Introduction
Nerve cross‐sectional area (CSA) is larger than normal in Charcot–Marie–Tooth disease 1A (CMT1A), although to a variable extent. We explored whether CSA is correlated with CMT clinical ...severity measured with neuropathy score version 2 (CMTNS2) and its examination subscore (CMTES2) in CMT1A.
Methods
We assessed 56 patients with CMT1A (42 families). They underwent nerve conduction study (NCS) and nerve high‐resolution ultrasound (HRUS) of the left median, ulnar, and fibular nerves.
Results
Univariate analysis showed NCS and HRUS variables to be significantly correlated with CMTNS2 and CMTES2 and with each other. Multivariate analysis showed that ulnar motor nerve conduction velocity (β: −0.19) and fibular compound muscle action potential amplitude (−1.50) significantly influenced CMTNS2 and that median forearm CSA significantly influenced CMTNS2 (β: 5.29) and CMTES2 (4.28).
Discussion
Nerve size is significantly associated with clinical scores in CMT1A, which suggests that it might represent a potential biomarker of CMT damage and progression.
Abstract In cases of complex neuromuscular defects, finding the proximal stump of a transected nerve in order to restore innervation to damaged muscle is often impossible. In this study we ...investigated whether a neighboring uninjured nerve could serve as a source of innervation of denervated damaged muscle through a biomaterial-based nerve conduit while preserving the uninjured nerve function. Tubular nerve conduits were fabricated by electrospinning a polymer blend consisting of poly(ϵ-caprolactone) (PCL) and type I collagen. Using a rat model of common peroneal injury, the proximal end of the nerve conduit was connected to the side of the adjacent uninjured tibial branch (TB) of the sciatic nerve after partial axotomy, and the distal end of the conduit was connected to the distal stump of the common peroneal nerve (CPN). The axonal continuity recovered through the nerve conduit at 8 weeks after surgery. Recovery of denervated muscle function was achieved, and simultaneously, the donor muscle, which was innervated by the axotomized TB also recovered at 20 weeks after surgery. Therefore, this end-to-side neurorrhaphy (ETS) technique using the electrospun PCL/collagen conduit appears to be clinically feasible and would be a useful alternative in instances where autologous nerve grafts or an adequate proximal nerve stump is unavailable.
•Peroneal nerve injury leads to foot drop.•Current treatments of foot drop offer less optimal outcomes.•Soleus nerve transfer to deep peroneal nerve is an acceptable surgery for foot droop ...treatment.•Clinical outcomes of nerve transfer depend on mechanism of injury that leads to foot drop.
Different mechanisms including knee dislocation, replacement surgery, nerve tumor, lumbar disc herniation, sharp injury, and gunshot wound lead to foot drop. Several surgical techniques have been used for treatment of foot drop, however, they have had sub-optimal outcomes. Soleus branch of tibial nerve is a good donor for nerve transfer for treatment of foot drop. In this is retrospective study, we reviewed medical records of 6 consecutive patients with sustained foot drop following injury to lumbar root or peroneal nerve, who underwent transfer of the soleus branch of tibial nerve to deep peroneal nerve during 2014–2016. The mean age of the patients was 44.8 years and duration of injury to surgery and follow-up was 8.3 and 14.6 months, respectively. At the end of the follow-up, ankle dorsiflexion force was M4 in two patients (with traumatic peroneal nerve injury with M3 toe extension) and was M2 in one patient. There were three patients with lumbar degenerative disease. Of these patients, two showed M0 and one patient experienced M1 ankle dorsiflexion. We recommend that transfer of soleus nerve to deep peroneal nerve is used as an alternative technique for treatment of foot drop.
Common peroneal nerve dysfunction after a multiligament knee injury can be devastating. In patients with persistent foot drop, posterior tibial tendon transfer to the dorsum of the foot is a reliable ...and safe procedure to restore dorsiflexion. These authors favor passing the posterior tibial tendon through the interosseous membrane and docking it into the lateral/middle cuneiforms. A Strayer procedure or tendo-Achilles lengthening must be performed in patients unable to achieve at least 10° of passive dorsiflexion. Despite the operative limb having 30% to 40% of ankle dorsiflexion strength of the uninjured limb, short- and long-term functional outcomes are excellent.
Abstract Background The common peroneal nerve (CPN) is an important structure of the lower limb and is at risk of injury during total knee arthroplasty (TKA). The aim of this study was to use a ...tibial reference system to determine the position of the CPN relative to the knee centre and popliteus. Methods Two hundred consecutive knee magnetic resonance images at the level of a standard tibial arthroplasty cut were evaluated for: (i) distance of the CPN from the posterolateral capsule; (ii) angle of the CPN from the centre of the tibial AP axis; and (iii) location of CPN with respect to the popliteus. Results The mean distance between the common peroneal nerve and the posterolateral joint capsule was 11.9mm (range 4.7 – 22.13mm) which correlated positively with the medial-lateral axis of the tibia (Pearson correlation 0.157, p = 0.026) and negatively with the angle of the nerve from the midline (Pearson correlation -0.237, p = 0.001). The mean angle of the nerve from the midline was 42.2 degrees (range 25.0 –64.0 degrees). In 116 knees (58%) the CPN was in line with the popliteus from the centre of the knee, in 69 knees (34.5%) the CPN was lateral to the popliteus, and in 15 knees (7.5%) the CPN was medial to the popliteus. A danger zone was identified as between 29.95 to 54.57 degrees from the AP axis. Conclusion The common peroneal nerve is at risk during TKA. This study describes a method to help predict the location of the CPN intra-operatively and therefore avoid direct injury.
Background:
The anterocentral portal is not a standard portal in anterior ankle arthroscopy due to its proximity to the anterior neurovascular bundle. However, it provides certain advantages, ...including a wide field of vision, and portal changes become redundant. The purpose of this study was to evaluate the neurovascular complications after anterior ankle arthroscopy using the anterocentral portal.
Methods:
We retrospectively identified patients who had undergone anterior ankle arthroscopy with an anterocentral portal at our institution from 2013 to 2018. Medical record data were reviewed and patients were invited for clinical follow-up, where a clinical examination, quantitative sensory testing for the deep peroneal nerve, and ultrasonography of the structures at risk were performed. A total of 101 patients (105 arthroscopies) were identified and evaluated at a mean follow-up of 31.5 ± 17.7 months.
Results:
Leading indications to surgery were heterogeneous and included anterior impingement (48.6%), osteochondral lesions of the talus (24.8%), chronic ankle instability (14.3%), and fractures (8.6%). The overall complication rate was 7.6%, and no major complications were observed. In 1.9% (2/105) of the cases, the complications were associated with the anterocentral portal and included injury to the medial branch of the superficial nerve (1/105) and to the deep peroneal nerve (1/105). Injury to the deep peroneal nerve was associated with a loss of detection and nociception. There were no injuries to the anterior tibial artery. In 41.9% (44/105) of the cases, only 1 working portal was used in addition to the anterocentral portal, and in 19% (20/105) the anterolateral portal could be avoided. Ultrasonography confirmed the integrity of the deep peroneal nerve, the medial branch of the superficial peroneal nerve, and the anterior tibial artery in all patients. Patients with nerve injuries associated with the anterocentral portal showed no signs of neuroma or pseudoaneurysm.
Conclusion:
Using a standardized technique, the anterocentral portal in ankle arthroscopy is safe with a low number of neurovascular injuries and can be recommended as a standard portal. The anterolateral portal remains associated with a high number of injuries to the superficial peroneal nerve.
Level of Evidence:
Level III, retrospective cohort study.
The anterior approach to the ankle for surgery can result in injury to the superficial peroneal nerve, resulting in a painful neuroma and significant patient morbidity. A paucity of data is available ...evaluating the role of the superficial peroneal nerve to deep peroneal nerve transfer as a method of treatment of neuromas in continuity after ankle arthrodesis. We describe 11 patients who underwent nerve transfer with nerve allograft and conduit repair to treat recalcitrant painful neuromas after ankle arthrodesis. At a mean follow-up period of 31 months, the mean visual analog pain scale score had improved from 7.9 preoperatively to 2.45 postoperatively (p < .0001). These data suggest that nerve transfer with a nerve allograft can provide significant clinical improvement for painful neuromas of the peripheral nerves at the ankle.
ABSTRACT
Introduction
In 30% of patients with common fibular (CF) neuropathy at the fibular head, reliable localization of the site of the lesion by means of electrodiagnostic testing is challenging.
...Methods
We prospectively assessed proximal CF nerve cross‐sectional area (CSA) measurements and at the fibular head in 87 patients with CF neuropathy and 16 with a different condition. Reference values were obtained in 64 healthy volunteers.
Results
Patients with CF neuropathy had a significantly larger CF nerve CSA than controls and patient controls (P < 0.0001). Sonography localized the lesion at the fibular head in 55% and just above it in 71% of patients. Assessment of the most thickened part of the CF nerve resulted in a cut‐off value of >8 mm2 with a sensitivity of 90% (CI 81–95%) and a specificity of 69% (CI 58–78%).
Conclusion
High‐resolution sonography in addition to electrodiagnostic testing improves diagnostic reliability in CF neuropathy. Muscle Nerve, 48: 171–178, 2013
Background: The hip surgery may be complicated with an iatrogenic peroneal nerve injury. The spontaneous recovery of these patients is usually poor, and majority of them require additional surgical ...treatment. In this paper, we presented a case of iatrogenic peroneal nerve injury following posttraumatic hip surgery, which was decompressed at the knee level, and achieved complete postoperative recovery. The case: A 32-year-old woman was admitted to our department due to EMNG-verified peroneal nerve lesion. Eight months before, the patient was injured in a traffic accident, followed by knee dislocation, hip dislocation, and acetabular fracture. After open reduction of the acetabular fracture performed by the orthopedic surgeons, the peroneal nerve palsy followed. At the admission, the clinical findings included left sided incomplete peroneal nerve palsy (MRC=2), pain in the lateral lower leg (VAS=3), and gait disturbances. Using EMNG, the nerve lesion was located at the knee level, while US indicated suspectable nerve compression, due to visible nerve thickening. The PNSQoL and SF-36 scores indicated a significant decline in patients' quality of life (QOL). Following GETA, the external neurolysis, decompression, and complete nerve deliberation were performed at the knee level, with preservation of all nerve branches. The patient reported immediate relief, while completely recovered 8 months following the surgery (MRC = 5, VAS = 0). In order to assess postoperative QOL, a prolonged follow-up is needed. Conclusion: The iatrogenic peroneal nerve injury following hip surgery may not always be located in the hip region. A proper anamnesis, physical examination, and diagnostic evaluation are necessary for proper treatment of these patients.
•The within and between center variability shows good reliability of the iMAX procedure.•iMAX is fast, non-invasive and measurable at any stimulation point without specific equipment.•In patients ...with peripheral neuropathy, iMAX allows monitoring excitability changes of motor axon.
This study was undertaken to establish by a multicentric approach the reliability of a new technique evaluating motor axon excitability.
The minimal threshold, the lowest stimulus intensity allowing a maximal response by 1 mA increments (iUP) and then by 0.1 mA adjustments (iMAX) were prospectively derived from three nerves (median, ulnar, fibular) in four university centers (Liège, Marseille, Fraiture, Nice). iMAX procedure was applied in 28 healthy volunteers (twice) and 32 patients with Charcot-Marie-Tooth (CMT1a), chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain-Barré syndrome (SGB) or axonal neuropathy.
Healthy volunteers results were not significantly different between centers. Correlation coefficients between test and retest were moderate (> 0.5). Upper limits of normal were established using the 95th percentile. Comparison of volunteers and patient groups indicated significant increases in iMAX parameters especially for the CMT1a and CIDP groups. In CMT1a, iMAX abnormalities were homogeneous at the three stimulation sites, which was not the case for CIDP.
The iMAX procedure is reliable and allows the monitoring of motor axon excitability disorders.
The iMAX technique should prove useful to monitor motor axonal excitability in routine clinical practice as it is a fast, non-invasive procedure, easily applicable without specific software or devices.
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