ENTRAPMENT OF THE SUPERFICIAL PERONEAL NERVE
|
|
- Tamsyn Morgan
- 6 years ago
- Views:
Transcription
1 ENTRAPMENT OF THE SUPERFICIAL PERONEAL NERVE DIAGNOSIS AND RESULTS OF DECOMPRESSION JORMA STYF From Gothenburg University, Sweden Entrapment of the superficial peroneal nerve was treated in 24 legs of 21 patients by fasciotomy and neurolysis; 19 of the patients were reviewed after a mean period of 37 months. Nine were satisfied with the result, another six were improved but not satisfied because of residual limitation of athletic activity, three were unchanged and one was worse. Conduction velocity in the superficial peroneal nerve had increased after operation, but the change was not significant. In five patients the nerve had an anomalous course and in 1 1 there were fascial defects over the lateral compartment. Chronic lateral compartment is an unusual cause of nerve entrapment. Operative decompression produces cure or improvement in three-quarters of the cases, but is less effective in athletes. Entrapment of the superficial peroneal nerve was first described by Henry in The symptoms are pain and sometimes sensory abnormality in the distribution of the nerve over the dorsum of the foot. Only a few cases have been reported, but several possible causes for compression have been described. These include : lipoma (Banerjee and Koons 1981), ankle sprain (Kernohan, Levack and Wilson 1985), muscle herniation (Garfin, Mubarak and Owen 1977; McAuliffe, Fiddian and Browett 1985), a peroneal tunnel (Lowdon 1985) and after fasciotomy for chronic anterior compartment (Styf and K#{246}rner 1986b). The incidence of superficial peroneal nerve entrapment as a cause of anterolateral leg pain is probably higher than is suggested by the literature (Styf 1988). This study aimed to determine the effects of operation on both the symptoms and the nerve conduction velocity in 21 patients with superficial peroneal nerve entrapment. MATERIALS AND METHODS From 1981 to 1986, a prospective study was made of 21 patients with entrapment of the superficial peroneal nerve. Two patients were excluded because they did not want an operation, so 19 patients were reviewed. There were 10 male and 1 1 female patients with a mean age of J. Styf, MD, PhD, Senior Registrar Department of Orthopaedics, Gothenburg University, East Hospital, Gothenburg, Sweden. Correspondence should be sent to Dr Styf British Editorial Society of Bone and Joint Surgery X/89/1014 $2.00 J Bone Joint Surg [Br] 1989:71-B: years (range 1 5 to 79 years). Three patients had bilateral symptoms. Clinical details and the results of pre-operative and postoperative tests for nerve conduction velocity are given in Table I. Questionnaire. Each patient was asked a number of questions about symptoms and physical limitations both before entering the study, and again at an average of 37 months (range 10 to 56 months) after operation. The patients also indicated on three drawings ofthe leg where they felt pain or sensory abnormality, and reported whether the operation had a satisfactory result. Examination. Each patient was examined to record the range ofmovement ofall legjoints, stability ofthe ankle, and the presence of fascial herniae. Three provocation tests were used : in the first, pressure is applied where the nerve emerges from the deep fascia, while the patient actively dorsiflexes and everts the foot against resistance (Styf 1988); in the second test, the foot is passively plantar flexed and inverted without local pressure over the nerve; finally, maintaining passive stretch, gentle percussion is applied over the course of the nerve (Tinel 1915). Pain or paraesthesia caused by any of these tests suggested compression of the peroneal nerve and was taken as an indication for neurophysiological investigation. Anteroposterior, lateral and oblique radiographs of the leg were taken to exclude stress fracture and bone tumour. Electrophysiology. Conduction velocities in the superficial peroneal nerve were determined using surface electrodes, and electromyograms of both peroneal muscles and the anterior tibial muscles were recorded from needle electrodes (Jabre 1981 ; Ma and Liveson 1983). VOL. 71-B, No. 1, JANUARY
2 I 32 J. STYF Conduction velocities were obtained before operation and between six and 1 2 weeks afterwards. Conduction velocities below 44 m/sec were considered abnormal (Jabre 1981), though there is a relationship to the age of the patient. Usually, the symptom-free leg could be used as a control. Compartment pressure. This was recorded bilaterally in the lateral compartment in all patients and in the anterior compartment also in 1 5 of the 2 1 patients. Two patients with chronic lateral compartment (Cases 6 and 20) had recordings six months after decompression. Recordings were made with the patient supine, wearing shoes which were attached to an ergometer to ensure that the work was equal in both legs. For the peroneal muscles, eversion and dorsiflexion was repeated against a load of 4 to 6 kg about once every second until pain or weakness forced the patient to stop. Intramuscular pressure was measured by microcapillary infusion technique (Styfand K#{246}rner1986a) using an infusion rate of 1.5 ml/hour, a teflon catheter and an electromagnetic transducer. Diagnostic criteria. Entrapment of the nerve was diagnosed when there was decreased sensibility and pain over the dorsum of the foot at rest or during an exercise test and at least one of the three provocation tests was positive. A nerve conduction velocity of less than 44 m/sec or a fascial defect where the nerve emerges from the lateral compartment provided confirmation. Chronic lateral compartment was diagnosed when muscle relaxation pressure exceeded Table I. Details of all 21 patients with results in 19 Nerve conduction Operative findings velocity (m/sec) Age Duration Post- Peroneus Fascial Case and Athletic of pain Follow-up Pre-op Post-op stenotic tunnel defect number sex Possible cause activity Side yr/mth yr/mth L/R L/R Result Waist swelling (cm) (mm) Other I 32 F Contusion L 4/10 3/1 48/54 NS 2 20 F Anterior fasciotomy Tennis L/R 2/0 3/2 0/0 52/51 S 3 22 M Fractured tibia Running R 4/5 2/2 61/37 - S F Sprained ankle R 1/0 4/ /49 NS x F Muscle herniation Running R 3/2 2/9 59/56 S x M Anterior and lateral fasciotomies Football R 0/8 4/8 48/22 51/50 NS* Scar 7 22 M Anterior fasciotomy Running R 0/8 3/8 54/44 52/50 NS* x15 8 5SF 9 67 M Anterior compartment R 7/0 0/10 50/48 L 4/3 2/8 33/45 38/41 NS + I 5 x 50 Impingement M Muscle herniation F Muscle herniation 12 20M M Anterior compartment F Anterior fasciotomy L/R 1/6 2/8 28/49 43/46 NS R 2/0 2/0 50/0 45/39 S + Football L 2/0 2/7 21/50 45/46 NS5 Running R 1/0 0/10 46/39 L 1/0 3/11 11/46 12/52 S + + 3/3 20 x 20 Impingement IS x x F Varicose veins R 3/0 2/10 - S + 15 x 15 Impingement M Muscle herniation R 5/0 4/2 0/0 0/0 NS* + 20 x 20 Scar F Running L 1/ F Anterior fasciotomy Running L 0/9 4/0 54/55 51/51 NS + 3/9 29/47 57/53 S M Varicose veins Running R 3/0 3/10 lsxls Impingement M Lateral compartment L/R 7/0 4/2 26/42 46/51 S 3/ F Varicose veins L 2/6 3/9 32/33 - NS + 15 x I 5 Impingement S improved NS not satisfied: S satisfied THE JOURNAL OF BONE AND JOINT SURGERY
3 ENTRAPMENT OF THE SUPERFICIAL PERONEAL NERVE 133 d Superficial peroneal nerve 30 mmhg during exercise (Styf and K#{246}rner 1987), intramuscular pressure exceeded 30 mmhg at rest after exercise (Mubarak and Hargens 1981) and it took more than 10 minutes for pressure to return to normal Fascia (Reneman 1975). Fig. Diagram of the superficial peroneal nerve showing findings at operation and some possible sites of entrapment: a, the peroneus tunnel : h, impingement at the exit from the tunnel : c, compression by herniating muscle producing a waist on the nerve tissue: d, poststenotic swelling. I Operation. The site of nerve compression is identified and marked pre-operatively and decompression is performed under general anaesthesia with a tourniquet. A 7 to 10 cm skin incision is made over the middle and distal thirds of the lateral compartment, 1 cm posterior to the site ofcompression. The nerve is located and released by local fasciectomy and, in addition, a subcutaneous fascial release is performed from the level of the head of the fibula to the anterior retinaculum. The epimysium of the muscle is protected during the fasciotomy. In five patients with an anomalous course of the nerve, a local fasciectomy of the anterior intermuscular septum and fasciotomy of the anterior compartment was performed. Statistics. Pressures and conduction velocities are given as the mean with one standard deviation. Significance was tested, using Student s t-test. RESULTS Fig. 2 About 5 mm ofthe peroneus tunnel has been incised. Impingement and flattening is seen, with some post-stenotic swelling (large arrow). Table II. Summary of the patients opinions at six months and 37 months (s.d. 12) after decompression Time since operation Six months 37 months n=2l n=19 Satisfied No symptoms 3 S Few symptoms 5 4 Not satisfied Improved 6 6 Unchanged S 3 Worse 2 I Physical activity Unlimited 4 6 Increased 6 7 Unchanged 11 6 Decreased 0 0 The clinical results are shown in Table II. At a mean of 37 months, nine patients were satisfied and 10 were not. Physical ability was unlimited or increased in 13 and unchanged in six. Four of those with improvement were athletes (Cases 6, 7, 12 and 17), but they remained unsatisfied because they could not attain the desired level ofcompetitive activity. One patient (Case 4) had another operation, at which the nerve was found to be trapped in scar tissue. Except after known fractures, radiographs were normal. Electrophysiology. Pre-operative conduction velocities were 28 m/sec (s.d. 18.5) in the symptomatic legs and 49.8 m/sec (s.d. 6.7) in symptom-free legs. After operation, this increased to 40.3 m/sec (s.d. 17.1) in the operated legs and it was unchanged on the normal side. This increase of conduction velocity was not significant. All electromyographic studies were normal. Findings at operation. Details are given in Table I and are shown in Figure 1. Clearly visible waisting of the nerve was seen in 1 2 legs, and was associated with a poststenotic swelling in five (Fig. 2). When the nerve was found to be compressed and flattened very locally between the fascial edge and herniating muscle, this was termed impingement (Fig. 2) and was found in six legs. A peroneus tunnel of up to 3 cm was accepted as normal, and a short tunnel was found in most legs. However, the tunnel was between 3 and 1 1 cm in 10 legs, and in several of these the nerve was noticeably thinner within the tunnel. Two patients with long tunnels (Cases 10 and 19) also had impingement. VOL. 71-B, No. I. JANUARY 1989
4 134 J. STYF In six legs of five patients the course of the nerves was anomalous. These nerves entered the anterior compartment of the leg through a fascial opening in the anterior intermuscular septum at 1 2 to 16 cm proximal to the ankle, and emerged through the fascia ofthe anterior compartment between 6 and 10 cm above the ankle. In one patient (Case 1 1 ), only the medial dorsal cutaneous branch was anomalous, the intermediate dorsal cutaneous branch emerging through a fascial defect over the lateral compartment. Fascial openings over the lateral compartment exceeding 1 5 mm in diameter were considered abnormal (Fig. 3), and muscle herniation through such a fascial defect where the nerve emerged was found in 12 legs. patients (Cases 1, 8 and 1 7), two of whom were found to have an anomalous nerve. Normally the nerve runs in a short fibrous tunnel in the corner between the anterior intermuscular septum and the fascia over the lateral compartment. In nine patients, the tunnel was fibrotic, of low compliance and more than 3 cm in length; it is speculated that, in such a tunnel, oedema after trauma may lead to a mini compartment. Compartment pressure. Chronic lateral compartment was diagnosed in two patients (Cases 6 and 20) with increased muscle relaxation pressure, and pressure at rest after exercise of 32 to 40 mmhg in the anterior and lateral compartments. Pressure did not return to normal within 20 minutes. Six months after decompressive fasciotomy of the lateral compartment, pressures were normal. DISCUSSION Only nine of the 19 patients were completely satisfied, though I 3 had unlimited or increased physical ability after 37 months, and the mean conductive velocity of the nerve had increased. Entrapment of the superficial peroneal nerve has many causes. A history of local trauma has been reported in about 25% of patients with nerve compression (Kopell and Thompson 1963; Stack, Bianco and MacCarty 1965); this is in line with the findings of the present study. Five of the patients had had an operation for chronic anterior compartment (Table I); the mechanism by which compression of the nerve may follow fasciotomy of the anterior compartment has been discussed previously (Styf 1988). Only two patients had chronic lateral compartment. This agrees with other reports that this is an unusual cause of anterolateral pain (Styf and K#{246}rner 1987; Styf 1988). Nerve compression in patients with fascial defects is explained by the normal increase in muscle relaxation pressure and intramuscular pressure at rest during and after exercise (Styf and K#{246}rner 1986). This increase is sufficient to herniate muscle tissue and impinge upon or compress the nerve (Fig. 3). The exercise test, followed by clinical examination, was useful in the diagnosis. During this test all patients had local pain and many developed diminished sensation to light touch over the dorsum of the foot. Electrophysiological studies helped the diagnosis, especially in patients who had pain after an anterior fasciotomy. Normal conduction velocity at rest does not exclude compression of the superficial peroneal nerve, as was shown in three Fig. 3 Operative view of an abnormal fascial opening. The arrow shows where the nerve has been displaced by muscle herniation. The patients who were not satisfied with their result, were unable to increase their athletic activity to the desired level, but old trauma and previous surgery to the leg may have contributed, while too cautious postoperative mobilisation may have allowed oedema formation. Complete fasciotomy of the lateral compartment does give some minor discomfort over the proximal third of the compartment, and it is considered that an operation including only incision of the peroneus tunnel and local fasciectomy may be preferable in appropriate patients and help avoid the edge effect of fascia on the normal swelling of muscle. It is concluded that entrapment of the superficial peroneal nerve is an unusual reason for pain in the lower leg but the diagnosis can be made from local tenderness and sensory abnormality, and confirmed by an exercise test. Nerve conduction studies were complementary in the diagnosis and follow-up. Decompression of the nerve relieves pain and sensory abnormality in half of the patients, and produces improvement in another quarter ofthem, but it is less effective in athletes because of their levels of physical activity. No benefits in any form have been received or will he received from a commercial party related directly or indirectly to the subject of this article. THE JOURNAL OF BONE AND JOINT SURGERY
5 ENTRAPMENT OF THE SUPERFICIAL PERONEAL NERVE 135 REFERENCES Banerjee T, Koons DD. Superficial peroneal nerve entrapment : report oftwo cases. J Neurosurg 1981:55: Garfin S, Mubarak SJ, Owen CA. Exertional anterolateral-compartment : case report with fascial defect, muscle herniation, and superficial peroneal-nerve entrapment. J Bone Joint Surg [Am] 1977:59-A : Henry AK. Extensile exposure. Edinburgh etc : E & S Livingstone, Jabre JF. The superficial peroneal sensory nerve revisited. Arch Neuro/ 1981:38: Kernohan J, Levack B, Wilson JN. Entrapment of the superficial peroneal nerve: three case reports. J Bone Joint Surg [Br] l985:67-b:60-l. Kopell HP, Thompson WAL. Peripheral entrapment neuropathies. Baltimore: Williams and Wilkins, Lowdon IMR. Superficial peroneal nerve entrapment: a case report. J Bone Joint Surg [Br] 1985:67-B:58-9. Ma D, Liveson JA. Nen e conduction handbook. Philadelphia, F.A. Davis Co Mubarak SJ, Hargens AR. Compartment s and Vo/kmanns contracture. Saunders Monographs in Clinical Orthopaedics 3. Philadelphia etc: WB Saunders, McAuliffe TB, Fiddian NJ, Browett JP. Entrapment neuropathy of the superficial peroneal nerve : a bilateral case. J Bone Joint Surg [Br] 1985 :67-B :62-3. Reneman RS. The anterior and lateral compartmental of the leg due to intensive use of muscles. C/in Orthop 1975 :1 13: Stack RE, Bianco AJ Jr, MacCarty CS. Compression of the common peroneal nerve by ganglion cysts : report of nine cases. J Bone Joint Surg [Am] 1965;4-A: Styf J, K#{246}rnerL. Microcapillary infusion technique for measurement of intramuscular pressure during exercise. C/in Ort hop 1986a ;207 : Styf JR, K#{246}rnerLM. Chronic anterior-compartment of the leg : results of treatment by fasciotomy. J Bone Joint Surg [AmJ 1986b;68-A : StyfJ, K#{246}rnerL. Diagnosis ofchronic anterior compartment of the lower leg. Acta Orthop Scand 1987:58: Styf J. Diagnosis of exercised-induced pain in the lower leg. Am J Sports Med 1988;l6: Tinel J. Le signe du foumillement dans lesions des nerfs p#{233}riph#{233}riques. Presse Med Par 1915,23: VOL. 71-B, No. I. JANUARY 1989
Case report. Your Diagnosis?
Case report 18 year Male Panel beater referred with a tibial shin syndrome with pain of 6 months. Pain over the anterolateral aspect of leg, bilateral and is precipitated walking 10 minutes. Your Diagnosis?
This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.
Introduction Compartment Syndromes of the Leg Related to Athletic Activity Mark M. Casillas, M.D. Consequences of a misdiagnosis persistence of a performance limitation loss of function/compartment loss
~, /' ~::'~ EXTENSOR HALLUCIS LONGUS. Leg-anterolateral :.:~ / ~\,
TIBIALIS ANTERIOR Lateral condyle of tibia, upper half of lateral surface of tibia, interosseous membrane Medial side and plantar surface of medial cuneiform bone, and base of first metatarsal bone Dorsiflexes
The Leg. Prof. Oluwadiya KS
The Leg Prof. Oluwadiya KS www.oluwadiya.sitesled.com Compartments of the leg 4 Four Compartments: 1. Anterior compartment Deep fibular nerve Dorsiflexes the foot and toes 2. Lateral Compartment Superficial
Leg. Dr. Heba Kalbouneh Associate Professor of Anatomy and Histology
Leg Dr. Heba Kalbouneh Associate Professor of Anatomy and Histology Skin of the Leg Cutaneous Nerves Medially: The saphenous nerve, a branch of the femoral nerve supplies the skin on the medial surface
The Lower Limb VI: The Leg. Anatomy RHS 241 Lecture 6 Dr. Einas Al-Eisa
The Lower Limb VI: The Leg Anatomy RHS 241 Lecture 6 Dr. Einas Al-Eisa Muscles of the leg Posterior compartment (superficial & deep): primary plantar flexors of the foot flexors of the toes Anterior compartment:
INTRAMUSCULAR PRESSURE AND MUSCLE BLOOD FLOW DURING EXERCISE IN CHRONIC COMPARTMENT SYNDROME
INTRAMUSCULAR PRESSURE AND MUSCLE BLOOD FLOW DURING EXERCISE IN CHRONIC COMPARTMENT SYNDROME JORMA STYF, LARS KORNER, MADIS SUURKULA From the East Hospital, G#{246}tehorg In nine patients with chronic
Compartment Syndrome
Compartment Syndrome Chapter 34 Compartment Syndrome Introduction Compartment syndrome may occur with an injury to any fascial compartment. The fascial defect caused by the injury may not be adequate to
Tibial and Common Peroneal Nerve Compression in The Popliteal Fossa: A Case Report and Literature Review
ISPUB.COM The Internet Journal of Plastic Surgery Volume 2 Number 1 Tibial and Common Peroneal Nerve Compression in The Popliteal Fossa: A Case Report and Literature D Reichner, G Evans Citation D Reichner,
The near-nerve sensory nerve conduction in tarsal tunnel syndrome
Journal of Neurology, Neurosurgery, and Psychiatry 1985;48: 999-1003 The near-nerve sensory nerve conduction in tarsal tunnel syndrome SHN J OH, HYUN S KM, BASHRUDDN K AHMAD From the Department ofneurology,
Minimally Invasive Fasciotomy in Chronic Exertional Compartment Syndrome and Fascial Hernias of the Anterior Lower Leg: Short- and Long-Term Results
MILITARY MEDICINE, 171, 5:399, 2006 Minimally Invasive Fasciotomy in Chronic Exertional Compartment Syndrome and Fascial Hernias of the Anterior Lower Leg: Short- and Long-Term Results Guarantor: M. R.
Copyright 2004, Yoshiyuki Shiratori. All right reserved.
Ankle and Leg Evaluation 1. History Chief Complaint: A. What happened? B. Is it a sharp or dull pain? C. How long have you had the pain? D. Can you pinpoint the pain? E. Do you have any numbness or tingling?
Claw toes after tibial fracture in children
J Child Orthop (2009) 3:339 343 DOI 10.1007/s11832-009-0200-y ORIGINAL CLINICAL ARTICLE Claw toes after tibial fracture in children Frank Fitoussi Æ Brice Ilharreborde Æ Florent Guerin Æ Philippe Souchet
Type II Type III Type IV Triplane
Fracture in Children [Salter And Harris] Type II Type III Type IV Triplane Surgical Rx III and IV Type II, V Non-operative treatment Type I, II When not reduced ORIF Type III ORIF Informed consent: about
While common peroneal nerve compression is a. Decompression of the superficial peroneal nerve: clinical outcomes and anatomical study
clinical article J Neurosurg 126:330 335, 2017 Decompression of the superficial peroneal nerve: clinical outcomes and anatomical study Michael J. Franco, MD, Benjamin Z. Phillips, MD, MPH, Gopal R. Lalchandani,
Introduction Compartment syndrome can be a life or limbthreatening
Original Article Chaudhary et.al. Measurement of compartmental pressure in a leg by Whitesides method in a Nepalese patients attending a tertiary care hospital in eastern region of Nepal P Chaudhary 1,
VENOUS DRAINAGE OF THE LOWER LIMB
Anatomy of the lower limb Superficial veins & nerve injuries Dr. Hayder VENOUS DRAINAGE OF THE LOWER LIMB The venous drainage of the lower limb is of huge clinical & surgical importance. Since the venous
Susan Bettcher, MD and Chad Asplund, MD The Ohio State University. exertional compartment syndrome. To minimize confusion, the terms exerciseinduced
PHYSICIAN PERSPECTIVE Tracy Ray, MD, AMSSM Member, Report Editor Exertional Leg Pain Susan Bettcher, MD and Chad Asplund, MD The Ohio State University EXERCISE-INDUCED leg pain is a common condition in
Leo Kormanik DC, MS, CCSP Ohio Sports Chiropractic
Leo Kormanik DC, MS, CCSP Ohio Sports Chiropractic ! Been running at a high level for 15 years.! 2012 Olympics Trials qualifier in the marathon and 6-time All-American in college! Owner of Ohio Sports
Section Three: The Leg, Ankle, and Foot Lecture: Review of Clinical Anatomy, Patterns of Dysfunction and Injury, and
Section Three: The Leg, Ankle, and Foot Lecture: Review of Clinical Anatomy, Patterns of Dysfunction and Injury, and Treatment Implications for the Leg, Ankle, and Foot Levels I and II Demonstration and
Integrated Manual Therapy & Orthopedic Massage For Complicated Lower Extremity Conditions
Integrated Manual Therapy & Orthopedic Massage For Complicated Lower Extremity Conditions Assessment Protocols Treatment Protocols Treatment Protocols Corrective Exercises Artwork and slides taken from
Interesting Case Series. Ganglion Cyst of the Peroneus Longus
Interesting Case Series Ganglion Cyst of the Peroneus Longus Andrew A. Marano, BA, Paul J. Therattil, MD, Dare V. Ajibade, MD, PhD, MPH, and Ramazi O. Datiashvili, MD, PhD Division of Plastic and Reconstructive
Where should you palpate the pulse of different arteries in the lower limb?
Where should you palpate the pulse of different arteries in the lower limb? The femoral artery In the femoral triangle, its pulse is easily felt just inferior to the inguinal ligament midway between the
Cubital tunnel syndrome: Simple decompression versus decompression and anterior subcutaneous transposition
CLINICAL ARTICLE SA ORTHOPAEDIC JOURNAL Autumn 2009 / Page 43 C LINICAL A RTICLE Cubital tunnel syndrome: Simple versus and anterior subcutaneous Y Ramguthy BMedSc(UDW), MBChB (Medunsa) Orthopaedic Registrar*
Prevention and Treatment of Injuries. Anatomy. Anatomy. Tibia: the second longest bone in the body
Prevention and Treatment of Injuries The Ankle and Lower Leg Westfield High School Houston, Texas Anatomy Tibia: the second longest bone in the body Serves as the principle weight-bearing bone of the leg.
Anatomy MCQs Week 13
Anatomy MCQs Week 13 1. Posterior to the medial malleolus of the ankle: The neurovascular bundle lies between Tibialis Posterior and Flexor Digitorum Longus The tendon of Tibialis Posterior inserts into
Deltoid and Syndesmosis Ligament Injury of the Ankle Without Fracture
Deltoid and Syndesmosis Ligament Injury of the Ankle Without Fracture Chris D. Miller, MD, Walter R. Shelton,* MD, Gene R. Barrett, MD, F. H. Savoie, MD, and Andrea D. Dukes, MS From the Mississippi Sports
Anterior Impingement
Anterior Impingement Ziali Sivardeen BMedSci, (MRCS), AFRCS, FRCS (Tr & Orth) Consultant Trauma and Orthopaedic Surgeon (Shoulder, Knee and Sports Injuries) Aims Causes of Anterior Ankle Pain Ankle Impingement
Therapeutic Foot Care Certificate Program Part I: Online Home Study Program
Therapeutic Foot Care Certificate Program Part I: Online Home Study Program 1 Anatomy And Terminology Of The Lower Extremity Joan E. Edelstein, MA, PT, FISPO Associate Professor of Clinical Physical Therapy
Topic 4: Fractures and External Fixation
Topic 4: Fractures and External Fixation Acute Compartment Syndrome Prof. Dr. Andreas Platz Stadtspital Triemli, Zürich Demographics Incidence: Men 7.3/100,000 Women 0.7/100,000 69% due to trauma 36% fx
The myofascial compartments of the foot
The myofascial compartments of the foot A CADAVER STUDY Z. X. Ling, V. P. Kumar From the National University of Singapore, Republic of Singapore Compartment syndrome of the foot requires urgent surgical
Lecture 09. Popliteal Fossa. BY Dr Farooq Khan Aurakzai
Lecture 09 Popliteal Fossa BY Dr Farooq Khan Aurakzai Dated: 14.02.2018 What is popliteus? Introduction Anything relating to, or near the part of the leg behind the knee. From New Latin popliteus the muscle
Review relevant anatomy of the foot and ankle. Learn the approach to examining the foot and ankle
Objectives Review relevant anatomy of the foot and ankle Learn the approach to examining the foot and ankle Learn the basics of diagnosis and treatment of ankle sprains Overview of other common causes
The first published report of chronic exertional compartment. Chronic Exertional Compartment Syndrome. Diagnosis and Management
Bulletin Hospital for Joint Diseases Volume 62, Numbers 3 & 4 2005 77 Chronic Exertional Compartment Syndrome Diagnosis and Management Matthew R. Bong, M.D., Daniel B. Polatsch, M.D., Laith M. Jazrawi,
Using the Amplitude of Pulse-Synchronous Intramuscular Pressure Oscillations When Diagnosing Chronic Anterior Compartment Syndrome
Using the Amplitude of Pulse-Synchronous Intramuscular Pressure Oscillations When Diagnosing Chronic Anterior Compartment Syndrome Andreas Nilsson,* MSc, Qiuxia Zhang, PhD, and Jorma Styf, MD, PhD Investigation
1. A worker falls from a height and lands on his feet. Radiographs reveal a fracture of the sustentaculum tali. The muscle passing immediately
1. A worker falls from a height and lands on his feet. Radiographs reveal a fracture of the sustentaculum tali. The muscle passing immediately beneath it that would be adversely affected is the: fibularis
ANKLE PLANTAR FLEXION
ANKLE PLANTAR FLEXION Evaluation and Measurements By Isabelle Devreux 1 Ankle Plantar Flexion: Gastrocnemius and Soleus ROM: 0 to 40-45 A. Soleus: Origin: Posterior of head of fibula and proximal1/3 of
Cavus Foot: Subtle and Not-So-Subtle AOFAS Resident Review Course September 28, 2013
Cavus Foot: Subtle and Not-So-Subtle Course September 28, 2013 Matthew M. Roberts, MD Associate Professor of Clinical Orthopaedic Surgery Co-Chief, Foot and Ankle Service Hospital for Special Surgery Disclosure
Interesting Case Series. Radial Tunnel Syndrome Complicated by Lateral Epicondylitis in a Middle-Aged Female
Interesting Case Series Radial Tunnel Syndrome Complicated by Lateral Epicondylitis in a Middle-Aged Female Sumesh Kaswan, MD, a Olivier Deigni, MD, MPH, a Kashyap K. Tadisina, BS, b Michael Totten, BS,
Ganglion of the peroneal nerve. CULLY A. COBB, III, M.D., AND RICHARD H. MoIr4 M.D.
Ganglion of the peroneal nerve Report of two cases CULLY A. COBB, III, M.D., AND RICHARD H. MoIr4 M.D. Division of Neurological Surgery, Baylor College of Medicine, Houston, Texas ~" Peroneal nerve ganglion
Tarsal Tunnel Syndrome
43 Thames Street, St Albans, Christchurch 8013 Phone: (03) 356 1353. Website: philip-bayliss.com Tarsal Tunnel Syndrome The foot is subjected to forces hundreds of times the bodyweight, thousands of times
ORIGINAL ARTICLE DISTALLY BASED PERONEUS BREVIS MUSCLE FLAP FOR DISTAL LEG DEFECTS
DISTALLY BASED PERONEUS BREVIS MUSCLE FLAP FOR DISTAL LEG DEFECTS Peddi Manjunath 1, Ramesha K.T 2, Smitha S Segu 3, Jainath 4, Shankarappa M 5 HOW TO CITE THIS ARTICLE: Peddi Manjunath, Ramesha KT, Smitha
Ankle Tendons in Athletes. Laura W. Bancroft, M.D.
Ankle Tendons in Athletes Laura W. Bancroft, M.D. Outline Protocols Normal Anatomy Tendinopathy, partial and complete tears Posterior tibial, Flexor Hallucis Longus, Achilles, Peroneal and Anterior Tibial
Surgical Decompression Improves Symptoms of Late Peroneal Nerve Dysfunction After TKA
Surgical Decompression Improves Symptoms of Late Peroneal Nerve Dysfunction After TKA Joseph P. Ward, MD; Lynda J.-S. Yang, MD; Andrew G. Urquhart, MD abstract Full article available online at Healio.com/Orthopedics.
Sports Injuries of the Foot and Ankle. Mark McEleney, MD University of Iowa College of Medicine Refresher Course for the Family Physician 4/4/2018
Sports Injuries of the Foot and Ankle Mark McEleney, MD University of Iowa College of Medicine Refresher Course for the Family Physician 4/4/2018 I. Objectives A. By the end of the lecture attendees will
fig fig For the following diagrams
fig. 1271 For the following diagrams Please draw small circles at the following points (pts in bold are main syllabus pts): Liver-1 Liver-2 Liver-3 Liver-4 Spleen-4 Spleen-5 Stomach-41 Stomach-42 Stomach-43
DIFFERENTIAL DIAGNOSIS: WHEN HEEL PAIN IS NOT PLANTAR FASCIITIS HEATHER RAFAL, DPM 2ND VICE PRESIDENT, AAWP PRESIDENT, DPMA
DIFFERENTIAL DIAGNOSIS: WHEN HEEL PAIN IS NOT PLANTAR FASCIITIS HEATHER RAFAL, DPM 2ND VICE PRESIDENT, AAWP PRESIDENT, DPMA THE HEEL PAIN PATIENT WHO DOES NOT HAVE PLANTAR FASCIITIS If every patient who
MEDIAL HEAD GASTROCNEMIUS TEAR (Tennis Leg)
MEDIAL HEAD GASTROCNEMIUS TEAR (Tennis Leg) Description Expected Outcome Medial head gastrocnemius tear is a strain of the inner part (medial head) of the major calf muscle (gastrocnemius muscle). Muscle
Unrecognized acute exertional compartment syndrome of the leg and treatment
Acta Orthop. Belg., 2011, 77, 265-269 CASE REPORT Unrecognized acute exertional compartment syndrome of the leg and treatment Nebojsa POPOviC, Craig BOTTONi, Charles CASSiDy From Aspetar, Qatar Orthopaedic
موسى صالح عبد الرحمن الحنبلي أحمد سلمان
8 موسى صالح عبد الرحمن الحنبلي أحمد سلمان 1 P a g e Today we will talk about a new region, which is the leg. And as always, we will start with studying the sensory innervation of the leg. What is the importance
Ankle and Foot Orthopaedic Tests Orthopedics and Neurology DX 612
Ankle and Foot Orthopaedic Tests Orthopedics and Neurology DX 612 James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic Ankle & Foot Anatomy Stability of the ankle is dependent
Compound Nerve Action Potential of Common Peroneal Nerve and Sural Nerve Action Potential in Common Peroneal Neuropathy
J Korean Med Sci 2008; 23: 117-21 ISSN 1011-8934 DOI: 10.3346/jkms.2008.23.1.117 Copyright The Korean Academy of Medical Sciences Compound Nerve Action Potential of Common Peroneal Nerve and Sural Nerve
Gluteal compartment syndrome
Acta Orthop. Belg., 2009, 75, 147-152 REVIEW ARTICLE Gluteal compartment syndrome Jeff T. HENSON, Craig S. ROBERTS, Peter V. GIANNOUDIS From the University of Louisville, Louisville, Kentucky, USA A systematic
Evidence-Based Examination of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs
Evidence-Based Examination of the Foot Presented by Alexis Wright, PT, PhD, DPT, FAAOMPT Practice Sessions/Skill Check-offs Module Five: Movement Assessment of the Foot/Ankle (1 hour CEU Time) Skilled
Lower Limb Nerves. Clinical Anatomy
Lower Limb Nerves Clinical Anatomy Lumbar Plexus Ventral rami L1 L4 Supplies: Abdominal wall External genitalia Anteromedial thigh Major nerves.. Lumbar Plexus Nerves relation to psoas m. : Obturator n.
The amplitude of pulse-synchronous oscillations varies with the level of intramuscular pressure in simulated compartment syndrome
Nilsson et al. Journal of Experimental Orthopaedics (2015) 2:3 DOI 10.1186/s40634-015-0020-6 RESEARCH Open Access The amplitude of pulse-synchronous oscillations varies with the level of intramuscular
1-Muscles: 2-Blood supply: Branches of the profunda femoris artery. 3-Nerve supply: Sciatic nerve
1-Muscles: B i c e p s f e m o r i s S e m i t e n d i n o s u s S e m i m e m b r a n o s u s a small part of the adductor magnus (h a m s t r i n g p a r t o r i s c h i a l p a r t ) 2-Blood supply:
Chronic Exertional Compartment Syndrome. Christopher A George, MD a, Mark R Hutchinson, MD b
Chronic Exertional Compartment Syndrome Christopher A George, MD a, Mark R Hutchinson, MD b a Resident physician, University of Illinois Hospital at Chicago, Department of Orthopaedic Surgery, Chicago
Anatomy and evaluation of the ankle.
Anatomy and evaluation of the ankle www.fisiokinesiterapia.biz Ankle Anatomical Structures Tibia Fibular Talus Tibia This is the strongest largest bone of the lower leg. It bears weight and the bone creates
Year 2004 Paper one: Questions supplied by Megan
QUESTION 47 A 58yo man is noted to have a right foot drop three days following a right total hip replacement. On examination there is weakness of right ankle dorsiflexion and toe extension (grade 4/5).
musculoskeletal system anatomy nerves of the lower limb 2 done by: Dina sawadha & mohammad abukabeer
musculoskeletal system anatomy nerves of the lower limb 2 done by: Dina sawadha & mohammad abukabeer #Sacral plexus : emerges from the ventral rami of the spinal segments L4 - S4 and provides motor and
SURGICAL AND APPLIED ANATOMY
Página 1 de 9 Copyright 2001 Lippincott Williams & Wilkins Bucholz, Robert W., Heckman, James D. Rockwood & Green's Fractures in Adults, 5th Edition SURGICAL AND APPLIED ANATOMY Part of "47 - ANKLE FRACTURES"
Contents of the Posterior Fascial Compartment of the Thigh
Contents of the Posterior Fascial Compartment of the Thigh 1-Muscles: B i c e p s f e m o r i s S e m i t e n d i n o s u s S e m i m e m b r a n o s u s a small part of the adductor magnus (h a m s t
Understanding Leg Anatomy and Function THE UPPER LEG
Understanding Leg Anatomy and Function THE UPPER LEG The long thigh bone is the femur. It connects to the pelvis to form the hip joint and then extends down to meet the tibia (shin bone) at the knee joint.
Ulnar Neuropathy in the Distal Ulnar Tunnel
Ulnar Neuropathy in the Distal Ulnar Tunnel DAVID W. SHUPE, PT, ATC' Journal of Orthopaedic & Sports Physical Therapy A brief anatomical review of the ulnar nerve and areas of ulnar nerve entrapment is
Introduction to Anatomy. Dr. Maher Hadidi. Laith Al-Hawajreh. Mar/25 th /2013
Introduction to Anatomy Dr. Maher Hadidi Laith Al-Hawajreh 22 Mar/25 th /2013 Lower limb - The leg The skeleton of the leg is formed by two bones: 1) Medial: Tibia 2) Lateral: Fibula The two bones are
BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK Musculoskeletal Anatomy & Kinesiology KNEE & ANKLE MUSCLES
BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK Musculoskeletal Anatomy & Kinesiology KNEE & ANKLE MUSCLES MSAK201-I Session 3 1) REVIEW a) THIGH, LEG, ANKLE & FOOT i) Tibia Medial Malleolus
حسام أبو عوض. - Ahmad. 1 P a g e
- 9 حسام أبو عوض - - Ahmad 1 P a g e In the last lecture, we finished discussing the superficial part of the posterior compartment and the popliteus muscle of the deep layer[reminder: The entire posterior
Chronic Exertional Compartment Syndrome
Michael J. Fraipont, MD, and Gregory J. Adamson, MD Abstract Chronic exertional compartment syndrome is an often overlooked and uncommon cause of pain in the extremities of individuals who engage in repetitive
Compartment Syndrome
Compartment Syndrome Andrew H. Schmidt, M.D. Professor, Dept. of Orthopedic Surgery, Univ. of Minnesota Chief, Department of Orthopaedic Surgery Hennepin County Medical Center April 2016 Disclosure Information
musculoskeletal system anatomy muscles of foot sheet done by: dina sawadha & mohammad abukabeer
musculoskeletal system anatomy muscles of foot sheet done by: dina sawadha & mohammad abukabeer Extensor retinaculum : A- superior extensor retinaculum (SER) : originates from the distal ends of the tibia
POPLITEAL ARTERY ENTRAPMENT SYNDROME
POPLITEAL ARTERY ENTRAPMENT SYNDROME Background 1. Definition: Rare cause of exertional leg pain o Due to an abnormal relationship between popliteal artery and surrounding myofascial structures in popliteal
MIDFOOT INJURIES-ARE WE UNDERTREATING IT? Mr Rajiv Limaye Mr Prasad Karpe University Hospital of North Tees 3 rd Foot and Ankle Symposium
MIDFOOT INJURIES-ARE WE UNDERTREATING IT? Mr Rajiv Limaye Mr Prasad Karpe University Hospital of North Tees 3 rd Foot and Ankle Symposium Introduction Increasing sports injuries RTA and traumatic injuries
Feet First. Michael K. Cooper, DO FACOFP Family Practice/OMM St John Clinic - Claremore OOA 2018 Annual Convention
Feet First Michael K. Cooper, DO FACOFP Family Practice/OMM St John Clinic - Claremore OOA 2018 Annual Convention Disclaimer I have no conflict of interest. I am not on any pharmaceutical company payroll
Muscles of the Hip 1. Tensor Fasciae Latae O: iliac crest I: lateral femoral condyle Action: abducts the thigh Nerve: gluteal nerve
Muscles of the Hip 1. Tensor Fasciae Latae O: iliac crest I: lateral femoral condyle Action: abducts the thigh Nerve: gluteal nerve 2. Gluteus Maximus O: ilium I: femur Action: abduct the thigh Nerve:
Index. Clin Sports Med 23 (2004) Note: Page numbers of article titles are in boldface type.
Clin Sports Med 23 (2004) 169 173 Index Note: Page numbers of article titles are in boldface type. A Achilles enthesopathy, calcaneal spur with, 133 clinical presentation of, 135 136 definition of, 131
Located Deep to Flexor Retinaculum on medial aspect of ankle. Posterior to Posterior Tibial Artery. Tom, Dick, and Very Nervous Harry
ANKLE BLOCK ANESTHESIA GREGORY CLARK D.P.M. HEAD, SECTION OF PODIATRY SCRIPPS CLINIC LA JOLLA, CALIFORNIA A METHOD BY WHICH ONE MAY PROVIDE AN ANESTHETIC BLOCK TO THE FOOT OR ANKLE WITH A MINIMUM OF PATIENT
Hany El-Rashidy and Anand Vora
Chapter 194 Lisfranc Injuries Chapter 194 Lisfranc Injuries Hany El-Rashidy and Anand Vora 8 ICD-9 CODE 838.03 Lisfranc (Tarsometatarsal) Fracture-Dislocation Key Concepts The Lisfranc joint represents
The course of the superficial peroneal nerve in relation to the ankle position: anatomical study with ankle arthroscopic implications
Knee Surg Sports Traumatol Arthrosc (2010) 18:612 617 DOI 10.1007/s00167-010-1099-z ANKLE The course of the superficial peroneal nerve in relation to the ankle position: anatomical study with ankle arthroscopic
myofascial techniques BY TIL LUCHAU
myofascial techniques BY TIL LUCHAU There is a continuous line of connection from the gastrocnemius/soleus to the plantar fascia (whose fibrous aponeuroses are shown here in salmon). A lack of resilience
Everything. You Should Know. About Your Ankles
Everything You Should Know About Your Ankles How Your Ankle Works The ankle joint is a hinge type joint that participates in movement and is involved in lower limb stability. There are 2 types of motions
Compartment Syndrome Associated with Tibial Fracture* 1
Compartment Syndrome Associated with Tibial Fracture* 1 BY PAUL TORNETTA, III, M.D4, BROOKLYN, NEW YORK, AND DAVID TEMPLEMAN, M.D.ij, MINNEAPOLIS, MINNESOTA An Instructional Course Lecture, The American
Anatomic Landmarks for the Radial Tunnel
Anatomic Landmarks for the Radial Tunnel Ron Hazani, MD, Nitin J. Engineer, MD, Arian Mowlavi, MD, Michael Neumeister, MD, W.P. Andrew Lee, MD, and Bradon J. Wilhelmi, MD Division of Plastic and Reconstructive
Dr. Gene Desepoli Anterolateral Shin Splints Summary Treatment Sheet
Dr. Gene Desepoli Anterolateral Shin Splints Summary Treatment Sheet Pathology: Anterolateral shin splints results from strain to the tibialis anterior muscle from eccentric overuse, running on hard ground
Arthroscopy Of the Ankle.
Arthroscopy Of the Ankle www.fisiokinesiterapia.biz Ankle Arthroscopy Anatomy Patient setup Portal placement Procedures Complications Anatomy Portals Anterior Anteromedial Anterolateral Anterocentral Posterior
ANTERIOR ANKLE IMPINGEMENT
ANTERIOR ANKLE IMPINGEMENT Description Possible Complications Pinching of bone or soft tissue, including scar tissue, at the Frequent recurrence of symptoms, resulting in chronically front of the ankle
Common Peroneal Nerve Entrapment in the Differential Diagnosis of Chronic Exertional Compartment Syndrome of the Lateral Lower Leg
Common Peroneal Nerve Entrapment in the Differential Diagnosis of Chronic Exertional Compartment Syndrome of the Lateral Lower Leg A Report of 5 Cases Aniek P.M. van Zantvoort,* MD, MSc, Maikel J.M. Setz,
Case Example. Nerve Entrapments in the Lower limb
Nerve Entrapments in the Lower limb February, 2013 William S. Pease, M.D. Ernest W. Johnson Professor of PM&R Case Example CC: Right ankle dorsiflexion weakness with minimal paresthesias HPI: 87 year-old
Awad Alsaidi محمد الشطناوي. Ahmad
12 Awad Alsaidi محمد الشطناوي Ahmad Clinical applications on the lower limb (injuries) 1. Common Peroneal nerve injury: *The common peroneal nerve is exposed to a high risk of injury, due to its course
Multiple variations involving all the terminal branches of the brachial plexus and the axillary artery a case report
SHORT REPORT Eur J Anat, 10 (3): 61-66 (2006) Multiple variations involving all the terminal branches of the brachial plexus and the axillary artery a case report K. Ramachandran, I. Kanakasabapathy and
Interesting Case Series. Posterior Interosseous Nerve Compression
Interesting Case Series Posterior Interosseous Nerve Compression Jeon Cha, BMedSci, MBBS, Blair York, MBChB, and John Tawfik, MBBS, BPharm, FRACS The Sydney Hospital Hand Unit, Sydney Hospital and Sydney
1. Split the evaluation form into four sections 2. Different sections on form
1. Split the evaluation form into four sections a. 1 st year student does history/observation/palpation b. 2 nd year student does muscle testing/rom c. 3 rd year student does stress testing d. 4 th year
DISSECTION SCHEDULE. Session I - Hip (Front) & Thigh (Superficial)
DISSECTION SCHEDULE Session I - Hip (Front) & Thigh (Superficial) Surface anatomy Inguinal region Gluteal region Thigh Leg Foot bones Hip bone Femur Superficial fascia Great saphenous vein Superficial
Case Presentation MATT WORONCZAK ADVANCED MUSCULOSKELETAL PHYSIOTHERAPIST DANDENONG HOSPITAL VICTORIA
Case Presentation MATT WORONCZAK ADVANCED MUSCULOSKELETAL PHYSIOTHERAPIST DANDENONG HOSPITAL VICTORIA Scenario Supervising an intern 22 year old male playing soccer yesterday, rolled ankle and unable to
Dorsal surface-the upper area or top of the foot. Terminology
It is important to learn the terminology as it relates to feet to properly communicate with referring physicians when necessary and to identify the relationship between the anatomical structure of the
Ankle Sprains and Their Imitators
Ankle Sprains and Their Imitators Mark Halstead, MD Dr. Mark Halstead is the Associate Professor of the Departments of Orthopedics and Pediatrics at Washington University School of Medicine; Director of
Ankle Arthroscopy.
Ankle Arthroscopy Key words: Ankle pain, ankle arthroscopy, ankle sprain, ankle stiffness, day case surgery, articular cartilage, chondral injury, chondral defect, anti-inflammatory medication Our understanding
Dr. Mahir Alhadidi Anatomy Lecture #9 Feb,28 th 2012
Quick Revision: Upper arm is divided into two compartments: 1. Anterior Compartment: Contains three muscles (Biceps brachii, Coracobrachialis, Brachialis). Innervated by Musculocutaneous nerve. 2. Posterior
Compartmental Syndromes: When the Pressure Gets Too Great
FREDERICK A. MATSEN III, M.D. PROFESSOR AND CHAIRMAN UNIVERSITY OF WASHINGTON MEDICAL CENTER SHOULDER AND ELBOW WWW.ORTHOP.WASHINGTON.EDU/FACULTY/MATSEN Compartmental Syndromes: When the Pressure Gets
Endoscopic Soft Tissue Release System. SafeViewTM 360 Panoramic Visualization Sterile Packaged Fully Disposable
L O W E R E X T R E M I T Y T E C H N I Q U E G U I D E Endoscopic Soft Tissue Release System SafeViewTM 360 Panoramic Visualization Sterile Packaged Fully Disposable Versatility and Control SafeView is