Ultrasound-guided diagnostic IPACK as a valuable tool in the management of a patient with soleal sling syndrome: a doubly rare case report.

This article describes the use of an infiltration between the popliteal artery and capsule of the knee joint (IPACK) to diagnose an entrapment neuropathy of the tibial nerve (TN) in a patient presenting with chronic neuropathic pain in the medial posterior compartment of the left knee, with a previous electromyography showing no evidence of tibial or common peroneal nerve neuropathy. After a positive sciatic nerve block, the patient was evaluated for a TN block, cancelled due to the presence of an abnormal leash of vessels wrapping around the nerve. For this reason, the patient was submitted to a diagnostic IPACK. A negative IPACK suggested that a compression of the TN at the popliteal fossa was the most likely source of the symptoms. After surgical decompression of the TN nerve at the popliteal fossa, the patient's symptoms decreased substantially.

Lay abstract This case report describes the use of an infiltration between the popliteal artery and capsule of the knee joint (IPACK), a technique in which local anesthetic is injected between the popliteal artery and the back side of the knee joint, to diagnose a compression of the tibial nerve (TN) in a patient with chronic knee pain. A female adult patient presented for further evaluation of chronic pain in the inner side of the back of her left knee. A previous electromyography showed no evidence of tibial or common peroneal nerve disease. After a positive diagnostic block of the left sciatic nerve, the patient was evaluated for a left TN block, so as to ascertain whether a compression of this nerve at the back side of the knee could be the origin of the patient's symptoms. During the ultrasound scanning of the TN, a group of abnormal vessels was found wrapping around the nerve, which made it impossible to inject the TN in a safe manner, even with the guidance of ultrasound. For this reason, the patient was instead submitted to a diagnostic left IPACK. A negative IPACK suggested that a compression of the TN at the popliteal fossa, the region behind the knee joint, was the most likely source of the patient's symptoms. After surgical decompression of the TN at the popliteal fossa, the patient's symptoms decreased substantially.

A Systematic Review of the Omohyoid Muscle Syndrome (OMS): Clinical Presentation, Diagnosis, and Treatment Options.

OBJECTIVE: Omohyoid muscle syndrome (OMS) is a condition that causes a X-shaped lateral neck lump on swallowing, caused by the failure of the central tendon of the omohyoid muscle to restrict movement of the muscle during swallowing. We aim to review the etiology, pathophysiology, diagnostic tests, and management options for this condition. DATA SOURCES: Pubmed, MEDLINE, EMBASE, and Cochrane databases were searched for all articles and abstracts related to OMS up to 29th July 2020. REVIEW METHODS: A systematic review was performed, data extracted from relevant full text articles. Both quantitative data and qualitative data were analyzed. RESULTS: Twenty cases of OMS were reported. Patients presented at a mean age of 36.0. All cases were Asian. There is a 7:3 ratio of males to females. The most common symptom was a transient neck mass. Most cases were managed conservatively with good prognosis. Open or endoscopic transection of the muscle and ultrasound-guided botulinum toxin injection were 3 treatment options, with no recurrence at 4 years, 6 months, and 6 months respectively. CONCLUSION: OMS could be genetic as all cases were Asian in ethnicity. The deep cervical fascia which usually envelopes the omohyoid muscle may be weakened by stress as 20% of cases had a preceding traumatic event. Real-time ultrasonography establishes the diagnosis, demonstrating the anterolateral displacement of the sternocleidomastoid muscle by a thickened omohyoid muscle during swallowing. Surgical transection can achieve cure, but due to limited studies available, they should be reserved for patients who are extremely bothered. Intramuscular injection of botulinum toxin is an effective alternative, but recurrence is expected.

Omohyoid Muscle Syndrome in a Mixed Martial Arts Athlete: A Case Report.

Omohyoid muscle syndrome is a rare cause of an X-shaped bulging lateral neck mass that occurs on swallowing. This is a diagnostic case report of a 22-year-old mixed martial arts athlete who acquired this condition.