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Insights Into Imaging Oct 2023Peripheral nerves of the lower limb may become entrapped at various points during their anatomical course. While clinical assessment and nerve conduction studies are the... (Review)
Review
Peripheral nerves of the lower limb may become entrapped at various points during their anatomical course. While clinical assessment and nerve conduction studies are the mainstay of diagnosis, there are multiple imaging options, specifically ultrasound and magnetic resonance imaging (MRI), which offer important information about the potential cause and location of nerve entrapment that can help guide management. This article overviews the anatomical course of various lower limb nerves, including the sciatic nerve, tibial nerve, medial plantar nerve, lateral plantar nerve, digital nerves, common peroneal nerve, deep peroneal nerve, superficial peroneal nerve, sural nerve, obturator nerve, lateral femoral cutaneous nerve and femoral nerve. The common locations and causes of entrapments for each of the nerves are explained. Common ultrasound and MRI findings of nerve entrapments, direct and indirect, are described, and various examples of the more commonly observed cases of lower limb nerve entrapments are provided.Critical relevance statement This article describes the common sites of lower limb nerve entrapments and their imaging features. It equips radiologists with the knowledge needed to approach the assessment of entrapment neuropathies, which are a critically important cause of pain and functional impairment.Key points• Ultrasound and MRI are commonly used to investigate nerve entrapment syndromes.• Ultrasound findings include nerve hypo-echogenicity, calibre changes and the sonographic Tinel's sign.• MRI findings include increased nerve T2 signal, muscle atrophy and denervation oedema.• Imaging can reveal causative lesions, including scarring, masses and anatomical variants.
PubMed: 37782348
DOI: 10.1186/s13244-023-01514-6 -
Diagnostics (Basel, Switzerland) Nov 2023Entrapment neuropathies of the lower limb are a misunderstood and underdiagnosed group of disorders, characterized by pain and dysesthesia, muscular weakness, and... (Review)
Review
Entrapment neuropathies of the lower limb are a misunderstood and underdiagnosed group of disorders, characterized by pain and dysesthesia, muscular weakness, and specific provoking movements on physical examination. The most frequent of these syndromes encountered in clinical practice are fibular nerve entrapment, proximal tibial neuropathy, sural nerve neuropathy, deep gluteal syndrome or sciatic nerve entrapment, and lateral femoral cutaneous nerve entrapment, also known as meralgia paresthetica. These are commonly mistaken for lumbar plexopathies, radiculopathies, and musculotendinous diseases, which appear even more frequently and have overlapping clinical presentations. A comprehensive anamnesis, physical examination, and electrodiagnostic studies should help clarify the diagnosis. If the diagnosis is still unclear or a secondary cause of entrapment is suspected, magnetic resonance neurography, MRI, or ultrasonography should be conducted to clarify the etiology, rule out other diseases, and confirm the diagnosis. The aim of this narrative review was to help clinicians gain familiarity with this disease, with an increase in diagnostic confidence, leading to early diagnosis of nerve damage and prevention of muscle atrophy. We reviewed the epidemiology, anatomy, pathophysiology, etiology, clinical presentation, and EDX technique and interpretation of the entrapment neuropathies of the lower limb, using articles published from 1970 to 2022 included in the Pubmed, MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Scopus databases.
PubMed: 37958280
DOI: 10.3390/diagnostics13213385 -
Journal of Orthopaedic Surgery and... Sep 2023We aimed to describe anatomical landmarks to accurately locate the five nerves that are infiltrated to accomplish anaesthesia of the foot in an ankle block. Twenty-four...
We aimed to describe anatomical landmarks to accurately locate the five nerves that are infiltrated to accomplish anaesthesia of the foot in an ankle block. Twenty-four formaldehyde-fixed cadaveric ankles were studied. Photographs of cross sections of the frozen legs, cut at a horizontal plane across the most prominent points of the medial and lateral malleoli, were analysed. The curvilinear distance from the most prominent point of the closest malleolus to each of the five cutaneous nerves and their depth from the skin surface were measured. Sural, tibial, deep peroneal, saphenous and medial dorsal cutaneous nerves were located 5.2 ± 1.3, 9.2 ± 2.4, 7.4 ± 1.9, 2.8 ± 1.1, 2.1 ± 0.6 mm deep to the skin surface. The curvilinear distances from the medial malleolus to the tibial, deep peroneal and saphenous nerves were 32.5 ± 8.9, 62.8 ± 11.1 and 24.4 ± 7.9 mm, respectively. The curvilinear distances from the lateral malleolus to the sural and medial dorsal cutaneous branches of superficial peroneal nerves were 27.9 ± 6.3 and 52.7 ± 7.3 mm, respectively. The deep peroneal nerve was found between the tendons of the extensor hallucis longus and the extensor digitorum longus in the majority of specimens, while the medial dorsal cutaneous nerve was almost exclusively found on the extensor digitorum longus tendon. The sural and tibial nerves were located around halfway between the most prominent point of the relevant malleolus and the posterior border of the Achilles tendon. In conclusion, this study describes easily identifiable, palpable bony and soft tissue landmarks that could be used to locate the nerves around the ankle.
Topics: Humans; Ankle; Nerve Block; Lower Extremity; Leg; Achilles Tendon
PubMed: 37674225
DOI: 10.1186/s13018-023-04039-2 -
Tzu Chi Medical Journal 2024Achilles tendon rupture is a common and primary cause of lower limb tendon injury suffered during sports-related activities. The causes of Achilles tendon rupture... (Review)
Review
Achilles tendon rupture is a common and primary cause of lower limb tendon injury suffered during sports-related activities. The causes of Achilles tendon rupture include the calf muscle and tendon overuse, poor tendon quality, and various medical conditions. Historically, acute Achilles tendon rupture was treated conservatively. However, historical techniques are now associated with an increased risk of rerupture. To address this problem, open repair has been proposed. Open repair is associated with a reduced risk of rerupture; however, it is also closely associated with wound complications, like wound infection, whose treatment is time-consuming and costly. Therefore, minimally invasive Achilles tendon repair has been proposed as a promising option with acceptable functional outcomes. Nevertheless, despite its benefits, minimally invasive Achilles tendon repair is associated with increased risks of sural nerve injury and rerupture. In this review, we evaluate the currently used treatment strategies for acute Achilles tendon rupture and their historical evolution to provide evidence-based recommendations for physicians.
PubMed: 38406567
DOI: 10.4103/tcmj.tcmj_113_23