22-6). 22-4). Needle. 22-gauge, 5-cm, b-bevel needle. Figure 22-2 Figure 22-4 Figure 22-6 Teaching Points. Do not use epinephrine-con- taining local anesthetic for this block. If a pares- thesia is elicited, the needle should be redirected prior to injection because intraneural injection can cause significant damage in these small nerves. Injection around the ankle can be un- comfortable; preemptive analgesia can be very helpful. 80.

Copy Link

Recommended publications

Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions
Hindawi International Journal of Rheumatology Volume 2020, Article ID 2919625, 13 pages https://doi.org/10.1155/2020/2919625 Review Article Clinical Presentations of Lumbar Disc Degeneration and Lumbosacral Nerve Lesions Worku Abie Liyew Biomedical Science Department, School of Medicine, Debre Markos University, Debre Markos, Ethiopia Correspondence should be addressed to Worku Abie Liyew; [email protected] Received 25 April 2020; Revised 26 June 2020; Accepted 13 July 2020; Published 29 August 2020 Academic Editor: Bruce M. Rothschild Copyright © 2020 Worku Abie Liyew. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lumbar disc degeneration is deﬁned as the wear and tear of lumbar intervertebral disc, and it is mainly occurring at L3-L4 and L4-S1 vertebrae. Lumbar disc degeneration may lead to disc bulging, osteophytes, loss of disc space, and compression and irritation of the adjacent nerve root. Clinical presentations associated with lumbar disc degeneration and lumbosacral nerve lesion are discogenic pain, radical pain, muscular weakness, and cutaneous. Discogenic pain is usually felt in the lumbar region, or sometimes, it may feel in the buttocks, down to the upper thighs, and it is typically presented with sudden forced ﬂexion and/or rotational moment. Radical pain, muscular weakness, and sensory defects associated with lumbosacral nerve lesions are distributed on
[Show full text]
4-Brachial Plexus and Lumbosacral Plexus (Edited).Pdf
Color Code Brachial Plexus and Lumbosacral Important Doctors Notes Plexus Notes/Extra explanation Please view our Editing File before studying this lecture to check for any changes. Objectives At the end of this lecture, the students should be able to : Describe the formation of brachial plexus (site, roots) List the main branches of brachial plexus Describe the formation of lumbosacral plexus (site, roots) List the main branches of lumbosacral plexus Describe the important Applied Anatomy related to the brachial & lumbosacral plexuses. Brachial Plexus Formation Playlist o It is formed in the posterior triangle of the neck. o It is the union of the anterior rami (or ventral) of the 5th ,6th ,7th ,8th cervical and the 1st thoracic spinal nerves. o The plexus is divided into 5 stages: • Roots • Trunks • Divisions • Cords • Terminal branches Really Tired? Drink Coffee! Brachial Plexus A P A P P A Brachial Plexus Trunks Divisions Cords o Upper (superior) trunk o o Union of the roots of Each trunk divides into Posterior cord: C5 & C6 anterior and posterior From the 3 posterior division divisions of the 3 trunks o o Middle trunk Lateral cord: From the anterior Continuation of the divisions of the upper root of C7 Branches and middle trunks o All three cords will give o Medial cord: o Lower (inferior) trunk branches in the axilla, It is the continuation of Union of the roots of the anterior division of C8 & T1 those will supply their respective regions. the lower trunk The Brachial Plexus Long Thoracic (C5,6,7) Anterior divisions Nerve to Subclavius(C5,6) Posterior divisions Dorsal Scapular(C5) Suprascapular(C5,6) upper C5 trunk Lateral Cord C6 middle (2LM) trunk C7 lower C8 trunk T1 Posterior Cord (ULTRA) Medial Cord (4MU) In the PowerPoint presentation this slide is animated.
[Show full text]
Cutaneous Innervation of the Lower Limb Cutaneous Nerves on the Front of the Thigh
Cutaneous Innervation of the Lower Limb https://www.earthslab.com/anatomy/cutaneous-innervation-of-the-lower-limb/ Cutaneous nerves on the front of the thigh • The ilio-inguinal nerve (L1) • The femoral branch of genitofemoral nerve (L1, L2) • The lateral cutaneous nerve of thigh (L2, L3) • The intermediate cutaneous nerve of thigh (L2, L3) • The medial cutaneous nerve of thigh (L2, L3) • The saphenous nerve (L3,4) https://www.slideshare.net/DrMohammadMahmoud/2-front-of-the-thigh-ii https://slideplayer.com/slide/9424949/ Cutaneous nerves of the gluteal region • Subcostal (T12) and ilio- hypogastric (L1) nerves • Posterior primary rami of L1,2,3 and S1,2,3 • Lateral cutaneous nerve of thigh (L2,3) • Posterior cutaneous nerve of thigh (S1,2,3) and perforating cutaneous nerve (S2,3) Cutaneous nerves on the front of leg and dorsum of foot • The infrapatellar branch of the saphenous nerve • The saphenous nerve • The lateral cutaneous nerve of the calf • The superficial peroneal nerve • The sural nerve • The deep peroneal nerve • The digital branches of the medial and lateral plantar nerves Cutaneous nerves on the back of leg • Saphenous nerve (L3, L4) • Posterior division of the medial cutaneous nerve of the thigh (L2, L3) • Posterior cutaneous nerve of the thigh (S1, S2, S3) • Sural nerve (L5, S1, S2) • Lateral cutaneous nerve of the calf (L4, L5, S1) • Peroneal or sural communicating nerve (L5, S1, S2) • Medial calcanean branches (S1, S2) Cutaneous nerves of the sole • Medial calcaneal branches of tibial nerve • Branches from medial plantar nerve • Branches from lateral plantar nerve SEGMENTAL INNERVATION Dermatomes • The area of skin supplied by one spinal segment is called a dermatome.
[Show full text]
LECTURE (SACRAL PLEXUS, SCIATIC NERVE and FEMORAL NERVE) Done By: Manar Al-Eid Reviewed By: Abdullah Alanazi
CNS-432 LECTURE (SACRAL PLEXUS, SCIATIC NERVE AND FEMORAL NERVE) Done by: Manar Al-Eid Reviewed by: Abdullah Alanazi If there is any mistake please feel free to contact us: [email protected] Both - Black Male Notes - BLUE Female Notes - GREEN Explanation and additional notes - ORANGE Very Important note - Red CNS-432 Objectives: By the end of the lecture, students should be able to: . Describe the formation of sacral plexus (site & root value). List the main branches of sacral plexus. Describe the course of the femoral & the sciatic nerves . List the motor and sensory distribution of femoral & sciatic nerves. Describe the effects of lesion of the femoral & the sciatic nerves (motor & sensory). CNS-432 The Mind Maps Lumber Plexus 1 Branches Iliohypogastric - obturator ilioinguinal Femoral Cutaneous branches Muscular branches to abdomen and lower limb 2 Sacral Plexus Branches Pudendal nerve. Pelvic Splanchnic Sciatic nerve (largest nerves nerve), divides into: Tibial and divides Fibular and divides into : into: Medial and lateral Deep peroneal Superficial planter nerves . peroneal CNS-432 Remember !! gastrocnemius Planter flexion – knee flexion. soleus Planter flexion Iliacus –sartorius- pectineus – Hip flexion psoas major Quadriceps femoris Knee extension Hamstring muscles Knee flexion and hip extension gracilis Hip flexion and aids in knee flexion *popliteal fossa structures (superficial to deep): 1-tibial nerve 2-popliteal vein 3-popliteal artery. *foot drop : planter flexed position Common peroneal nerve injury leads to Equinovarus Tibial nerve injury leads to Calcaneovalgus CNS-432 Lumbar Plexus Formation Ventral (anterior) rami of the upper 4 lumbar spinal nerves (L1,2,3 and L4). Site Within the substance of the psoas major muscle.
[Show full text]
Dynamic Phases of Peroneal and Tibial Intraneural Ganglia Formation: a New Dimension Added to the Unifying Articular Theory
J Neurosurg 107:, 2007 Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory ROBERT J. SPINNER, M.D.,1–3 KIMBERLY K. AMRAMI, M.D.,4 ALEXANDRA P. WOLANSKYJ, M.D.,5 NICHOLAS M. DESY, B.SC.,1,6 HUAN WANG, M.D.,1,7 EDUARDO E. BENARROCH, M.D.,8 JOHN A. SKINNER, M.D.,4 MICHAEL G. ROCK, M.D.,2 AND BERND W. SCHEITHAUER, M.D.9 Departments of 1Neurologic Surgery, 2Orthopedics, 3Anatomy, 4Radiology, 5Medicine, 8Neurology, and 9Anatomic Pathology, Mayo Clinic, Rochester, Minnesota; 6McGill University School of Medicine, Montreal, Quebec, Canada; and 7Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China Object. The pathogenesis of intraneural ganglia has been a controversial issue for longer than a century. Recently the authors identified a stereotypical pattern of occurrence of peroneal and tibial intraneural ganglia, and based on an under- standing of their pathogenesis provided a unifying articular explanation. Atypical features, which occasionally are ob- served, have offered an opportunity to verify further and expand on the authors’ proposed theory. Methods. Three unusual cases are presented to exemplify the dynamic features of peroneal and tibial intraneural gan- glia formation. Results. Two patients with a predominant deep peroneal nerve deficit shared essential anatomical findings common to peroneal intraneural ganglia: namely, 1) joint connections to the anterior portion of the superior tibiofibular joint, and 2) dissection of the cyst along the articular branch of the peroneal nerve and proximally. Magnetic resonance (MR) images obtained in these patients demonstrated some unusual findings, including the presence of a cyst within the tibial and sural nerves in the popliteal fossa region, and spontaneous regression of the cysts, which was observed on serial images obtained weeks apart.
[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]
Human Distal Sciatic Nerve Fascicular Anatomy: Implications for Ankle Control Using Nerve-Cuff Electrodes
Volume 49, Number 2, 2012 JRRDJRRD Pages 309–322 Human distal sciatic nerve fascicular anatomy: Implications for ankle control using nerve-cuff electrodes Kenneth J. Gustafson, PhD;1–2* Yanina Grinberg, MS;1 Sheeba Joseph, BS;3 Ronald J. Triolo, PhD1–2,4 1Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH; 2Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; 3Case Western Reserve University School of Medicine, Cleveland, OH; 4Department of Orthopedics, Case Western Reserve University, Cleveland, OH Abstract—The design of neural prostheses to restore standing eversion of the talocrural (ankle) joint and are therefore balance, prevent foot drop, or provide active propulsion during critical for standing balance and walking functions. The ambulation requires detailed knowledge of the distal sciatic sciatic nerve originates in the lumbar and sacral spinal nerve anatomy. Three complete sciatic nerves and branches cord and supplies motor and sensory innervation to the were dissected from the piriformis to each muscle entry point lower limb. It has two major terminal branches, the tibial to characterize the branching patterns and diameters. Fascicle nerve and common fibular nerve. The common fibular maps were created from serial sections of each distal terminus (common peroneal) branches into the deep and superfi- below the knee through the anastomosis of the tibial and com- cial fibular (SF) nerves and is commonly targeted in neu- mon fibular nerves above the knee. Similar branching patterns ral prostheses used to correct foot drop [1–5]. The deep and fascicle maps were observed across specimens. Fascicles innervating primary plantar flexors, dorsiflexors, invertors, and fibular (DF) branch innervates the tibialis anterior mus- evertors were distinctly separate and functionally organized in cle, which dorsiflexes and inverts the foot.
[Show full text]
Tarsal Tunnel Syndrome Secondary to the Posterior Tibial Nerve Schwannoma
Case Report http://dx.doi.org/10.12972/The Nerve.2015.01.01.034 www.thenerve.net Tarsal Tunnel Syndrome Secondary to the Posterior Tibial Nerve Schwannoma Jung Won Song1, Sung Han Oh1, Pyung Goo Cho1, Eun Mee Han2 Departments of 1Neurosurgey, 2Pathology, Bundang Jesaeng General Hospital, Seongnam, Korea A 77-year-old female presented with complaint of burning pain and paresthesia along the medial aspect of ankle, heel and sole of the left foot. An ankle MRI, electromyelogram (EMG) with nerve conduction velocity (NCV) and pathologic findings were all compatible with Tarsal tunnel syndrome caused by the posterior tibial nerve Schwannoma. Operative release of the Tarsal tunnel and surgical excision of Schwannoma were performed under the microscopy. It is necessary to have a possible lump in mind when Tarsal tunnel syndrome is suspected, such as posterior tibial nerve Schwannoma. Key Words: Posterior Tibial NerveㆍSchwannomaㆍTarsal Tunnel Syndrome diagnose neurofibromatosis was insufficient. An ankle magne- tic resonance imaging (MRI) revealed about a 22×19×9 mm- INTRODUCTION sized ovoid soft tissue mass in the posterior ankle connected to the posterior tibial nerve. The mass lies beneath the flexor Although Schwannomas are the most common peripheral retinaculum of ankle and showed relatively strong enhance- nerve sheath tumor, Schwannoma of the posterior tibial nerve ment (Fig. 1). and it branch is a rare etiology causing Tarsal tunnel syndrome. The NCV study showed no response sensory nerve action We report a case of Tarsal tunnel syndrome caused by the pos- potentials of the left medial and lateral plantar nerves. Motor terior tibial nerve Schwannoma and mention surgical strategy conduction study of the deep peroneal and tibial nerves was with literature review.
[Show full text]
Nonsystemic Vasculitic Neuropathy: a Clinicopathological Study of 22 Cases
Nonsystemic Vasculitic Neuropathy: A Clinicopathological Study of 22 Cases EVANGELIA KARARIZOU, PANAGIOTA DAVAKI, NIKOS KARANDREAS, ROUBINI DAVOU, and DIMITRIOS VASSILOPOULOS ABSTRACT. Objective. The involvement of the peripheral nervous system in patients with systemic vasculitis has been reported, but nonsystemic peripheral nervous system vasculitis is not so well known. We inves- tigated the clinical, electrophysiological, and pathological features of nonsystemic vasculitic neu- ropathy (NSVN) in order to establish the clinical and histological manifestations and to promote the earlier diagnosis of the syndrome. Methods. Biopsies were selected from over 700 sural nerve biopsies performed at the Section of Neuropathology, Neurological Clinic of Athens University Hospital. The diagnosis of vasculitis was based on established clinicopathological criteria. Other causes of peripheral neuropathy were excluded. Complete laboratory, clinical, electrophysiological, and pathological studies were per- formed in all cases. Results. Nerve biopsies of 22 patients were diagnosed as NSVN. The pathological features were vasculitis and predominant axonal degeneration with a varying pattern of myelinated fiber loss. The vasculitic changes were found mainly in small epineural blood vessels. Mononeuritis multiplex and distal symmetrical sensorimotor neuropathy were equally frequent. Conclusion. NSVN should be suspected in a case of unexplained polyneuropathy without evidence of systemic involvement. Clinical and neurophysiological studies are essential for the detection of nerve involvement, but the specific diagnosis of NSVN may be missed unless a biopsy is performed. (J Rheumatol 2005;32:853–8) Key Indexing Terms: NONSYSTEMIC VASCULITIC NEUROPATHY NONSYSTEMIC VASCULITIS POLYNEUROPATHY AXONAL The syndrome of peripheral neuropathy due to vasculitis We examined the clinical, electrophysiological, and without manifestations of disorders in other systems was histopathological features of 22 patients with NSVN in first reported by Kernohan and Woltman in 19381.
[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]
The Muscles That Act on the Lower Limb Fall Into Three Groups: Those That Move the Thigh, Those That Move the Lower Leg, and Those That Move the Ankle, Foot, and Toes
MUSCLES OF THE APPENDICULAR SKELETON LOWER LIMB The muscles that act on the lower limb fall into three groups: those that move the thigh, those that move the lower leg, and those that move the ankle, foot, and toes. Muscles Moving the Thigh (Marieb / Hoehn – Chapter 10; Pgs. 363 – 369; Figures 1 & 2) MUSCLE: ORIGIN: INSERTION: INNERVATION: ACTION: ANTERIOR: Iliacus* iliac fossa / crest lesser trochanter femoral nerve flexes thigh (part of Iliopsoas) of os coxa; ala of sacrum of femur Psoas major* lesser trochanter --------------- T – L vertebrae flexes thigh (part of Iliopsoas) 12 5 of femur (spinal nerves) iliac crest / anterior iliotibial tract Tensor fasciae latae* superior iliac spine gluteal nerves flexes / abducts thigh (connective tissue) of ox coxa anterior superior iliac spine medial surface flexes / adducts / Sartorius* femoral nerve of ox coxa of proximal tibia laterally rotates thigh lesser trochanter adducts / flexes / medially Pectineus* pubis obturator nerve of femur rotates thigh Adductor brevis* linea aspera adducts / flexes / medially pubis obturator nerve (part of Adductors) of femur rotates thigh Adductor longus* linea aspera adducts / flexes / medially pubis obturator nerve (part of Adductors) of femur rotates thigh MUSCLE: ORIGIN: INSERTION: INNERVATION: ACTION: linea aspera obturator nerve / adducts / flexes / medially Adductor magnus* pubis / ischium (part of Adductors) of femur sciatic nerve rotates thigh medial surface adducts / flexes / medially Gracilis* pubis / ischium obturator nerve of proximal tibia rotates
[Show full text]
Review Isolated Vasculitis of the Peripheral Nervous System
Review Isolated vasculitis of the peripheral nervous system M.P. Collins, M.I. Periquet Department of Neurology, Medical College ABSTRACT combination therapy to be more effec- of Wisconsin, Milwaukee, Wisconsin, USA. Vasculitis restricted to the peripheral tive than prednisone alone. Although Michael P. Collins, MD, Ass. Professor; nervous system (PNS), referred to as most patients have a good outcome, M. Isabel Periquet, MD, Ass. Professor. nonsystemic vasculitic neuropathy more than 30% relapse and 60% have Please address correspondence and (NSVN), has been described in many residual pain. Many nosologic, path- reprint requests to: reports since 1985 but remains a poorly ogenic, diagnostic, and therapeutic Michael P. Collins, MD, Department of understood and perhaps under-recog- questions remain unanswered. Neurology, Medical College of Wisconsin, nized condition. There are no uniform 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA. diagnostic criteria. Classifi cation is Introduction E-mail: [email protected] complicated by the occurrence of vas- The vasculitides comprise a broad Received on March 6, 2008; accepted in culitic neuropathies in many systemic spectrum of diseases which exhibit, revised form on April 1, 2008. vasculitides affecting small-to-me- as their primary feature, infl ammation Clin Exp Rheumatol 2008; 26 (Suppl. 49): dium-sized vessels and such clinical and destruction of vessel walls, with S118-S130. variants as nonsystemic skin/nerve secondary ischemic injury to the in- © CopyrightCopyright CLINICAL AND vasculitis and diabetic/non-diabetic volved tissues (1). They are generally EXPERIMENTAL RHEUMATOLOGY 2008.2008. lumbosacral radiculoplexus neuropa- classifi ed based on sizes of involved thy. Most patients present with pain- vessels and histopathologic and clini- Key words: Vasculitis, peripheral ful, stepwise progressive, distal-pre- cal features.
[Show full text]