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1.
World Neurosurg ; 135: 171-172, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31870821

RESUMO

Benign peripheral nerve sheath tumors are well known to neurosurgeons and a relatively commonly seen pathology. Intraneural ganglion cysts, once thought to be rare and poorly understood, are increasingly recognized in clinical practice and better understood based on the advent of high-resolution imaging. There are few reports of different nerve lesions in the same anatomic location appearing concurrently. Herein we present a patient with 2 distinct pathologies explaining 2 distinct symptom complexes-sensory changes in the superficial peroneal distribution (from a schwannoma of the superficial peroneal nerve) and mild motor weakness in the tibialis anterior (from an intraneural ganglion cyst arising from the superior tibiofibular joint affecting this motor branch). Recognition of the 2 pathologies allowed targeted surgical approaches, which led to resolution of the symptoms.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Idoso , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Imagem por Ressonância Magnética , Neurilemoma/complicações , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/cirurgia , Neuropatias Fibulares/complicações , Neuropatias Fibulares/cirurgia
2.
World Neurosurg ; 122: 518-521, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30266693

RESUMO

BACKGROUND: Foot drop is defined as inability to dorsiflex the foot at the ankle joint. Although a well-documented entity with a myriad of causes along the neuraxis, starting from parasagittal intracranial pathologies to peripheral nerve lesions, treatment has always remained uniform (i.e., elimination of the causative pathology. A conservative approach with complete recovery has never been documented with video evidence). CASE DESCRIPTION: A 74-year-old female presented with dorsiflexion weakness of the left ankle secondary to a prolapsed disk at the L4-5 level. The duration of the foot drop was short (3 days). She was planned for surgery but kept under close observation considering the consistent recovery of the symptoms. To our astonishment she had rapid pain relief in the next 5 days. Motor power improved over 3 weeks, and she had complete recovery in 4 weeks. Video recordings were made to document the improved power at both stages. CONCLUSIONS: Spontaneous recovery of complete foot drop is possible, and there is a role for the conservative management even with dense neurologic deficit in cases of lumbar disk herniation. Careful repeated examination is the key for conservative management before jumping to aggressive surgical intervention.


Assuntos
Traumatismos do Pé/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Neuropatias Fibulares/cirurgia , Estenose Espinal/cirurgia , Idoso , Articulação do Tornozelo/cirurgia , Feminino , Traumatismos do Pé/diagnóstico por imagem , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Neuropatias Fibulares/complicações , Neuropatias Fibulares/diagnóstico , Recuperação de Função Fisiológica/fisiologia
4.
Neurol Med Chir (Tokyo) ; 58(7): 320-325, 2018 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-29925720

RESUMO

Superficial peroneal nerve (S-PN) entrapment neuropathy (S-PNEN) is comparatively rare and may be an elusive clinical entity. There is yet no established surgical procedure to treat idiopathic S-PNEN. We report our surgical treatment and clinical outcomes. We surgically treated 5 patients (6 sites) with S-PNEN. The 2 men and 3 women ranged in age from 67 to 91 years; one patient presented with bilateral leg involvement. Mean post-operative follow-up was 25.3 months. We recorded their symptoms before- and at the latest follow-up visit after surgery using a Numerical Rating Scale and the Japan Orthopedic Association score to evaluate the affected area. We microsurgically decompressed the affected S-PN under local anesthesia without a proximal tourniquet. We made a linear skin incision along the S-PN and performed wide S-PN decompression from its insertion point at the peroneal tunnel to the peroneus longus muscle (PLM) to the point where the S-PN penetrated the deep fascia. One patient who had undergone decompression in the area of a Tinel-like sign at the initial surgery suffered symptom recurrence and required re-operation 4 months later. We performed additional extensive decompression to address several sites with a Tinel-like sign. All 5 operated patients reported symptom improvement. In patients with idiopathic S-PNEN, neurolysis under local anesthesia may be curative. Decompression involving only the Tinel area may not be sufficient and it may be necessary to include the area from the PLM to the peroneal nerve exit point along the S-PN.


Assuntos
Descompressão Cirúrgica , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/cirurgia , Neuropatias Fibulares/diagnóstico , Neuropatias Fibulares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Síndromes de Compressão Nervosa/complicações , Neuropatias Fibulares/complicações , Estudos Retrospectivos , Resultado do Tratamento
5.
J Back Musculoskelet Rehabil ; 31(4): 667-670, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29562484

RESUMO

BACKGROUND: Nerve injury due to a movable cystic mass during knee motion is a rare neuropathy, which can be diagnosed precisely using a dynamic ultrasonogram. OBJECTIVE: To present a case with foot drop and common peroneal neuropathy that involved a movable cystic mass during knee flexion adjacent to the proximal tibiofibular joint. METHODS: Case report. RESULTS: A 47-year-old female was referred to our institute for a right foot drop. Common peroneal nerve (CPN) injury was confirmed by an electrophysiologic study. Upon a dynamic ultrasonographic study during knee flexion, a cystic mass was found that was not scanned on the static images. The mass displaced the lateral head of the gastrocnemius muscle and CPN. A cystic mass that was adjacent to the proximal tibiofibular joint was confirmed by magnetic resonance imaging. CONCLUSION: Ultrasonography is a convenient first-line diagnostic method of peripheral nerve disorder by virtue of its higher spatial resolution, cost-effectiveness, and prompt diagnosis. The real-time and dynamic scanning attributes are the discriminative merits of this imaging tool. This case report suggests that CPN compression occurred due to a movable cystic mass during knee flexion. Dynamic ultrasonographic evaluations could be helpful to diagnose pathologic musculoskeletal conditions.


Assuntos
Cistos/complicações , Articulação do Joelho/patologia , Músculo Esquelético/fisiopatologia , Neuropatias Fibulares/complicações , Cistos/diagnóstico , Cistos/fisiopatologia , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico , Neuropatias Fibulares/fisiopatologia
7.
World Neurosurg ; 111: 307-310, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29309980

RESUMO

BACKGROUND: Peroneal intraneural ganglion cysts (IGCs) are nonneoplastic lesions. They are responsible for a small number of footdrop cases, which occur after additional nerve damage. The earliest patient symptom related to IGCs is knee pain. CASE DESCRIPTION: A 17-year-old boy developed pain in the left knee, which progressively worsened over 14 months. He did not seek any medical assistance during this time. The patient subsequently was involved in a bicycle accident, and 3 months later he was unable to raise his left foot and was referred to our clinic for footdrop. Surgery was performed, but the weakness persisted. We could not detect any functional reinnervation on electromyography 12 months after surgery. CONCLUSIONS: The most important factors in determining the prognosis of IGCs are the extent of the nerve trauma and the early diagnosis and treatment of the IGC. Detection of almost complete functional denervation on electromyography may indicate that it is too late for surgery.


Assuntos
Artralgia/etiologia , Transtornos Neurológicos da Marcha/etiologia , Cistos Glanglionares/complicações , Neuropatias Fibulares/complicações , Adolescente , Artralgia/diagnóstico por imagem , Artralgia/fisiopatologia , Artralgia/cirurgia , Diagnóstico Tardio , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/cirurgia , Cistos Glanglionares/diagnóstico por imagem , Cistos Glanglionares/fisiopatologia , Cistos Glanglionares/cirurgia , Humanos , Joelho/diagnóstico por imagem , Joelho/patologia , Traumatismos do Joelho/complicações , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/cirurgia , Masculino , Neuropatias Fibulares/diagnóstico por imagem , Neuropatias Fibulares/fisiopatologia , Neuropatias Fibulares/cirurgia , Recidiva
8.
Occup Med (Lond) ; 67(1): 75-77, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27694375

RESUMO

Compression neuropathy of the common peroneal nerve (CPN) at the fibula head is a common condition, but it has not attracted attention in working environments. Here, we report a 38-year-old sewer pipe worker who presented with bilateral CPN palsy following 6h working with a squatting posture in a narrow sewer pipe. During the work, he could not stretch his legs sufficiently because of the confined space. His symptoms deteriorated with repetition of the same work for 1 week. Motor nerve conduction study showed conduction block at the fibula head of bilateral CPNs, compatible with compression neuropathy at this lesion. Three months after cessation of work requiring the causative posture, his symptoms and neurophysiological abnormalities had resolved completely. Almost all seven of his co-workers presented transiently with similar and milder symptoms, although one showed CPN palsy for 6 months. Prolonged squatting posture in a confined space causes acute compression neuropathy at the fibula head in the CPN. More attention should be paid to 'confined space worker's compression neuropathy'.


Assuntos
Artrogripose/complicações , Neuropatia Hereditária Motora e Sensorial/complicações , Nervo Fibular/fisiopatologia , Postura/fisiologia , Adulto , Artrogripose/diagnóstico , Neuropatia Hereditária Motora e Sensorial/diagnóstico , Humanos , Masculino , Neuropatias Fibulares/complicações , Neuropatias Fibulares/diagnóstico , Neuropatia Tibial/complicações , Neuropatia Tibial/diagnóstico
9.
Acta Chir Orthop Traumatol Cech ; 84(6): 466-468, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29351531

RESUMO

For a foot drop resulting from peroneal nerve palsy transferring the tibialis posterior tendon is a standard surgical treatment. The situation of foot drop with no functioning tibialis posterior presents a challenge. We describe a case of successful flexor hallucis longus transfer in such a case. Key words: foot drop, flexor hallucis longus, peroneal nerve palsy; tendon transfer.


Assuntos
Deformidades Adquiridas do Pé/cirurgia , Neuropatias Fibulares/cirurgia , Transferência Tendinosa/métodos , Deformidades Adquiridas do Pé/etiologia , Humanos , Neuropatias Fibulares/complicações
10.
Foot Ankle Spec ; 10(4): 372-376, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27920102

RESUMO

Neurogenic contracture often results in spastic, nonreducible equinovarus deformity. Rigid contracture leads to pain, instability, and bracing difficulties. This case report details the utilization of the modified Lambrinudi triple arthrodesis intended to create a plantigrade, functional limb that is amenable to an extremity brace in a case of an acquired neurologic clubfoot. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case Report.


Assuntos
Artrodese/métodos , Pé Torto Equinovaro/cirurgia , Articulações Tarsianas/cirurgia , Acidentes de Trânsito , Adolescente , Pé Torto Equinovaro/etiologia , Feminino , Humanos , Neuropatias Fibulares/complicações , Neuropatia Tibial/complicações
11.
Foot Ankle Int ; 37(10): 1098-1105, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27340257

RESUMO

BACKGROUND: Localized nerve pain in the foot and ankle can be a chronic source of disability after trauma and has been identified as the most common complication following operative interventions in the foot and ankle. The superficial location of the injured nerves and lack of suitable tissue for nerve implantation make this pain refractory to conventional methods of neuroma management. We describe a novel strategy for management using processed nerve allografts to bridge nerve gaps created by resection of both end neuromas and neuromas-in-continuity. METHODS: A retrospective review of a prospectively maintained database was performed of all patients who received a processed nerve allograft for treatment of painful neuromas in the foot and ankle between May 2010 and June 2015. Patient demographic and operative information was obtained, as well as preoperative and postoperative pain assessments using a conventional ordinal scale and PROMIS (Patient Reported Outcomes Measurement Information System) Pain Behavior and Pain Interference assessments. Twenty-two patients were identified, with postoperative pain assessments occurring at a mean of 15.5 months after surgery. RESULTS: Neuromas of the sural and superficial peroneal nerves were the most common diagnoses, with 3-cm nerve allografts being used as the interposition graft in the majority of cases. Eight patients had end neuromas and 18 patients had neuromas in continuity. Analysis of paired data demonstrated a mean ordinal pain score decrease of 2.6, with 24 and 31 percentage-point decreases in PROMIS Pain Behavior and Pain Interference measures, respectively. All changes were significant (P < .002). CONCLUSION: The painful sequelae of superficial nerve injuries in the foot and ankle was significantly improved with complete excision of the involved nerve segment followed by bridging of the resulting nerve gap with a processed nerve allograft. This approach limits surgery to the site of injury and reconstitutes the peripheral nerve anatomy. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Assuntos
Pé/inervação , Neuralgia/cirurgia , Neuroma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/cirurgia , Neuropatias Fibulares/cirurgia , Adolescente , Adulto , Idoso , Aloenxertos , Tornozelo/inervação , Dor Crônica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Neuroma/complicações , Neoplasias do Sistema Nervoso Periférico/complicações , Nervo Fibular/lesões , Neuropatias Fibulares/complicações , Estudos Retrospectivos
14.
Neurosurg Focus ; 39(3): E8, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26323826

RESUMO

OBJECT Knee dislocations are often accompanied by stretch injuries to the common peroneal nerve (CPN). A small subset of these injuries also affect the tibial nerve. The mechanism of this combined pattern could be a single longitudinal stretch injury of the CPN extending to the sciatic bifurcation (and tibial division) or separate injuries of both the CPN and tibial nerve, either at the level of the tibiofemoral joint or distally at the soleal sling and fibular neck. The authors reviewed cases involving patients with knee dislocations with CPN and tibial nerve injuries to determine the localization of the combined injury and correlation between degree of MRI appearance and clinical severity of nerve injury. METHODS Three groups of cases were reviewed. Group 1 consisted of knee dislocations with clinical evidence of nerve injury (n = 28, including 19 cases of complete CPN injury); Group 2 consisted of knee dislocations without clinical evidence of nerve injury (n = 19); and Group 3 consisted of cases of minor knee trauma but without knee dislocation (n = 14). All patients had an MRI study of the knee performed within 3 months of injury. MRI appearance of tibial and common peroneal nerve injury was scored by 2 independent radiologists in 3 zones (Zone I, sciatic bifurcation; Zone II, knee joint; and Zone III, soleal sling and fibular neck) on a severity scale of 1-4. Injury signal was scored as diffuse or focal for each nerve in each of the 3 zones. A clinical score was also calculated based on Medical Research Council scores for strength in the tibial and peroneal nerve distributions, combined with electrophysiological data, when available, and correlated with the MRI injury score. RESULTS Nearly all of the nerve segments visualized in Groups 1 and 2 demonstrated some degree of injury on MRI (95%), compared with 12% of nerve segments in Group 3. MRI nerve injury scores were significantly more severe in Group 1 relative to Group 2 (2.06 vs 1.24, p < 0.001) and Group 2 relative to Group 3 (1.24 vs 0.13, p < 0.001). In both groups of patients with knee dislocations (Groups 1 and 2), the MRI nerve injury score was significantly higher for CPN than tibial nerve (2.72 vs 1.40 for Group 1, p < 0.001; 1.39 vs 1.09 for Group 2, p < 0.05). The clinical injury score had a significantly strong correlation with the MRI injury score for the CPN (r = 0.75, p < 0.001), but not for the tibial nerve (r = 0.07, p = 0.83). CONCLUSIONS MRI is highly sensitive in detecting subclinical nerve injury. In knee dislocation, clinical tibial nerve injury is always associated with simultaneous CPN injury, but tibial nerve function is never worse than peroneal nerve function. The point of maximum injury can occur in any of 3 zones.


Assuntos
Luxação do Joelho/complicações , Neuropatias Fibulares/etiologia , Neuropatia Tibial/etiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuropatias Fibulares/complicações , Neuropatia Tibial/complicações , Adulto Jovem
16.
J Ultrasound Med ; 34(4): 705-11, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25792587

RESUMO

The common peroneal nerve arises from the sciatic nerve and is subject to a variety of abnormalities. Although diagnosis is often is based on the clinical findings and electrodiagnostic tests, high-resolution sonography has an increasing role in determining the type and location of common peroneal nerve abnormalities and other peripheral nerve disorders. This article reviews the normal sonographic appearance of the common peroneal nerve and the findings in 21 patients with foot drop related to common peroneal neuropathy.


Assuntos
Transtornos Neurológicos da Marcha/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Adulto , Idoso , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neuropatias Fibulares/complicações , Ultrassonografia , Adulto Jovem
17.
J Bodyw Mov Ther ; 18(2): 200-3, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24725786

RESUMO

Peroneal nerve palsy is the most common entrapment neuropathy in the lower extremity, and the presentation of foot drop is a frequent initial manifestation of this disorder. This condition can have a marked influence on the patient's activities of daily living, and is classified as 'Impairment of Body Structure.' Current literature provides little direction to its evaluation and management, and the importance to differentially diagnose the causes of foot drop. Therefore, the purpose of this case report is to describe the application of chiropractic manipulative therapy, for a 14-year-old female with an insidious onset of foot drop.


Assuntos
Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/reabilitação , Manipulação Quiroprática/métodos , Neuropatias Fibulares/complicações , Adolescente , Diagnóstico Diferencial , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Humanos
20.
J Am Acad Orthop Surg ; 21(5): 276-85, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23637146

RESUMO

The adult paralytic foot is a common clinical entity. It has numerous neurologic, systemic, and traumatic causes that result in muscle imbalance and foot deformity. A thorough physical examination and diagnostic work-up, as well as an understanding of the relevant functional anatomy, are essential to proper management. Treatment goals include the establishment of a plantigrade foot, elimination of deforming forces, and, when possible, restoration of active motor control.


Assuntos
Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/cirurgia , Descompressão Cirúrgica , Eletromiografia , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Perna (Membro)/inervação , Músculo Esquelético/patologia , Paraplegia/diagnóstico , Paraplegia/etiologia , Paraplegia/cirurgia , Neuropatias Fibulares/complicações , Exame Físico , Transferência Tendinosa
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