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1.
JBJS Case Connect ; 14(3)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-39146438

RESUMO

CASE: An overall healthy 48-year-old man suffered a left foot mangled crush injury resulting in a post-transmetatarsal amputation and subsequently developing a painful neuroma on the plantar surface of the foot. To avoid the zone of injury, targeted muscle reinnervation was used to treat the neuroma by coapting the tibial nerve to the motor point of the flexor hallucis longus (FHL) muscle. At 1-year follow-up, the patient reported no pain at rest, returned to work, and could ambulate with an orthosis for 30 minutes. CONCLUSION: Rare tibial nerve coaptations to the FHL could serve as a treatment option for patients with neuromas in traumatic postmetatarsal amputation.


Assuntos
Neuroma , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma/cirurgia , Neuroma/etiologia , Músculo Esquelético/cirurgia , Músculo Esquelético/inervação , Músculo Esquelético/transplante , Nervo Tibial/cirurgia , Nervo Tibial/lesões , Amputação Traumática/cirurgia
2.
J Am Anim Hosp Assoc ; 60(4): 164-168, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38885491

RESUMO

This case report describes the treatment of a postoperative painful neuroma of the tibial nerve using an autologous nerve graft in a dog. The patient presented with sudden non-weight-bearing lameness 10 days after iatrogenic tibial nerve injury during preparation of a reverse saphenous conduit flap. The dog showed severe pain at the surgical site without nerve deficits. A magnetic resonance imaging examination revealed an enlarged tibial nerve at the injury site, consistent with a neuroma. Analgesics were administered over 11 days, but the patient remained in severe pain and non-weight-bearing. Therefore, surgical resection was recommended. The fusiform neuroma was resected microsurgically, and a saphenous nerve graft was transplanted using an epineural nerve repair technique. Histopathological examination was consistent with a neuroma. The dog showed immediate pain relief and weight-bearing the day after surgery with normal motor function. The dog made a full recovery by the last follow-up 6 mo after surgery. If patients develop pain and lameness following surgery or nerve injury, neuroma formation must be considered, even shortly after surgery. Microsurgical resection and autologous nerve transplantation using an epineural nerve repair technique is a viable method to treat painful neuromas and minimize the risk for recurrence in dogs.


Assuntos
Doenças do Cão , Neuroma , Nervo Tibial , Cães , Animais , Doenças do Cão/cirurgia , Neuroma/veterinária , Neuroma/cirurgia , Neuroma/etiologia , Nervo Tibial/cirurgia , Nervo Tibial/lesões , Neoplasias do Sistema Nervoso Periférico/veterinária , Neoplasias do Sistema Nervoso Periférico/cirurgia , Transplante Autólogo/veterinária , Feminino , Masculino
3.
Neurochem Res ; 49(9): 2469-2479, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38856888

RESUMO

The restoration of adequate function and sensation in nerves following an injury is often insufficient. Electrical stimulation (ES) applied during nerve repair can promote axon regeneration, which may enhance the likelihood of successful functional recovery. However, increasing operation time and complexity are associated with limited clinical use of ES. This study aims to better assess whether short-duration ES types (voltage mode vs. current mode) are able to produce enhanced regenerative activity following peripheral nerve repair in rat models. Wistar rats were randomly divided into 3 groups: no ES (control), 30-minute ES with a current pulse, and 30-minute ES with a voltage pulse. All groups underwent sciatic nerve transection and repair using a silicone tube to bridge the 6-mm gap between the stumps. In the 2 groups other than the control, ES was applied after the surgical repair. Outcomes were evaluated using electrophysiology, histology, and serial walking track analysis. Biweekly walking tracks test over 12 weeks revealed that subjects that underwent ES experienced more rapid functional improvement than subjects that underwent repair alone. Electrophysiological analysis of the newly intratubular sciatic nerve at week 12 revealed strong motor function recovery in rats that underwent 30-minute ES. Histologic analysis of the sciatic nerve and its tibial branch at 12 weeks demonstrated robust axon regrowth in all groups. Both types of short-duration ES applied during nerve repair can promote axon regrowth and enhance the chances of successful functional recovery.


Assuntos
Axônios , Regeneração Nervosa , Ratos Wistar , Recuperação de Função Fisiológica , Nervo Isquiático , Animais , Regeneração Nervosa/fisiologia , Nervo Isquiático/lesões , Axônios/fisiologia , Recuperação de Função Fisiológica/fisiologia , Ratos , Estimulação Elétrica/métodos , Nervo Tibial/lesões , Masculino , Terapia por Estimulação Elétrica/métodos
4.
Neuroscience ; 551: 55-68, 2024 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-38788828

RESUMO

Gamma-aminobutyric acid and glycine (GABA/Gly) are predominantly inhibitory neurotransmitters in the mature central nervous system; however, they mediate membrane potential depolarization during development. These differences in actions depend on intracellular Cl- concentrations ([Cl-]i), which are primarily regulated by potassium chloride cotransporter 2 (KCC2). After nerve injury, KCC2 expression markedly decreases and GABA/Gly mediate depolarization. Following nerve regeneration, KCC2 expression recovers and GABA/Gly become inhibitory, suggesting that KCC2 reduction and GABA/Gly excitation may be crucial for axonal regeneration. To directly clarify their involvement in regeneration, we analyzed recovery processes after tibial nerve severance and suturing between heterozygous KCC2 knockout mice (HT), whose KCC2 levels are halved, and their wild-type littermates (WT). Compared with WT mice, the sciatic functional index-indicating lower limb motor function-was significantly higher until 28 days after operation (D28) in HT mice. Furthermore, at D7, many neurofilament-positive fibers were elongated into the distal part of the sutured nerve in HT mice only, and myelinated axonal density was significantly higher at D21 and D28 in HT animals. Electron microscopy and galanin immunohistochemistry indicated a shorter nerve degeneration period in HT mice. Moreover, a less severe decrease in choline acetyltransferase was observed in HT mice. These results suggest that nerve degeneration and regeneration proceed more rapidly in HT mice, resulting in milder motor dysfunction. Via similar microglial activation, nerve surgery may reduce KCC2 levels more rapidly in HT mice, followed by earlier increased [Cl-]i and longer-lasting GABA/Gly excitation. Taken together, reduced KCC2 may accelerate nerve regeneration via GABA/Gly excitation.


Assuntos
Axônios , Cotransportadores de K e Cl- , Regeneração Nervosa , Simportadores , Nervo Tibial , Animais , Feminino , Masculino , Camundongos , Axônios/metabolismo , Modelos Animais de Doenças , Camundongos Endogâmicos C57BL , Camundongos Knockout , Traumatismos dos Nervos Periféricos/metabolismo , Simportadores/metabolismo , Simportadores/genética , Nervo Tibial/lesões , Nervo Tibial/metabolismo
5.
Int J Mol Sci ; 25(3)2024 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-38339124

RESUMO

Peripheral nerve injury denervates muscle, resulting in muscle paralysis and atrophy. This is reversible if timely muscle reinnervation occurs. With delayed reinnervation, the muscle's reparative ability declines, and muscle-resident fibro-adipogenic progenitor cells (FAPs) proliferate and differentiate, inducing fibro-fatty muscle degradation and thereby physical disability. The mechanisms by which the peripheral nerve regulates FAPs expansion and differentiation are incompletely understood. Using the rat tibial neve transection model, we demonstrated an increased FAPs content and a changing FAPs phenotype, with an increased capacity for adipocyte and fibroblast differentiation, in gastrocnemius muscle post-denervation. The FAPs response was inhibited by immediate tibial nerve repair with muscle reinnervation via neuromuscular junctions (NMJs) and sensory organs (e.g., muscle spindles) or the sensory protection of muscle (where a pure sensory nerve is sutured to the distal tibial nerve stump) with reinnervation by muscle spindles alone. We found that both procedures reduced denervation-mediated increases in glial-cell-line-derived neurotrophic factor (GDNF) in muscle and that GDNF promoted FAPs adipogenic and fibrogenic differentiation in vitro. These results suggest that the peripheral nerve controls FAPs recruitment and differentiation via the modulation of muscle GDNF expression through NMJs and muscle spindles. GDNF can serve as a therapeutic target in the management of denervation-induced muscle injury.


Assuntos
Fator Neurotrófico Derivado de Linhagem de Célula Glial , Músculo Esquelético , Ratos , Animais , Fator Neurotrófico Derivado de Linhagem de Célula Glial/metabolismo , Músculo Esquelético/metabolismo , Diferenciação Celular , Nervo Tibial/lesões , Adipogenia , Denervação
6.
Front Biosci (Landmark Ed) ; 28(11): 298, 2023 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-38062831

RESUMO

BACKGROUND: Severe peripheral nerve injuries, such as deficits over long distances or proximal nerve trunk injuries, pose complex reconstruction challenges that often result in unfavorable outcomes. An innovative approach to repairing severe peripheral nerve damage involves using conduit suturing for nerve transposition repair. Cylindrical nerve guides are typically unsuitable for nerve transposition repair. Moreover, postsurgical adjuvant treatment is essential to promote the development of axonal lateral sprouts, proximal growth, and the restoration of neurostructure and function. The purpose of this research is to assess the impact of chitosan-based conduits with varying inner diameters on nerve transposition repair when combined with modified formula Radix Hedysari (MFRH). METHODS: Using chitosan, we created conduits with varying inner diameters on both ends. These conduits were then utilized to repair the distal common peroneal and tibial nerves in SD rats using the proximal common peroneal nerve. Subsequently, MFRH was employed as a supplementary treatment. The assessment of the repair's effectiveness took place 16 weeks postsurgery, utilizing a range of techniques, including the neurological nerve function index, neuroelectrophysiological measurements, muscle wet weight, and examination of nerve and muscle histology. RESULTS: The outcomes of our study showed that following 16 weeks of postoperative treatment, MFRH had a significant positive impact on the recovery of neuromotor and nerve conduction abilities. Moreover, there was a significant increase in the ratio of wet weight of muscles, cross-sectional area of muscle fibers, quantity and structure of regenerated myelinated nerve fibers, and the count of neurons. CONCLUSIONS: A combination of chitosan-based chitin conduits possessing different inner diameters and MFRH can considerably promote the regeneration and functional recovery of damaged nerves, which in turn enhances nerve transposition repair efficacy.


Assuntos
Quitosana , Doenças do Sistema Nervoso Periférico , Ratos , Animais , Nervo Isquiático/lesões , Nervo Isquiático/patologia , Nervo Isquiático/fisiologia , Ratos Sprague-Dawley , Nervo Tibial/cirurgia , Nervo Tibial/lesões , Nervo Tibial/fisiologia , Regeneração Nervosa/fisiologia
7.
Behav Brain Res ; 441: 114269, 2023 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-36574845

RESUMO

Cold intolerance is a debilitating effect of nerve injury, has a strong impact on the life of patients and no advisable treatment exists against it. Testosterone influences pain pathways and has analgesic effects. A recent study showed testosterone as being an agonist of TRPM8, the predominant ion channel that contributes to cold hypersensitivity after injury. We investigated the effect of testosterone on cold sensitivity after nerve injury. Specifically, using the double plate test (DPT) (thermo-neutral-plate: 31 ºC and cold-plate: 18 ºC) we determined the thermal preference of mice at different points during the study design consisting of: orchiectomy, tibial nerve transection (TNT) (30 days after orchiectomy), 15-days-repeated subcutaneous injections of testosterone enanthate (250 or 500 µg/kg/day) or vehicle (started 12 h after TNT surgery). Different parameters such as time spent on cold plates, distance traveled, animal speed on the cold- and thermo-neutral-plates were determined in naïve, sham and neuropathic animals. Neither orchiectomy nor sham TNT surgery generate effects on cold intolerance and animal activity while TNT surgery decreased the time spent on the cold-plate and the distance traveled during DPT. Testosterone administration reversed the effect of nerve injury, decreasing the cold hypersensitivity and increasing activity of TNT mice. However, the effect of testosterone on cold avoidance reduced with time and at 14 days after TNT surgery, a higher dose was needed to reverse the effect generated by nerve injury. This indicates that although testosterone administration has a positive effect on cold intolerance, it might not be suitable for prolongated treatment.


Assuntos
Síndromes Periódicas Associadas à Criopirina , Doenças do Sistema Nervoso Periférico , Camundongos , Animais , Dor , Nervo Tibial/lesões , Testosterona/farmacologia , Temperatura Baixa , Hiperalgesia/tratamento farmacológico
8.
Plast Reconstr Surg ; 149(4): 681e-690e, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35139047

RESUMO

BACKGROUND: Repair of nerve injuries can fail to achieve adequate functional recovery. Electrical stimulation applied at the time of nerve repair can accelerate axon regeneration, which may improve the likelihood of recovery. However, widespread use of electrical stimulation may be limited by treatment protocols that increase operative time and complexity. This study evaluated whether a short-duration electrical stimulation protocol (10 minutes) was efficacious to enhance regeneration following nerve repair using rat models. METHODS: Lewis and Thy1-green fluorescent protein rats were randomized to three groups: 0 minutes of electrical stimulation (no electrical stimulation; control), 10 minutes of electrical stimulation, and 60 minutes of electrical stimulation. All groups underwent tibial nerve transection and repair. In the intervention groups, electrical stimulation was delivered after nerve repair. Outcomes were assessed using immunohistochemistry, histology, and serial walking track analysis. RESULTS: Two weeks after nerve repair, Thy1-green fluorescent protein rats demonstrated increased green fluorescent protein-positive axon outgrowth from the repair site with electrical stimulation compared to no electrical stimulation. Serial measurement of walking tracks after nerve repair revealed recovery was achieved more rapidly in both electrical stimulation groups as compared to no electrical stimulation. Histologic analysis of nerve distal to the repair at 8 weeks revealed robust axon regeneration in all groups. CONCLUSIONS: As little as 10 minutes of intraoperative electrical stimulation therapy increased early axon regeneration and facilitated functional recovery following nerve transection with repair. Also, as early axon outgrowth increased following electrical stimulation with nerve repair, these findings suggest electrical stimulation facilitated recovery because of earlier axon growth across the suture-repaired site into the distal nerve to reach end-organ targets. CLINICAL RELEVANCE STATEMENT: Brief (10-minute) electrical stimulation therapy can provide similar benefits to the 60-minute protocol in an acute sciatic nerve transection/repair rat model and merit further studies, as they represent a translational advantage.


Assuntos
Axônios , Terapia por Estimulação Elétrica , Animais , Humanos , Ratos , Axônios/fisiologia , Estimulação Elétrica/métodos , Regeneração Nervosa/fisiologia , Ratos Endogâmicos Lew , Recuperação de Função Fisiológica/fisiologia , Nervo Tibial/lesões
9.
Mol Neurobiol ; 58(11): 5772-5789, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34406600

RESUMO

Increasing evidence suggests that transmembrane protein 16A (TMEM16A) in nociceptive neurons is an important molecular component contributing to peripheral pain transduction. The present study aimed to evaluate the role and mechanism of TMEM16A in chronic nociceptive responses elicited by spared nerve injury (SNI). In this study, SNI was used to induce neuropathic pain. Drugs were administered intrathecally. The expression and cellular localization of TMEM16A, the ERK pathway, and NK-1 in the dorsal root ganglion (DRG) were detected by western blot and immunofluorescence. Behavioral tests were used to evaluate the role of TMEM16A and p-ERK in SNI-induced persistent pain and hypersensitivity. The role of TMEM16A in the hyperexcitability of primary nociceptor neurons was assessed by electrophysiological recording. The results show that TMEM16A, p-ERK, and NK-1 are predominantly expressed in small neurons associated with nociceptive sensation. TMEM16A is colocalized with p-ERK/NK-1 in DRG. TMEM16A, the MEK/ERK pathway, and NK-1 are activated in DRG after SNI. ERK inhibitor or TMEM16A antagonist prevents SNI-induced allodynia. ERK and NK-1 are downstream of TMEM16A activation. Electrophysiological recording showed that CaCC current increases and intrathecal application of T16Ainh-A01, a selective TMEM16A inhibitor, reverses the hyperexcitability of DRG neurons harvested from rats after SNI. We conclude that TMEM16A activation in DRG leads to a positive interaction of the ERK pathway with activation of NK-1 production and is involved in the development of neuropathic pain after SNI. Also, the blockade of TMEM16A or inhibition of the downstream ERK pathway or NK-1 upregulation may prevent the development of neuropathic pain.


Assuntos
Anoctaminas/fisiologia , MAP Quinases Reguladas por Sinal Extracelular/fisiologia , Gânglios Espinais/patologia , Hiperalgesia/fisiopatologia , Neuralgia/fisiopatologia , Nervo Fibular/lesões , Receptores da Neurocinina-1/fisiologia , Células Receptoras Sensoriais/fisiologia , Transdução de Sinais/fisiologia , Nervo Tibial/lesões , Animais , Anoctaminas/antagonistas & inibidores , Butadienos/farmacologia , Dor Crônica/etiologia , Dor Crônica/fisiopatologia , Hiperalgesia/etiologia , Ligadura , Masculino , Neuralgia/etiologia , Nitrilas/farmacologia , Nociceptividade/fisiologia , Pirimidinas/farmacologia , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Tiazóis/farmacologia
10.
J Surg Res ; 264: 208-221, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33838405

RESUMO

BACKGROUND: Peripheral nerve damage is a frequent problem, with an estimated 2.8%-5.0% of trauma admissions involving peripheral nerve injury. End-to-end, tension-free microsurgical repair (neurorrhaphy) is the current gold standard treatment for complete transection (neurotmesis). While neurorrhaphy reapproximates the nerve, it does not address the complex molecular regenerative process. Evidence suggests that botulinum toxin A (BTX) and nimodipine (NDP) may improve functional recovery, but mechanisms of action remain unknown. METHODS: This research investigates BTX and NDP for their novel capacity to improve neural regeneration in the setting of neurorrhaphy using a Lewis rat tibial nerve neurotmesis model. In a triple-masked, placebo-controlled, randomized study design, we compared functional (rotarod, horizontal ladder walk), electrophysiological (conduction velocity, duration), and stereological (axon count, density) outcomes of rats treated with: NDP+saline injection, BTX+NDP, Saline+placebo, and BTX+placebo. Additional controls included sham surgery +/- BTX. RESULTS: NDP+saline outperformed other treatment groups in the ladder walk. This group had the fewest deep slips (15.07% versus 30.77% in BTX+NDP, P = 0.122), and the most correct steps (70.53% versus 55.58% in BTX+NDP, P = 0.149) in functional testing. NDP+saline also had the fastest nerve conduction velocity (0.811m/s versus 0.598m/s in BTX+NDP, P = 0.126) among treatment groups. BTX+NDP had the highest axon count (10,012.36 versus 7,738.18 in NDP+Saline, P = 0.009). CONCLUSION: This study is the first to test NDP with BTX in a multimodal assessment of nerve recovery following neurotmesis and neurorrhaphy. NDP outperformed BTX+NDP functionally. Future work will focus on nimodipine in an effort to improve nerve recovery in trauma patients.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Regeneração Nervosa/efeitos dos fármacos , Procedimentos Neurocirúrgicos , Nimodipina/administração & dosagem , Traumatismos dos Nervos Periféricos/terapia , Animais , Terapia Combinada , Modelos Animais de Doenças , Humanos , Masculino , Projetos Piloto , Ratos , Recuperação de Função Fisiológica , Nervo Tibial/efeitos dos fármacos , Nervo Tibial/lesões , Nervo Tibial/cirurgia
11.
Sports Med Arthrosc Rev ; 28(3): 87-93, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32740459

RESUMO

The traumatic knee dislocation (KD) is a complex condition resulting in injury to >1 ligament or ligament complexes about the knee, termed multiligament knee injuries. Typically, KDs result in injury to both cruciate ligaments with variable injury to collateral ligament complexes. Very rarely, KD may occur with single cruciate injuries combined with collateral involvement but it is important to understand that not all multiligament knee injuries are KDs. Patients can present in a wide spectrum of severity; from frank dislocation of the tibiofemoral joint to a spontaneously reduced KD, either with or without neurovascular injury. The initial evaluation of these injuries should include a thorough patient history and physical examination, with particularly close attention to vascular status which has the most immediate treatment implications. Multiple classification systems have been developed for KDs, with the anatomic classification having the most practical application.


Assuntos
Lesões do Ligamento Cruzado Anterior , Luxação do Joelho/classificação , Luxação do Joelho/diagnóstico , Ligamento Colateral Médio do Joelho/lesões , Ligamento Cruzado Posterior/lesões , Acidentes por Quedas , Índice Tornozelo-Braço , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/etiologia , Angiografia por Tomografia Computadorizada , França , Humanos , Luxação do Joelho/diagnóstico por imagem , Luxação do Joelho/etiologia , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/etiologia , Ortopedia , Nervo Fibular/lesões , Exame Físico , Artéria Poplítea/lesões , Radiografia , Sociedades Médicas , Nervo Tibial/lesões
12.
Medicine (Baltimore) ; 99(31): e21474, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756170

RESUMO

RATIONALE: Tibial nerve injury is a sustainable but rare complication during total-ankle arthroplasty (TAA). We outlined 2 previously unreported cases of tibial nerve injury in TAA, including the prognoses and possible causes. PATIENT CONCERNS: First, a 63-year-old woman complained of a 5-month history of persistent tingling sensation and numbness on the medial and plantar aspects of her foot after TAA. Second, a 50-year-old woman complained of a 6-month history of tingling sensation and numbness on the plantar surface of her forefoot after TAA. DIAGNOSIS: Explorations were performed on suspicion of tarsal tunnel syndrome; however, both patients exhibited complete laceration of tibial nerve with neuroma formation. INTERVENTIONS: In both patients, we excised the neuroma and performed end-to-end nerve repair. OUTCOMES: The sensory disturbance of the sole considerably improved at long-term follow-up over 8 years after the neurorrhaphy procedures. LESSONS: Tibial nerve injury is rare following TAA, and is sometimes unrecognized or misdiagnosed. If tibial nerve injury is suspected, prompt surgical exploration should be performed; great precaution must also be taken to prevent injury of the tibial nerve during TAA.


Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Neuroma/cirurgia , Parestesia/etiologia , Nervo Tibial/lesões , Assistência ao Convalescente , Feminino , Pé/fisiopatologia , Humanos , Hipestesia/etiologia , Doença Iatrogênica/epidemiologia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos de Cirurgia Plástica/efeitos adversos , Síndrome do Túnel do Tarso/diagnóstico , Nervo Tibial/patologia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(28): e21130, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664141

RESUMO

INTRODUCTION: It is well known that foot massage is a very prevalent stress relief method in China. Literatures have reported various massage-inducted peripheral nerve injuries. However, massage-inducted lateral plantar nerve (LPN) injury is very rare. Here, we represent an unusual case of massage-inducted LPN damage, and we also report the diagnostic method of this patient using musculoskeletal ultrasonography combined with electromyography (EMG). PATIENT CONCERNS: A 21-year-old woman presented symptoms of redness, swelling, pain and numbness in the medial right ankle joint for 2 days. DIAGNOSIS: The results of musculoskeletal ultrasonography and EMG provide great help for doctors to make accurate diagnosis. The patient was eventually diagnosed with LPN injury. INTERVENTIONS: No further foot massage was allowed. Vitamin B12 was taken orally for 2 months. Conservative therapy, including electrical stimulation therapy and infrared therapy, was conducted. Besides, active rehabilitation training was also performed. OUTCOMES: The discomfort symptoms were relieved significantly after 2 months conservative treatment. Clinical symptoms and EMG examination illustrated satisfactory result during follow up time. CONCLUSION: The report showed that the masseur should be very careful when doing foot massage to prevent nerve damage. Besides, musculoskeletal ultrasonography combined with EMG can provide important evidence for accurate and effective diagnosis of LPN injury.


Assuntos
Tornozelo/diagnóstico por imagem , Eletromiografia/métodos , Massagem/efeitos adversos , Traumatismos dos Nervos Periféricos/diagnóstico , Nervo Tibial/lesões , Ultrassonografia/métodos , Tornozelo/inervação , Diagnóstico Diferencial , Feminino , Humanos , Traumatismos dos Nervos Periféricos/etiologia , Adulto Jovem
14.
Rehabilitacion (Madr) ; 54(4): 292-295, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32680689

RESUMO

Chronic or recalcitrant plantar fasciitis is a cause of persistent plantar pain. These cases are usually resistant to conventional treatments consisting of exercises, orthoses, shock waves and infiltrations and require a surgical approach. Proximal medial gastrocnemius release is a surgical option that provides satisfactory results, but is not free of complications, which include injuries and nerve entrapment. We report the first published case of symptomatic medial gastrocnemius branch entrapment in the post-surgical scar of a tenotomy for the treatment of recalcitrant plantar fasciitis. We propose ultrasound-guided hydrodissection with local anesthetic as a treatment with promising results.


Assuntos
Dissecação/métodos , Fasciíte Plantar/cirurgia , Síndromes de Compressão Nervosa/terapia , Complicações Pós-Operatórias/terapia , Nervo Tibial/lesões , Ultrassonografia de Intervenção , Anestesia Local , Cicatriz/complicações , Dissecação/instrumentação , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Complicações Pós-Operatórias/etiologia , Pressão , Recidiva , Soluções/administração & dosagem , Soluções/uso terapêutico , Tenotomia/efeitos adversos , Escala Visual Analógica
15.
Unfallchirurg ; 123(8): 653-658, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32347369

RESUMO

This article reports a case of medial dislocation of the talus as a rare injury caused by a fall from a low height.Treatment recommendations given in the literature for this rare injury are heterogeneous but closed reduction is predominant. Little is known about possible obstacles in closed reduction. The known complications include posttraumatic arthritis and necrosis of the talus.A posttraumatic lesion of the tibial nerve has not been reported, which is why a treatment recommendation is illustrated and discussed based on this case report.


Assuntos
Luxações Articulares , Tálus , Nervo Tibial , Acidentes por Quedas , Humanos , Luxações Articulares/complicações , Tálus/lesões , Nervo Tibial/lesões
16.
Ann Vasc Surg ; 67: 388-394, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32209409

RESUMO

BACKGROUND: A distal approach in endovascular procedures for revascularization of lowers limbs can be considered in case of no re-entry in subintimal recanalization. The aim of this study is to evaluate the feasibility of a medial approach to the infrageniculate popliteal artery (IPA) using existing computed tomography (CT) scan simulation and punctures performed on cadavers. METHODS AND RESULTS: CT angiographies of lower extremities were used to simulate IPA puncture and puncture trajectory. Tissues damaged during the trajectory between the puncture site and the access-related injuries were analyzed. Anatomical punctures on cadaverous model were also performed. Corpses were placed in supine position, the hip in slight flexion (40°) and abduction (external rotation of 60°). A 16 G needle was used for the IPA puncture. Twelve CT angiography simulations were made. Of these 12 simulations, 9 revealed an isolated lesion of the popliteal vein and 2 isolated lesions of the tibial nerve. A lesion of the tibial nerve and the popliteal vein on the same simulation was once observed. Damage to the medial gastrocnemius muscle could not be avoided in each case. Ten punctures were performed on cadavers with technical success. There were 6 popliteal vein lesions, 3 tibial nerve lesions, and 1 case without lesion. In all cases, damage to the medial gastrocnemius muscle was seen. CONCLUSIONS: This medial approach was feasible and is accompanied by trauma of elements of the popliteal pedicle. Preoperative CT angiography could anticipate best site of puncture and potential access-related injury.


Assuntos
Cateterismo Periférico/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Modelagem Computacional Específica para o Paciente , Artéria Poplítea/diagnóstico por imagem , Cadáver , Estudos de Viabilidade , Humanos , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/lesões , Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Traumatismos dos Nervos Periféricos/etiologia , Veia Poplítea/diagnóstico por imagem , Veia Poplítea/lesões , Valor Preditivo dos Testes , Punções , Estudos Retrospectivos , Nervo Tibial/diagnóstico por imagem , Nervo Tibial/lesões , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
17.
J Orthop Sports Phys Ther ; 50(2): 111, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32005092

RESUMO

A 61-year-old woman was referred to physical therapy by a podiatrist who suspected a posterior tibialis degenerative tear. To further examine the irritable posterior tibial nerve, a musculoskeletal ultrasound examination was performed, showing a vascularized focal lesion suggestive of a nerve tumor. The patient was referred back to the referring podiatrist, who ordered magnetic resonance imaging, which confirmed the schwannoma of the posterior tibialis nerve. J Orthop Sports Phys Ther 2020;50(2):111. doi:10.2519/jospt.2020.9103.


Assuntos
Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Tibial/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Nervo Tibial/lesões , Ultrassonografia
18.
Brain Res ; 1733: 146718, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-32045595

RESUMO

Gamma-amino butyric acid (GABA) is an inhibitory neurotransmitter in the mature brain, but is excitatory during development and after motor nerve injury. This difference in GABAergic action depends on the intracellular chloride ion concentration ([Cl-]i), primarily regulated by potassium chloride co-transporter 2 (KCC2). To reveal precise processes of the neuropathic pain through changes in GABAergic action, we prepared tibial nerve ligation and severance models using male mice, and examined temporal relationships amongst changes in (1) the mechanical withdrawal threshold in the sural nerve area, (2) localization of the molecules involved in GABAergic transmission and its upstream signaling in the dorsal horn, and (3) histology of the tibial nerve. In the ligation model, tibial nerve degeneration disappeared by day 56, but mechanical allodynia, reduced KCC2 localization, and increased microglia density remained until day 90. Microglia density was higher in the tibial zone than the sural zone before day 21, but this result was inverted after day 28. In contrast, in the severance model, all above changes were detected until day 28, but were simultaneously and significantly recovered by day 90. These results suggested that in male mice, allodynia may be caused by reduced GABAergic synaptic inhibition, resulting from elevated [Cl-]i after the reduction of KCC2 by activated microglia. Furthermore, our results suggested that factors from degenerating nerve terminals may diffuse into the sural zone, whereby they induced the development of allodynia in the sural nerve area, while other factors in the sural zone may mediate persistent allodynia through the same pathway.


Assuntos
Microglia/metabolismo , Neuralgia/metabolismo , Simportadores/metabolismo , Nervo Tibial/lesões , Nervo Tibial/metabolismo , Animais , Masculino , Camundongos Endogâmicos C57BL , Neuralgia/patologia , Limiar da Dor , Nervo Tibial/patologia , Cotransportadores de K e Cl-
19.
Surg Radiol Anat ; 42(6): 681-684, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31938852

RESUMO

INTRODUCTION: The aim of this study was to investigate the location and distribution patterns of neurovascular structures and determine the effective injection point in the tarsal tunnel for heel pain. METHODS: Fifteen adult non-embalmed cadavers with a mean age of 71.5 years were studied. The most inferior point of the medial malleolus of the tibia (MM) and the tuberosity of the calcaneus (TC) were identified before dissection. A line connecting the MM and TC was used as a reference line. The reference point was expressed in absolute distance along the reference line using the MM as the starting point. For measurements using MRI, the depth from the skin was measured to inferior at an interval of 1 cm from the MM. RESULTS: The posterior tibial artery, lateral plantar nerve, and medial plantar nerve were located from 29.0 to 37.3% of the reference line from the MM. The distribution frequencies of the medial calcaneal nerve on the reference line from the MM were 0%, 8.60%, 37.15%, 37.15%, and 17.10%, respectively. The mean depth of the neurovascular structures was 0.3 cm. DISCUSSION: This study recommended an effective injection site from 45.0 to 80.0% of the reference line.


Assuntos
Neuralgia/terapia , Manejo da Dor/métodos , Artérias da Tíbia/anatomia & histologia , Nervo Tibial/anatomia & histologia , Neuropatia Tibial/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Calcâneo/anatomia & histologia , Calcâneo/diagnóstico por imagem , Dissecação , Feminino , Glucocorticoides/administração & dosagem , Calcanhar/anatomia & histologia , Calcanhar/diagnóstico por imagem , Humanos , Injeções Intralesionais/efeitos adversos , Injeções Intralesionais/métodos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Manejo da Dor/efeitos adversos , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/lesões , Nervo Tibial/diagnóstico por imagem , Nervo Tibial/lesões , Neuropatia Tibial/complicações , Adulto Jovem
20.
Biomed Res Int ; 2020: 5046832, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31998792

RESUMO

PURPOSE: Although many surgeons have anecdotally described reversing the polarity of the autograft with the intent of improving regeneration, the optimal orientation of the autogenous nerve graft remains controversial. The aim of this study was to compare (1) the outcomes of orthodromic and antidromic nerve grafts to clarify the effect of nerve graft polarity and (2) the outcome of either form of nerve grafts with that of nerve repair. METHODS: In 14 of the 26 rabbits used in this study, a 1 cm defect was made in the tibial nerve. An orthodromic nerve graft on one side and an antidromic nerve graft on the other were performed using a 1.2 cm long segment of the peroneal nerve. In the remaining 12 rabbits, the tibial nerve was transected completely and then repaired microscopically on one side but left untreated on the other. Electrophysiologic studies were performed in all animals at 8 weeks after surgery, and the sciatic nerves were harvested. RESULTS: Compound motor action potential was visible in all rabbits treated by nerve repair but in only half of the rabbits treated by nerve graft. There was no significant difference in the compound motor action potential, nerve conduction velocity, or total number of axons between the orthodromic and antidromic nerve graft groups. However, in both groups, the outcome was significantly poorer than that of the nerve repair group. CONCLUSION: There was no significant difference by electromyographic or histologic evaluation between orthodromic and antidromic nerve grafts. Direct nerve repair with moderate tension may be a more effective treatment than nerve grafting.


Assuntos
Atividade Motora , Regeneração Nervosa , Nervo Fibular/transplante , Recuperação de Função Fisiológica , Nervo Tibial , Animais , Coelhos , Nervo Tibial/lesões , Nervo Tibial/fisiologia , Nervo Tibial/cirurgia
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