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INTRODUCTION/AIMS: Magnetic resonance imaging (MRI) findings in peroneal neuropathy are not well documented and the prognostic value of imaging remains uncertain. Upper limits of cross-sectional area (CSA) on ultrasound (US) have been established, but uncertainty regarding generalizability remains. We aimed to describe MRI findings of the peroneal nerve in patients and healthy controls and to compare these results to US findings and clinical characteristics. METHODS: We prospectively included patients with foot drop and electrodiagnostically confirmed peroneal neuropathy, and performed clinical follow-up, US and MRI of both peroneal nerves. We compared MRI findings to healthy controls. Two radiologists evaluated MRI features in an exploratory analysis after images were anonymized and randomized. RESULTS: Twenty-two patients and 38 healthy controls were included. Whereas significant increased MRI CSA values were documented in patients (mean CSA 20 mm2 vs. 13 mm2 in healthy controls), intra- and interobserver variability was substantial (variability of, respectively, 7 and 9 mm2 around the mean in 95% of repeated measurements). A pathological T2 hyperintense signal of the nerve was found in 52.6% of patients (50% interobserver agreement). Increased CSA measurements (MRI/US), pathological T2 hyperintensity of the nerve and muscle edema were not predictive for recovery. DISCUSSION: Imaging is recommended in all patients with peroneal neuropathy to exclude compressive intrinsic and extrinsic masses but we do not advise routine MRI for diagnosis or prediction of outcome in patients with peroneal neuropathy due to high observer variability. Further studies should aim at reducing MRI observer variability potentially by semi-automation.
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Imageamento por Ressonância Magnética , Nervo Fibular , Neuropatias Fibulares , Ultrassonografia , Humanos , Neuropatias Fibulares/diagnóstico por imagem , Masculino , Feminino , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Ultrassonografia/métodos , Estudos Prospectivos , Adulto , Idoso , Nervo Fibular/diagnóstico por imagemRESUMO
The association between sleep and pain has been investigated widely. However, inconsistent results from animal studies compared with human data show the need for a validated animal model in the sleep-pain association field. Our study aims to validate common neuropathic pain models as a tool for evaluating the sleep-pain association. Electrodes electroencephalogram (EEG) and electromyogram (EMG) were surgically implanted to measure sleep. The von Frey test was used to measure pain sensitivity. Following the baseline data acquisition, two pain-modelling procedures were performed: sciatic nerve crush injury (SCI) and common peroneal nerve ligation (CPL). Post-injury measurements were performed on days 1, 5, 10, and 15 post-surgery. The results presented decreased paw withdrawal thresholds and reduced NREM sleep duration in both models on the first post-surgery day. In the SCI model, NREM sleep duration was negatively correlated with paw withdrawal thresholds (p = 0.0466), but not in the CPL model. Wake alpha and theta EEG powers were also correlated with the pain threshold. The results confirm that the SCI model shows disturbed sleep patterns associated with increased pain sensitivity, suggesting it is a reliable tool for investigating sleep disturbances associated with neuropathic pain.
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Modelos Animais de Doenças , Eletroencefalografia , Neuralgia , Nervo Isquiático , Transtornos do Sono-Vigília , Animais , Neuralgia/fisiopatologia , Neuralgia/etiologia , Transtornos do Sono-Vigília/fisiopatologia , Transtornos do Sono-Vigília/etiologia , Masculino , Nervo Isquiático/lesões , Nervo Isquiático/fisiopatologia , Ratos , Eletromiografia , Ratos Sprague-Dawley , Limiar da Dor/fisiologia , Compressão Nervosa , Neuropatia Ciática/fisiopatologiaRESUMO
BACKGROUND: Focal entrapment of the common fibular (peroneal) nerve (CFN) is the most common nerve entrapment in the lower extremity. Accurate diagnosis can be difficult due to co-existent pathology such as low back pathology. A 1% lidocaine block of CFN is often used to confirm the local entrapment pathology and demonstrate possibility of pain relief. A surprising, unexpected and temporary strengthening of CFN supplied ankle and foot muscles is occasionally produced, termed the Phoenix sign. Aetiology of this phenomenon has been puzzling, but restoration of neural circulation and nutrition via improved local blood flow has been postulated to be responsible. METHODS: This is a double-blinded, randomized, prospective controlled trial of 20 patients, comparing 2 vasodilating agents and their ability to produce the Phoenix effect. Ultrasound guided infiltration of 0.3 mL 1% lidocaine or papaverine HCl 10 mg/mL was executed adjacent to CFN. Motor strength pre- infiltration and 4 min post-infiltration were measured for anterior compartment muscles utilizing MRC manual motor testing reported on a 0-5 scale. The extensor hallucis longus (EHL) muscle proved to be the most significant. RESULTS: Average motor strength of the EHL improved from 2.2 (+/-0.40) to 4.9 (+/-0.32).) in the lidocaine group. In the papaverine group, pre-infiltration EHL motor strength averaging 2.1 (+/-0.93) improved to 4.4 (+/- 1.01) post-infiltration. Papaverine and lidocaine produced similar statistically significant increases in muscle strength (p = < 0.05). CONCLUSION: There was no difference between small local infiltrations of lidocaine or papaverine in production of increased anterior compartment EHL motor strength. It is most likely that the Phoenix Effect is explained by temporary local improvements in the microcirculation of the CFN vasa nervorum. TRIAL REGISTRATION: NCT06637046 10/10/2024 Retrospectively registered.
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Lidocaína , Bloqueio Nervoso , Papaverina , Recuperação de Função Fisiológica , Vasodilatação , Vasodilatadores , Humanos , Método Duplo-Cego , Lidocaína/administração & dosagem , Lidocaína/farmacologia , Lidocaína/uso terapêutico , Masculino , Bloqueio Nervoso/métodos , Feminino , Pessoa de Meia-Idade , Papaverina/administração & dosagem , Papaverina/farmacologia , Papaverina/uso terapêutico , Estudos Prospectivos , Vasodilatadores/administração & dosagem , Vasodilatadores/farmacologia , Adulto , Vasodilatação/efeitos dos fármacos , Nervo Fibular/efeitos dos fármacos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/farmacologia , Idoso , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/irrigação sanguínea , Força Muscular/efeitos dos fármacos , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/tratamento farmacológico , Resultado do Tratamento , Síndromes de Compressão Nervosa/tratamento farmacológico , Síndromes de Compressão Nervosa/fisiopatologiaRESUMO
Pediatric ankle injuries are common; ankle epiphyseal fractures are also common in children. But isolated distal epiphyseal fibular fractures of the distal fibula are clinically rare. We describe one unusual case of an adolescent with a completely displaced Salter-Harris type II distal fibular epiphyseal fracture. The attempt of closed reduction failed, and the patient required open reduction and internal fixation. The localized periosteum and the superior peroneal retinaculum were avulsed from the distal fibular metaphysis, with the peroneal tendons underneath exposed but no obvious subluxation. To the best of our knowledge, this combination of injuries has not been previously reported.
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Epífises , Fíbula , Fixação Interna de Fraturas , Adolescente , Humanos , Fraturas do Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Epífises/lesões , Epífises/cirurgia , Epífises/diagnóstico por imagem , Fíbula/lesões , Fíbula/cirurgia , Fíbula/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Redução Aberta/métodos , Resultado do TratamentoRESUMO
PURPOSE: The association of peroneal tendon dislocation with peroneal bone morphology and postoperative redislocation rates remains unknown. This study compared the fibula morphology in patients with peroneal tendon dislocation with that in a control population. METHODS: The study enrolled 48 patients who underwent surgery for peroneal tendon dislocation at our institution during between 2018 and 2023. Thirty-five patients with preoperative magnetic resonance imaging of the ankle were defined as Group D and 35 with magnetic resonance imaging of the ankle for other reasons and with similar background data were selected as the control group (Group C). The posterior tilting angle of the fibula, posterolateral angle and posterolateral edge angle were evaluated at the plafond level. The posterior tilting angle, posterolateral angle and retromalleolar bone shape according to the Rosenberg classification (flat, convex, concave) were evaluated at the midpoint between the plafond and the tip. RESULTS: At the plafond level, the posterior tilting, posterolateral and posterolateral edge angles were 57.7 ± 11.1°, 123.8 ± 12.3° and 90.8 ± 13.7°, respectively, in Group D and 64.1 ± 15.4°, 121.1 ± 12.3° and 88.7 ± 12.2°, respectively, in Group C, with no significant differences. No significant between-group differences existed in the posterior tilting and posterolateral angles at the midpoint level. Moreover, no significant differences existed in distribution of the bone geometry according to the Rosenberg classification. CONCLUSION: There were no differences in morphology between patients with peroneal tendon dislocation and controls. This study provides useful information on the indications for primary surgery and whether bony approach is useful for peroneal tendon dislocation. LEVEL OF EVIDENCE: Level IV.
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Fíbula , Luxações Articulares , Imageamento por Ressonância Magnética , Traumatismos dos Tendões , Humanos , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Masculino , Feminino , Adulto , Traumatismos dos Tendões/cirurgia , Traumatismos dos Tendões/diagnóstico por imagem , Luxações Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Pessoa de Meia-Idade , Incidência , Traumatismos do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico por imagem , Estudos Retrospectivos , Estudos de Casos e Controles , Adulto JovemRESUMO
PURPOSE: Injury to the superficial peroneal nerve (SPN) or the sural nerve (SN) is a common complication in subtalar arthroscopy. The purpose of this anatomical study was to evaluate the distance to surrounding subcutaneous nerves in the vicinity of three standard arthroscopic portals for subtalar joint arthroscopy and through actual portal placement for arthroscopic procedures, in order to define anatomical safe zones. METHODS: Forty paired fresh-frozen foot-and-ankle specimens were used. Subtalar arthroscopy using a three-portal technique (anterolateral [AL], posterolateral [PL] and accessory anterolateral [AAL] portals) was performed. After completion of subtalar arthroscopy, the portals were marked, and all surrounding subcutaneous nerves, that is, the branches of the SPN and SN, were dissected. The distance of the nearest nerve at the level of the respective portal was measured and potential injury was recorded. RESULTS: The nearest nerve at the level of the AL portal was the intermediate dorsal cutaneous nerve at a mean of 15.4 ± 5.1 mm medial to the portal. The nearest nerve at the level of the AAL portal was the lateral dorsal cutaneous nerve at a mean of 17.7 ± 4.8 mm, being lateral to the portal. The nearest nerve at the level of the PL portal was the SN at a mean of 6.7 ± 4.7 mm anterior to the portal. Based on the measurements, safe zones were defined. CONCLUSIONS: Placement of the AL and AAL portals in subtalar arthroscopy is saved using standard anatomical landmarks and a thorough surgical technique. At the level of the PL portal, the SN is the most endangered structure in subtalar arthroscopy. Surgeons should be aware of the proximity of the SN to the PL portal and take the utmost care during portal placement and instrument insertion to avoid iatrogenic injury. The risk of nerve damage during portal placement may be reduced when positioning the portals in the defined safe zones. LEVEL OF EVIDENCE: Not applicable.
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PURPOSE: The objective of this study was to validate a scale that could help surgeons evaluate patients' psychological readiness to return to sport (RTS) after peroneal tendon pathology surgery. METHODS: The Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) scale, which had previously been validated in ankle ligament reconstruction patients, was adapted to evaluate the psychological preparedness for RTS in athletic patients who underwent peroneal tendinopathy surgery. The Foot and Ankle Outcome Score (FAOS) and Foot Ankle Ability Measurement (FAAM) scores were employed as patient-related outcome measurement (PROM) instruments. RESULTS: This study included 57 patients. There was a strong correlation between ALR-RSI and both FAOS and FAAM (r = -0.68 and 0.74, respectively). ALR-RSI was considerably higher in patients who returned to sports than in those who did not. The mean score was 72.9 ± 19.0 in patients who returned to the same preinjury level, 48.5 ± 24.0 in those who returned to a lower level and 53.6 ± 31.1 in patients who changed their athletic activity (p < 0.0001). Furthermore, ALR-RSI showed at least a similar discrimination ability when compared to FAOS and FAAM. The test-retest intraclass correlation coefficient was 0.95. The Cronbach's α statistic used to measure the internal consistency was high (0.95). A Youden index of 0.65 was observed for a cut-off score of 68 points. CONCLUSION: ALR-RSI is a valid instrument for assessing psychological readiness to RTS in an athletic population following peroneal tendon surgery. When compared to the most commonly used PROMs, it was strongly correlated and demonstrated at least similar discrimination capacity. This could assist surgeons in identifying athletes who will have poor postoperative results and advising them on their capability to RTS. LEVEL OF EVIDENCE: Level III.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Esportes , Humanos , Volta ao Esporte/psicologia , Tornozelo/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/psicologia , Ligamentos Articulares/cirurgiaRESUMO
BACKGROUND: This study aims to assess the recovery patterns and factors influencing outcomes in patients with common peroneal nerve (CPN) injury. METHODS: This retrospective study included 45 patients with CPN injuries treated between 2009 and 2019 in Jing'an District Central Hospital. The surgical interventions were categorized into three groups: neurolysis (group A; n = 34 patients), nerve repair (group B; n = 5 patients) and tendon transfer (group C; n = 6 patients). Preoperative and postoperative sensorimotor functions were evaluated using the British Medical Research Council grading system. The outcome of measures included the numeric rating scale, walking ability, numbness and satisfaction. Receiver operating characteristic (ROC) curve analysis was utilized to determine the optimal time interval between injury and surgery for predicting postoperative foot dorsiflexion function, toe dorsiflexion function, and sensory function. RESULTS: Surgical interventions led to improvements in foot dorsiflexion strength in all patient groups, enabling most to regain independent walking ability. Group A (underwent neurolysis) had significant sensory function restoration (P < 0.001), and three patients in Group B (underwent nerve repair) had sensory improvements. ROC analysis revealed that the optimal time interval for achieving M3 foot dorsiflexion recovery was 9.5 months, with an area under the curve (AUC) of 0.871 (95% CI = 0.661-1.000, P = 0.040). For M4 foot dorsiflexion recovery, the optimal cut-off was 5.5 months, with an AUC of 0.785 (95% CI = 0.575-0.995, P = 0.020). When using M3 toe dorsiflexion recovery or S4 sensory function recovery as the gold standard, the optimal cut-off remained at 5.5 months, with AUCs of 0.768 (95% CI = 0.582-0.953, P = 0.025) and 0.853 (95% CI = 0.693-1.000, P = 0.001), respectively. CONCLUSIONS: Our study highlights the importance of early surgical intervention in CPN injury recovery, with optimal outcomes achieved when surgery is performed within 5.5 to 9.5 months post-injury. These findings provide guidance for clinicians in tailoring treatment plans to the specific characteristics and requirements of CPN injury patients.
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Nervo Fibular , Neuropatias Fibulares , Humanos , Estudos Retrospectivos , Nervo Fibular/cirurgia , Nervo Fibular/lesões , Neuropatias Fibulares/cirurgia , Procedimentos NeurocirúrgicosRESUMO
One of the most common nerve palsies - common fibular nerve palsy - can be caused by the variant small sesamoid bone in the posterolateral compartment of the knee joint known as the fabella. We compared and reviewed all reported cases of common fibular nerve palsy due to fabellae in the English literature. Compression can develop spontaneously or post-surgically (total knee arthroplasty). Symptoms progress rapidly to complete foot drop. Among all the cases reviewed, 68.42% were males with a median age of 39.39 years. Fabella compression was more common in the left common fibular nerve (CFN) (63.16%). Both big (23 × 20 × 16 mm) and small (5 × 5 mm) fabellae can be responsible for compression. While diagnosis can be problematic, the treatment (either surgical fabellectomy or conservative) is relatively easy and brings quick improvement.
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Neuropatias Fibulares , Ossos Sesamoides , Masculino , Humanos , Adulto , Feminino , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/cirurgia , Neuropatias Fibulares/diagnóstico , Nervo Fibular , Articulação do Joelho , Ossos Sesamoides/cirurgia , Paralisia/complicaçõesRESUMO
OBJECTIVES: Overactive bladder (OAB) affects millions of patients worldwide. Its treatment is challenging but improves the patient's quality of life. Besides standard techniques for neuromodulation (sacral and pudendal neuromodulation and posterior tibial nerve stimulation), several new techniques have been investigated to treat symptoms of refractory OAB. The purpose of the present review is to outline the state of the art of new neuromodulation techniques for lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS: In March 2023, a comprehensive MEDLINE, EMBASE, and Scopus search was carried out (keywords: LUTD, new technologies, neuromodulation, LUTS, OAB, painful bladder syndromes, etc). Articles were included according to inclusion (randomized controlled trials, prospective trials, large retrospective studies) and exclusion (case reports, outcomes not clearly expressed in full text, animal studies) criteria. The reference lists of the included studies also were scanned. Both adult and pediatric populations were included, in addition to both neurogenic and nonneurogenic OAB. A narrative review was then performed. RESULTS: Peroneal neuromodulation, transcutaneous electrical nerve stimulation, magnetic nerve stimulation, and parasacral transcutaneous neuromodulation are the most studied investigative techniques and were shown to yield promising results in treating OAB symptoms. Most studies showed promising results even in the complex scenarios of patients with OAB refractory to standard treatments. Comparing investigational techniques with standard of care and their respective clinical outcomes and safety profiles, and confronting their pros and cons, we reasonably believe that once such treatment modalities are further developed, they could play a role in the OAB treatment algorithm. CONCLUSIONS: Although the described neuromodulation techniques are being intensely studied, the available results are not yet sufficient for any guidelines to recommend their use.
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Estimulação Elétrica Nervosa Transcutânea , Bexiga Urinária Hiperativa , Humanos , Criança , Adulto , Bexiga Urinária , Estudos Prospectivos , Estudos Retrospectivos , Qualidade de Vida , Bexiga Urinária Hiperativa/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Nervo Tibial , Resultado do TratamentoRESUMO
OBJECTIVES: In this study, we aimed to investigate whether peroneal electrical Transcutaneous Neuromodulation invented for overactive bladder (OAB) treatment elicits activation in brain regions involved in neural regulation of the lower urinary tract. MATERIALS AND METHODS: Among 22 enrolled healthy female volunteers, 13 were eligible for the final analysis. Functional magnetic resonance imaging (fMRI) (Siemens VIDA 3T; Erlangen, Germany) was used to compare the brain region activation elicited by peroneal electrical Transcutaneous Neuromodulation with the activation elicited by sham stimulation. Each subject underwent brain fMRI recording during eight 30-second periods of rest, alternating with 30-second periods of passive feet movement using the sham device, mimicking the motor response to peroneal nerve stimulation. Subsequently, fMRI recording was performed during the analogic "off-on" stimulation paradigm using peroneal electrical transcutaneous neuromodulation. Magnetic resonance imaging data acquired during both paradigms were compared using individual and group statistics. RESULTS: During both peroneal electrical Transcutaneous Neuromodulation and sham feet movements, we observed activation of the primary motor cortex and supplementary motor area, corresponding to the cortical projection of lower limb movement. During peroneal electrical Transcutaneous Neuromodulation, we observed significant activations in the brain stem, cerebellum, cingulate gyrus, putamen, operculum, and anterior insula, which were not observed during the sham feet movement. CONCLUSIONS: Our study provides evidence that peroneal electrical Transcutaneous Neuromodulation elicits activation of brain structures that have been previously implicated in the perception of bladder fullness and that play a role in the ability to cope with urinary urgency. Our data suggest that neuromodulation at the level of supraspinal control of the lower urinary tract may contribute to the treatment effect of peroneal electrical Transcutaneous Neuromodulation in patients with OAB.
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Estimulação Elétrica Nervosa Transcutânea , Bexiga Urinária Hiperativa , Humanos , Feminino , Bexiga Urinária Hiperativa/diagnóstico por imagem , Bexiga Urinária Hiperativa/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Bexiga Urinária , Encéfalo/fisiologia , Imageamento por Ressonância Magnética/métodosRESUMO
PURPOSE: The most popular knee posterolateral corner (PLC) reconstruction techniques describe that a common peroneal nerve (CPN) neurolysis must be done to safely address the posterolateral aspect of the knee. The purpose of this study was to measure the distance between the CPN and the fibular insertion of the FCL in different degrees of knee flexion in cadaveric specimens, to identify if tunnel drilling could be done anatomically and safely without a CPN neurolysis. METHODS: Ex vivo experimental analytical study. Ten fresh frozen human knees were dissected leaving FCL and CPN in situ. Shortest distance from the centre of the FCL distal tunnel and CPN was measured (antero-posterior and proximal-distal wire-nerve distances) at 90°, 60°, 30°, and 0° of knee flexion. Measurements between different flexion angles were compared and correlation between knee flexion angle and distance was identified. RESULTS: The mean distance between the FCL tunnel and the CPN at 90° were 21.15 ± 6.74 mm posteriorly (95% CI: 16.33-25.97) and 13.01 ± 3.55 mm distally (95% CI: 10.47-15.55). The minimum values were 9.8 mm posteriorly and 8.9 mm, respectively. These distances were smaller at 0° (p ≤ 0.017). At 90° of knee flexion, the mean distance from the fibular tip to the CPN distally was 23.46 ± 4.13 mm (20.51-26.41). CONCLUSION: Anatomic localization and orientation of fibular tunnels can be done safely while avoiding nerve neurolysis. Further studies should aim to in vivo measurements and results.
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Ligamento Cruzado Anterior , Ligamentos Colaterais , Humanos , Ligamento Cruzado Anterior/cirurgia , Nervo Fibular/cirurgia , Nervo Fibular/anatomia & histologia , Fêmur/cirurgia , Cadáver , Articulação do Joelho/cirurgiaRESUMO
PURPOSE: Pathologic abnormality of the peroneal tendons are thought to be an under-appreciated source of vague ankle and hindfoot pain in paediatric patients, partly because they can be difficult to diagnose and differentiate from lateral ankle ligament injuries. While magnetic resonance imaging (MRI) is the primary imaging modality used to detect peroneal tendon pathology, previous studies in adults have found that positive MRIs demonstrate a positive predictive value (PPV) of associated clinical findings around 48%. There are no similar known published studies in the paediatric population. Our objective was to determine the positive predictive value of peroneal tendon pathology as diagnosed by MRI as related to positive clinical exam findings in the paediatric and adolescent population. METHODS: This IRB approved retrospective study was conducted at a tertiary children's hospital. Inclusion criteria included patients under 18 years from our tertiary care institution with (a) ankle MRI findings indicating pathology of the peroneus brevis/longus tendons confirmed by a board certified paediatric musculoskeletal radiologist and (b) formal review of the clinical examination by a fellowship trained paediatric orthopaedic surgeon. Patients with congenital deformities or previous surgical intervention of the lateral ankle were excluded. RESULTS: Forty-seven patients (with 48 MRIs) met inclusion criteria over a ten year period. The majority of the positive MRI scans (70%) demonstrated a peroneus brevis split tear. Of the patients with positive findings on MRI, 17 patients had an associated positive clinical exam. The positive predictive value of MRI for peroneal tendon tears with positive clinical findings was 35.41% (95% confidence interval = 31.1% to 41.6%). There were 31 patients with MRI positive findings with a negative clinical exam. CONCLUSION: Despite having a negative clinical exam, a high percentage of patients had positive MRI findings suggestive of peroneal tendon pathology which confirms findings of adult populations demonstrating a high rate of incidental finding of peroneal tendon pathology on MRI in paediatric patients.
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Imageamento por Ressonância Magnética , Traumatismos dos Tendões , Humanos , Imageamento por Ressonância Magnética/métodos , Adolescente , Criança , Estudos Retrospectivos , Masculino , Feminino , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico , Valor Preditivo dos Testes , Pré-Escolar , Tendões/diagnóstico por imagem , Tendões/patologiaRESUMO
INTRODUCTION: The aim of this study is to assess the risk of peroneal artery injury of hardware placement at the fixation of syndesmotic injuries. MATERIALS AND METHODS: The lower extremity computed tomography angiography was used to design the study. The syndesmosis screw placement range was simulated every 0.5 cm, from 0.5 to 5 cm proximal to the ankle joint. The screw axes were drawn as 20°, 30° or individual angle according to the femoral epicondylar axis. The proximity between the screw axis and the peroneal artery was measured in millimeters. Potential peroneal artery injury was noted if the distance between the peroneal artery to the axis of the simulated screw was within the outer shaft radius of the simulated screw. The Pearson chi-square test was used and a p-value < 0.05 was considered significant. RESULTS: The potential for injury to the peroneal artery increased as the syndesmosis screw level rose proximally from the ankle joint level or as the diameter of the syndesmosis screw increasds. In terms of syndesmosis screw trajection, the lowest risk of injury was observed with the syndesmosis screw angle of 20°. Simulations with a screw diameter of 3.5 mm exhibited the least potential for peroneal artery injury. CONCLUSION: Thanks to this radiological anatomy simulation study, we believe that we have increased the awareness of the peroneal artery potential in syndesmosis screw application. Each syndesmosis screw placement option may have different potential for injury to the peroneal artery. To decrease the peroneal artery injury potential, we recommend the followings. If individual syndesmosis screw angle trajection can be measured, place the screw 1.5 cm proximal to the ankle joint using a 3.5 mm screw shaft. If not, fix it with 30° trajection regardless of the screw diameter at the same level. If the most important issue is the peroneal artery circulation, use the screw level up to 1 cm proximal to the ankle joint regardless of the screw angle trajection and screw diameter.
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Parafusos Ósseos , Angiografia por Tomografia Computadorizada , Humanos , Parafusos Ósseos/efeitos adversos , Angiografia por Tomografia Computadorizada/métodos , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controle , Lesões do Sistema Vascular/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/efeitos adversos , Traumatismos do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico por imagem , Artérias/lesões , Artérias/diagnóstico por imagem , Artérias/anatomia & histologiaRESUMO
Wild boar-inflicted nerve injuries have been very rarely reported in the literature. A 62-year-old man was attacked by a wild boar in eastern Turkey and brought to the emergency department. He had 5 lacerations on the lower extremities and 2 on the posterior thoracic region. In addition to soft tissue lacerations, he sustained a complete laceration of the left common peroneal nerve with a foot drop. The common peroneal nerve was repaired primarily the day after the attack. The patient was discharged after a short hospital stay without any immediate complications; however, at the 10-mo follow-up, he still had a left foot drop.
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Lacerações , Neuropatias Fibulares , Animais , Humanos , Masculino , Pessoa de Meia-Idade , Extremidade Inferior , Nervo Fibular , Sus scrofaRESUMO
The ability to visualize the nerves of the lower extremities differs from that of the upper extremities in sonography because the soft tissue cover is significantly larger in some cases. Landmarks are also defined for the lower extremities, which enable precise visualization of the nerves. Nerves and muscles are to be understood as a functional unit. In addition to the clarification of nerve compression syndromes, polyneuropathies and nerve tumors, sonography is also used to visualize muscle atrophy.
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Síndromes de Compressão Nervosa , Polineuropatias , Humanos , Ultrassonografia , Extremidade Inferior/diagnóstico por imagemRESUMO
A ganglion cyst is a benign mass consisting of high-viscosity mucinous fluid. It can originate from the sheath of a tendon, peripheral nerve, or joint capsule. Compressive neuropathy caused by a ganglion cyst is rarely reported, with the majority of documented cases involving peroneal nerve palsy. To date, cases demonstrating both peroneal and tibial nerve palsies resulting from a ganglion cyst forming on a branch of the sciatic nerve have not been reported. In this paper, we present the case of a 74-year-old man visiting an outpatient clinic complaining of left-sided foot drop and sensory loss in the lower extremity, a lack of strength in his left leg, and a decrease in sensation in the leg for the past month without any history of trauma. Ankle dorsiflexion and great toe extension strength on the left side were Grade I. Ankle plantar flexion and great toe flexion were Grade II. We suspected peroneal and tibial nerve palsy and performed a screening ultrasound, which is inexpensive and rapid. In the operative field, several cysts were discovered, originating at the site where the sciatic nerve splits into peroneal and tibial nerves. After successful surgical decompression and a series of rehabilitation procedures, the patient's neurological symptoms improved. There was no recurrence.
Assuntos
Cistos Glanglionares , Neuropatias Fibulares , Humanos , Idoso , Masculino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/fisiopatologia , Nervo Fibular/fisiopatologia , Nervo Tibial/fisiopatologia , Paralisia/etiologia , Paralisia/fisiopatologiaRESUMO
Introduction: Peroneal disorders are a common cause of ankle pain and lateral instability and have been described in as much as 77% of patients with lateral ankle instability. Clicking, swelling, pain, and tenderness in the peroneal tendons track are frequent symptoms, but they can be confused with other causes of lateral ankle pain. The management of peroneal disorders can be conservative or surgical. When the conservative treatment fails, surgery is indicated, and open or tendoscopic synovectomy, tubularization, tenodesis or tendon transfers can be performed. The authors present a surgical technique of tendoscopy associated to minimally invasive tenodesis for the treatment of peroneal tendon tears, as well as the preliminary results of patients submitted to this procedure. Methods: Four patients with chronic lateral ankle pain who were diagnosed with peroneal brevis pathology were treated between 2020 and 2022 with tendoscopic-assisted minimally invasive synovectomy and tenodesis. Using a 2.7 mm 30° arthroscope and a 3.0 mm shaver blade, the entire length of the peroneus brevis tendon and most parts of the peroneus longus tendon can be assessed within Sammarco's zones 1 and 2. After the inspection and synovectomy, a minimally invasive tenodesis is performed. Results: All patients were evaluated at least six months after surgery. All of them reported improvement in daily activities and in the Foot Function Index (FFI) questionnaire (pre-surgery mean FFI = 23.86%; post-surgery mean FFI = 6.15%), with no soft tissue complications or sural nerve complaints. Conclusion: The tendoscopy of the peroneal tendons allows the surgeon to assess their integrity, confirm the extent of the lesion, perform synovectomy, prepare the tendon for tenodesis, and perform it in a safe and minimally invasive way, reducing the risks inherent to the open procedure.
Assuntos
Dor Crônica , Procedimentos Ortopédicos , Tenodese , Humanos , Tendões/cirurgia , Perna (Membro) , ArtralgiaRESUMO
BACKGROUND: A peroneus longus to brevis tendon transfer is recommended for a severely torn peroneus tendon, but there is little research on the outcome. We conducted a prospective cohort study to examine patient-reported outcomes after this procedure. METHODS: Thirty-two patients underwent a peroneus longus to brevis tendon transfer and lateral ankle ligament reconstruction, 11 had an additional calcaneal osteotomy. The Foot and Ankle Outcome Score (FAOS) and Short Form-36 (SF-36) were assessed preoperatively, six and 12 months after surgery. RESULTS: Preoperative mean FAOS was 51.7 (SD 17.8) compared with 72.7 (SD 21.2) at 12 months, an improvement of 21 (95 % CI 12.7-28.0) (p < 0.0001). SF-36 improved significantly in the three domains involving physical function and bodily pain (p < 0.007). CONCLUSION: Patient-reported outcomes improved significantly through peroneus longus to brevis tendon transfer. This procedure is worth considering for patients with a severely damaged peroneus tendon. LEVEL OF EVIDENCE: Level II: Prospective cohort study.
RESUMO
Purpose: The aim of this study was to investigate if ultrasound could be a reliable and accurate tool to measure the size of the peroneal tubercle. Material and methods: This study measured the width, length, and height of the peroneal tubercle in 100 asymptomatic patients, comparing the measurements to prior radiographs of the foot (if available) and previously reported anatomical data. This study also assessed the intra- and interrater reliability of ultrasound as a measurement tool. Results: Our findings show that ultrasound measurements of the peroneal tubercle were consistent with values reported in the literature and prior radiographs concerning width. Both intra- and inter-observer measurements were reliable. Conclusions: This study highlights the potential of ultrasound imaging as a promising tool to measure the peroneal tubercle, and it could contribute to a better understanding of peroneal tendon disorders.