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1.
J Am Podiatr Med Assoc ; 111(4)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478536

RESUMO

The Bosworth ankle fracture-dislocation is a rare injury and is often irreducible because of an entrapped proximal fragment of the fibula behind the posterior tibial tubercle. Repeated closed reduction or delayed open reduction may result in several complications. Thus, early open reduction and internal fixation enable a better outcome by minimizing soft-tissue damage. We report on a 27-year-old man who underwent open reduction and internal fixation after multiple attempts at failed closed reduction, complicated by severe soft-tissue swelling, rhabdomyolysis, and delayed peroneal nerve palsy around the ankle.


Assuntos
Fraturas do Tornozelo , Fratura-Luxação , Neuropatias Fibulares , Adulto , Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo , Fíbula/cirurgia , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas , Humanos , Masculino , Neuropatias Fibulares/diagnóstico , Neuropatias Fibulares/etiologia
2.
Lakartidningen ; 1182021 Aug 24.
Artigo em Sueco | MEDLINE | ID: mdl-34498242

RESUMO

Foot drop (FD) can be caused by a variety of diseases and injuries. FD leads to walking difficulties and reduced balance which also can lead to a higher risk of falling. Patient with a stroke often have an equinovarus deformity of the foot together with the DF. There is a need to optimize and standardize the treatment for patients with FD across different medical specialities. Surgical interventions, with goals of producing a balanced functional foot, have been shown to improve the function and quality of life and decrease the use of braces and walking aids in patients with FD after a CVI. In Sweden data regarding FD surgery is collected in the National Quality Registry for Foot and Ankle Surgery (Riksfot), but there is also an ongoing multicentre study, investigating the patient-reported and functional results of surgery due to FD caused by a CVI.


Assuntos
Pé Torto Equinovaro , Procedimentos Ortopédicos , Neuropatias Fibulares , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Pé Torto Equinovaro/cirurgia , Humanos , Estudos Multicêntricos como Assunto , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Caminhada
3.
Ann Plast Surg ; 87(3): 316-323, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397520

RESUMO

BACKGROUND: Neurolysis techniques have been adapted for decompression of peripheral nerves in multiple locations, including the common peroneal nerve (CPN) at the fibular neck. The aim of this study was to conduct a systematic review and meta-analysis to summarize the clinical outcomes of neurolysis for the management of peroneal nerve palsy (PNP). METHODS: Preferred Reporting Systems for Systematic Reviews and Meta-Analyses guidelines were followed for this meta-analysis. Four databases were queried, and randomized clinical trials, cohort studies, case-control studies, and case series with n > 10 published in English that evaluated clinical outcomes of neurolysis for the treatment of PNP and foot drop were included. Two reviewers completed screening and data extraction. Methodological quality was evaluated using the Newcastle-Ottawa Scale. RESULTS: A total of 493 articles were identified through literature search. Title and abstract screening identified 39 studies for full-text screening. Ten articles met the inclusion criteria for qualitative analysis, and 8 had complete data for meta-analysis.Overall, there were 368 patients (370 nerves) who had neurolysis of the CPN for PNP, of which 59.2% (n = 218) were men and 40.8% (n = 150) were women. The mean age of the patients was 47.1 years (SD, 10.0 years), mean time to surgery was 9.65 months (SD, 6.3 months), and mean follow-up time was 28 months (SD, 14.0 months). The median preoperative Medical Research Council (MRC) score was 1 (IQR 0, 3), with 42.2% (n = 156) having MRC score of 0. The median postoperative MRC score was 5 (IQR 4, 5), with 53.9% (n = 199) having MRC score of 5. Complications of neurolysis of the peroneal nerve for treatment of PNP included postoperative infection (0.54%, n = 2), wound dehiscence (0.27%, n = 1), hematoma (0.54%, n = 2), bleeding (0.27%, n = 1), relapse of PNP (0.27%, n = 1), and 1 case of mortality due to sepsis. CONCLUSIONS: Our meta-analysis shows that neurolysis of the CPN is safe and improves ankle dorsiflexion strength in patients with PNP. Future studies should use a standardized method of measuring sensory outcomes, and studies of higher levels of evidence are needed to better assess the clinical outcomes of neurolysis for treatment of PNP.


Assuntos
Neuropatias Fibulares , Feminino , Fíbula , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Paralisia , Nervo Fibular/cirurgia , Neuropatias Fibulares/cirurgia
5.
Muscle Nerve ; 64(4): 494-499, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34197644

RESUMO

INTRODUCTION/AIMS: Isolated injuries to the lateral cutaneous nerve of the calf (LCNC) branch of the common peroneal nerve can cause obscure chronic posterolateral knee and upper calf pain and sensory symptoms. Routine examination and electrodiagnostic testing do not detect them because the LCNC has no motor distribution and it is not interrogated by the typical peroneal nerve conduction study. There are only about 10 prior cases, thus scant physician awareness, so most LCNC injuries remain misdiagnosed or undiagnosed, hindering care. METHODS: We extracted pertinent records from seven patients with unexplained posterolateral knee/calf pain, six labeled as complex regional pain syndrome, to investigate for mononeuropathies. Patients were asked to outline their skin area with abnormal responses to pin self-examination independently. Three underwent an LCNC-specific electrodiagnostic study, and two had skin-biopsy epidermal innervation measured. Cadaver dissection of the posterior knee nerves helped identify potential entrapment sites. RESULTS: Initiating events included knee surgery (three), bracing (one), extensive kneeling (one), and other knee trauma. All pin-outlines included the published LCNC neurotome. One oftwo LCNC-specific electrodiagnostic studies revealed unilaterally absent potentials. Longitudinal, controlled skin biopsies documented profound LCNC-neurotome denervation then re-innervation contemporaneous with symptom recovery. Cadaver dissection identified the LCNC traversing through the dense fascia of the proximolateral gastrocnemius muscle insertion. DISCUSSION: Isolated LCNC mononeuropathy can cause unexplained posterolateral knee/calf pain syndromes. This series characterizes presentations and supports patient pin-mappings as a sensitive, globally available, low-cost diagnostic aid. Improved recognition may facilitate more rapid, accurate diagnosis and, thus, optimize management and improve outcomes.


Assuntos
Perna (Membro)/inervação , Perna (Membro)/fisiopatologia , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Neuropatias Fibulares/diagnóstico , Neuropatias Fibulares/fisiopatologia , Adulto , Idoso , Eletrodiagnóstico/métodos , Feminino , Humanos , Masculino , Nervo Fibular/patologia , Nervo Fibular/fisiopatologia
6.
Orthopedics ; 44(4): e556-e562, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34292814

RESUMO

Common peroneal nerve palsy (CPNP) after total knee arthroplasty has a reported incidence of 0.3% to 4% and can lead to foot drop, equinovarus deformity, and marked disability if not resolved. Patients typically present in the early postoperative period with weakness or inability to dorsiflex the ankle and decreased sensation of the dorsum of the foot. The authors report their experience, technique, and outcomes of acute peroneal decompression within the first 90 days postoperatively for 5 patients with this unique complication. Preoperatively, all patients had valgus deformity with intact dorsiflexion and sensation of the foot. The diagnosis of CPNP was made on postoperative day 0 or 1 in all cases. After diagnosis, patients were offered acute peroneal decompression and returned to the operating room electively. The surgical technique for dissection, release, and decompression of the nerve is described. At an average follow-up of 12 weeks (range, 6-16 weeks), all patients showed return of motor and sensory function, as tested by ankle dorsiflexion and dorsal foot sensation, with average motor strength of 4.6 of 5.3. Acute decompression of acute CPNP after total knee arthroplasty is a prudent treatment option that provides good functional results and rapid recovery. [Orthopedics. 2021;44(4):e556-e562.].


Assuntos
Artroplastia do Joelho , Artroplastia do Joelho/efeitos adversos , Descompressão , Humanos , Joelho , Nervo Fibular/cirurgia , Neuropatias Fibulares/diagnóstico , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/cirurgia
7.
J Clin Neurosci ; 90: 36-38, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275576

RESUMO

Ischaemic neuropathy is a rare phenomenon given the rich arterial collateral supply afforded to peripheral nerves by the vasa nervorum. We report an unusual case of unilateral foot drop secondary to long-segment popliteal artery occlusion. Without expedient vessel imaging and revascularisation of the occluded artery, this reversible cause of neurological deficit would likely have resulted in a poor functional outcome for our patient.


Assuntos
Neuropatias Fibulares/etiologia , Artéria Poplítea/patologia , Doenças Vasculares/complicações , Humanos , Isquemia/complicações , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Neuropatias Fibulares/patologia , Artéria Poplítea/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
10.
J Int Med Res ; 49(5): 3000605211005954, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34024183

RESUMO

There are limited treatment options for patients with foot drop and associated lower back and/or leg pain. We present a case series of three patients who received permanent implantation of 10 kHz spinal cord stimulation (10 kHz SCS) devices. Following treatment, all patients reported sustained improvements in lower back and leg pain, foot mechanics and function which resulted in increased mobility and cessation of opioid use for pain management. Patients were followed up for approximately four years. Treatment with 10 kHz SCS may be a promising alternative to other interventional procedures commonly used for these patients.


Assuntos
Dor Crônica , Neuropatias Fibulares , Estimulação da Medula Espinal , Humanos , Perna (Membro) , Manejo da Dor , Medula Espinal , Resultado do Tratamento
12.
Clin Podiatr Med Surg ; 38(3): 427-443, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34053653

RESUMO

Management of the cavus foot is a difficult task for the foot and ankle surgeon. Tendon transfers have been a longstanding accepted treatment for the flexible cavus foot. Performing tendon transfers requires an in-depth understanding of the patient's medical history, factors leading to the development of deformity, as well as the deforming forces contributing to the deformity. Evaluation of the patient for rigid, progressive, and/or spastic deformities is critical to avoid postoperative complications. Educating the patient on postoperative rehabilitation, potential complications, and postoperative expectations is essential to ensure appropriate surgical outcomes.


Assuntos
Pé Cavo/cirurgia , Transferência Tendinosa/métodos , Algoritmos , Humanos , Espasticidade Muscular/complicações , Neuropatias Fibulares/complicações , Exame Físico , Tendões/cirurgia
13.
Neurology ; 97(2): e156-e165, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-33947785

RESUMO

OBJECTIVE: The primary objective of this study was to evaluate the correlation of large mitochondrial DNA (mtDNA) deletions in skin samples of people with HIV (PWH) with measures of neuropathy and prior exposure to therapy. We hypothesized that deletions would be associated with neuropathy. As secondary objectives, we determined the correlation of deletion burden with demographic data and neuropathy measures. METHODS: In this retrospective cohort study, we measured the accumulation of large mtDNA deletions in skin biopsies from PWH recruited as part of the AIDS Clinical Trials Group (ACTG). Our cohort includes individuals with and without sensory neuropathy, as well as individuals with normal or abnormal skin biopsies. Skin biopsies, sural and peroneal nerve conduction studies, total neuropathy score, and deletion burden scores were measured, along with baseline demographic data such as age, CD4+ cell count, viral counts, and prior nucleoside reverse transcriptase inhibitor exposures. RESULTS: Sixty-seven PWH were enrolled in the study. The mean age of the cohort (n = 67) was 44 years (SD 6.8, range 32-65 years), and 9 participants were female. The mean CD4+ T-cell count was 168 cells/mm3 (SD 97 cells/mm3, range 1-416 cells/mm3) and mean viral load was 51,129 copies/mL (SD 114,586 copies/mL, range 147-657,775 copies/mL). We determined that there was a correlation between the total mtDNA deletion and intraepidermal nerve fiber density (IENFD) (r = -0.344, p = 0.04) and sural nerve amplitude (r = -0.359, p = 0.004). CONCLUSIONS: Both IENFD and sural nerve amplitude statistically correlate with mitochondrial mutation burden in PWH, specifically in those with HIV-associated sensory neuropathy as assessed by skin biopsy.


Assuntos
DNA Mitocondrial/genética , Infecções por HIV/genética , Mutação , Doenças do Sistema Nervoso Periférico/genética , Neuropatias Fibulares/genética , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/fisiopatologia , Neuropatias Fibulares/fisiopatologia , Estudos Retrospectivos , Pele/patologia , Pele/fisiopatologia , Nervo Sural/fisiopatologia
14.
Zhonghua Shao Shang Za Zhi ; 37(6): 562-567, 2021 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-33894699

RESUMO

Objective: To explore the effects of wedge-shaped heel pad in the treatment of foot drop deformity in extremely severe burn patients. Methods: A retrospective cohort study method was conducted. From March 2015 to July 2016, 33 patients with foot drop deformity caused by extremely severe burn scar who met the inclusion criteria were admitted to the Department of Burn Rehabilitation of Kunshan Rehabilitation Hospital, including 18 males and 15 females, aged (38±9) years. Patients received comprehensive post-burn rehabilitation treatment after admission, and the wedge-shaped heel pad with appropriate height was placed under the patients' insole, according to the degree of the foot drop deformity in patients. Standing, squatting, and walking exercises were performed after putting on shoes with wedge-shaped heel pad. Before and immediately after the first treatment (hereinafter referred to as before and immediately after treatment), and in 1 month after treatment with wedge-shaped heel pad, the Simple Balance Scale was used to evaluate the standing balance ability of patients. In 1, 3, and 12 months after treatment, active ranges of motion (AROMs) of bilateral ankle joint dorsiflexion and knee joint flexion were measured with joint motion range measuring ruler, the shortest distance between buttocks of patients and the ground when squatting and walking distance in 1 min of patients were measured with measuring tape, and the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of activity of daily living (ADL) in patients were evaluated with modified Barthel index. Data were statistically analyzed with Friedman test, Wilcoxon rank sum test, unequal interval analysis of variance for repeated measurement, and Bonferroni correction. Results: Immediately after treatment, the standing balance ability of patients was 2.0 (1.0, 2.0) levels, which was significantly higher than 1.0 (0, 1.0) level before treatment (Z=-5.568, P<0.01); in 1 month after treatment, the standing balance ability of patients was 3.0 (2.5, 3.0) levels, which was significantly higher than that immediately after treatment (Z=-5.303, P<0.01). In 3 and 12 months after treatment, AROMs of the left and right ankle joint dorsiflexion and the left and right knee joint flexion in patients were significantly increased compared with those in 1 month after treatment (Z=-4.860, -4.836, -4.965, -4.909, -5.037, -5.025, -5.020, -4.942, P<0.01); in 12 months after treatment, AROMs of the left and right ankle joint dorsiflexion and knee joint flexion in patients were significantly increased compared with those in 3 months after treatment (Z=-5.062, -4.962, -5.017, -4.944, P<0.01). In 3 and 12 months after treatment, the shortest distances between buttocks of patients and the ground were (67±11) and (57±11) cm, which were significantly shorter than (72±11) cm in 1 month after treatment (P<0.01), respectively; in 12 months after treatment, the shortest distance between buttocks of patients and the ground was significantly shorter than that in 3 months after treatment (P<0.01). In 3 and 12 months after treatment, the walking distances within 1 min of patients were significantly longer than that in 1 month after treatment (Z=-5.043, -5.016, P<0.01); in 12 months after treatment, the walking distance within 1 min of patients was significantly longer than that in 3 months after treatment (Z=-5.025, P<0.01). In 3 and 12 months after treatment, the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ADL in patients were significantly increased compared with those in 1 month after treatment (Z=-4.472, -4.025, -4.707, -4.565, -3.994, -4.777, P<0.01); in 12 months after treatment, the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ADL in patients were significantly increased compared with those in 1 month after treatment (Z=-3.827, -3.358, -3.557, P<0.01). Conclusions: After using the wedge-shaped heel pad, the standing balance ability, ankle joint dorsiflexion range of motion, walking ability are significantly improved, and the independent levels of movement items in ADL are significantly increased in extremely severe burn patients with foot drop deformity.


Assuntos
Calcanhar , Neuropatias Fibulares , Articulação do Tornozelo , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Caminhada
15.
Muscle Nerve ; 64(1): 59-63, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33876440

RESUMO

INTRODUCTION/AIMS: Foot drop is common in chronic inflammatory demyelinating polyneuropathy (CIDP), but its prognosis is uncertain. METHODS: CIDP patients with less than anti-gravity strength (<3/5 power) of ankle dorsiflexion (ADF) on Medical Research Council manual muscle testing on presentation at our center were identified by retrospective review. After initiation of standard treatment, ADF power was serially tabulated, and predictors of recovery were determined. RESULTS: Of the 27 identified patients, ADF power at presentation was <3/5 in 48/54 legs. At 1 y after treatment, ADF power improved to >/= 3/5 in 17/27 patients in one (N = 6) or both (N = 11) legs. On multi-variate analysis, predictors of recovery of ADF power were tibialis anterior compound muscle action potential amplitude at presentation, shorter disease duration, and female gender. DISCUSSION: Foot drop improves to anti-gravity power in most treated CIDP patients depending in part on the severity of fibular motor axon loss at onset of treatment.


Assuntos
Neuropatias Fibulares/diagnóstico , Neuropatias Fibulares/fisiopatologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Eletrodiagnóstico/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neuropatias Fibulares/etiologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/complicações , Estudos Retrospectivos , Adulto Jovem
16.
Clin Geriatr Med ; 37(2): 241-252, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33858607

RESUMO

Compression neuropathies, also known as entrapment neuropathies, are common neurologic conditions seen in medicine. These often are due to mechanical injury, either compression or stretch of the affected nerve, and initially result in focal demyelinating changes. If left untreated, secondary axonal injury and lasting disability can result. Patients typically present with pain, sensory changes, and potentially weakness in the distribution of the affected nerve; therefore, a basic knowledge of neuromuscular anatomy is necessary to identify these conditions. Initial treatment of mild to moderate cases often is conservative. In severe cases or those refractory to conservative therapy, surgery should be considered.


Assuntos
Artrogripose , Neuropatia Hereditária Motora e Sensorial , Síndromes de Compressão Nervosa , Idoso , Síndrome do Túnel Carpal , Síndrome do Túnel Ulnar , Humanos , Dor , Neuropatias Fibulares
18.
Ann Plast Surg ; 86(6): 674-677, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33833176

RESUMO

ABSTRACT: Peroneal intraneural ganglia are rare, and their management is controversial. Presently, the accepted treatment of intraneural ganglia is decompression and ligation of the articular nerve branch. Although this treatment prevents recurrence of the ganglia, the resultant motor deficit of foot drop in the case of intraneural peroneal ganglia is unsatisfying. Foot drop is classically treated with splinting or tendon transfers to the foot. We have recently published a case report of a peroneal intraneural ganglion treated by transferring a motor nerve branch of flexor hallucis longus into a nerve branch of tibialis anterior muscle in addition to articular nerve branch ligation and decompression of the intraneural ganglion to restore the patient's ability to dorsiflex. We have since performed this procedure on 4 additional patients with appropriate follow-up. Depending on the initial onset of foot drop and time to surgery, nerve transfer from flexor hallucis longus to anterior tibialis nerve branch may be considered as an adjunct to decompression and articular nerve branch ligation for the treatment of symptomatic peroneal intraneural ganglion.


Assuntos
Cistos Glanglionares , Transferência de Nervo , Neuropatias Fibulares , Gânglios , Cistos Glanglionares/cirurgia , Humanos , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia , Nervo Fibular/cirurgia , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/cirurgia
19.
Medicine (Baltimore) ; 100(17): e25698, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907149

RESUMO

RATIONALE: Peripheral nerve injury related to vascular complications associated with extracorporeal membrane oxygenation (ECMO) is perhaps underappreciated. Compared to the well-described central nervous system complications of ECMO, brachial plexopathy and lumbosacral plexopathy have rarely been reported. We report this case to heighten awareness of lumbosacral plexus injury due to pelvic hematoma formation after ECMO. PATIENT CONCERNS: A 53-year-old woman developed a large pelvic hematoma with significant mass effect on intrapelvic structures after receiving lifesaving venoarterial ECMO for cardiogenic shock following a cardiac arrest. During her hospital course, she developed bilateral foot drop that was attributed to critical illness. Her lack of neurological recovery after 6 months prompted referral to neuromuscular medicine for consultation. DIAGNOSIS: The patient was retrospectively diagnosed with bilateral lumbosacral plexopathy due to the large pelvic hematoma. INTERVENTION: Electromyography/nerve conduction study (EMG/NCS) obtained at the time of referral to neuromuscular medicine localized her neurological deficits to the bilateral lumbosacral plexus and demonstrated no volitional motor unit action potentials in her lower leg muscles. OUTCOMES: The patient had minimal recovery of strength at the level of the ankles but was ambulatory with solid ankle-foot orthoses due to spared proximal lower extremity strength. Unfortunately, the absence of any volitionally activated motor unit action potentials in her lower leg muscles on EMG performed 6 months after the initial injury was a poor prognostic indicator for successful reinnervation and future neurological recovery. LESSONS: Neurological deficits occurring during the course of administration of ECMO require accurate localization. Neurology consultation and/or EMG/NCS may be useful if localization is not clear. Lesions localizing to the lumbosacral plexus should prompt radiographic evaluation with computed tomography of the abdomen and pelvis. Hemostasis of a retroperitoneal hematoma may be achieved with embolization. However, if neurological deficits do not improve, surgical consultation for hematoma evacuation may be warranted.


Assuntos
Oxigenação por Membrana Extracorpórea , Parada Cardíaca/cirurgia , Hematoma , Plexo Lombossacral/lesões , Pelve , Traumatismos dos Nervos Periféricos , Neuropatias Fibulares , Estado Terminal/terapia , Eletromiografia/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Parada Cardíaca/etiologia , Hematoma/complicações , Hematoma/fisiopatologia , Humanos , Pessoa de Meia-Idade , Condução Nervosa , Pelve/irrigação sanguínea , Pelve/patologia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Neuropatias Fibulares/diagnóstico , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Choque Cardiogênico/complicações
20.
J Int Med Res ; 49(3): 300060521998208, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33784844

RESUMO

OBJECTIVE: Outcome differences between selective abobotulinumtoxin type A (aboBoNT/A) injections into the soleus (SOL) and gastrocnemius (GAS) muscles were investigated in post-stroke patients with spastic foot drop. METHODS: A monocentric observational study was conducted at a university hospital botulinum toxin clinic including 24 free-walking adult, botulinum toxin-naive patients with post-stroke hemiplegia. AboBoNT/A (800 MU in 4 mL saline) was injected into the SOL or GAS muscle under electromyographic guidance. After 30 days post-injection, the effect of aboBoNT/A injection was assessed by patients. The treating physician scored spasticity and measured angles at the knee and ankle joint and gait speed. RESULTS: After 30 days, significant improvements of subjective and objective outcome measures were observed. No significant difference was observed in the modified Ashworth scale, gait speed, ankle and knee angles, or their angle combinations between the SOL and GAS groups. Tendencies toward greater active range of motion (RoM) improvement in the SOL group and passive RoM improvement in the GAS group were observed. The difference between active and passive ankle extensions plus knee flexions was significantly larger in the SOL group. CONCLUSIONS: Selective 800 MU aboBoNT/A injections into the SOL or GAS muscle were effective but without relevant clinical difference.


Assuntos
Toxinas Botulínicas Tipo A , Toxinas Botulínicas , Fármacos Neuromusculares , Neuropatias Fibulares , Acidente Vascular Cerebral , Adulto , Toxinas Botulínicas/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Humanos , Injeções Intramusculares , Espasticidade Muscular/tratamento farmacológico , Músculo Esquelético , Fármacos Neuromusculares/uso terapêutico , Amplitude de Movimento Articular , Acidente Vascular Cerebral/tratamento farmacológico , Resultado do Tratamento
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