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Journal of Computer Assisted Tomography 2001The purpose of this work was to demonstrate nerve anatomy of the medial plantar (MP) and lateral plantar (LP) nerves and the first branch of the lateral plantar (FBLP)...
PURPOSE
The purpose of this work was to demonstrate nerve anatomy of the medial plantar (MP) and lateral plantar (LP) nerves and the first branch of the lateral plantar (FBLP) nerve as depicted with MRI.
METHOD
High resolution MRI of the heel was performed with a standard transmit-receive extremity coil in six human cadaveric specimens using sagittal, axial, and coronal T1-weighted spin echo images. The specimens were then sectioned in the axial and coronal planes.
RESULTS
MRI depicted the MP and LP nerves arising from the posterior tibial (PT) nerve. Assessment of the anatomic course and trifurcation of the PT nerve into the plantar nerves and the FBLP nerve was best seen in the sagittal plane. Various portions of these nerves were visualized also in the axial and coronal imaging planes.
CONCLUSION
MRI may demonstrate the origin, course, and branching of nerves in the heel and can provide a means for assessment of the patient presenting with chronic heel pain and suspected entrapment neuropathy.
Topics: Aged; Aged, 80 and over; Cadaver; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Tibial Nerve
PubMed: 11351192
DOI: 10.1097/00004728-200105000-00014 -
The American Journal of Dermatopathology Jul 2015We report an unusual case of a fibrolipomatous hamartoma that arose in a nuchal nerve. Typically, fibrolipomatous hamartoma, otherwise known as a neural fibrolipoma or... (Review)
Review
We report an unusual case of a fibrolipomatous hamartoma that arose in a nuchal nerve. Typically, fibrolipomatous hamartoma, otherwise known as a neural fibrolipoma or lipomatosis of nerve, arises in the median nerve, brachial plexus, cranial nerves, or plantar nerves. The differential diagnosis is broad and includes benign and malignant spindle cell lesions, such as spindle cell lipoma, perineurioma, and myxoid liposarcoma. We were able to identify the lesion based on the typical histology, including triphasic composition with spindle cell, neural, and adipocytic components and whorled architecture. Because of the atypical location in the neck, detailed immunohistochemical staining was performed. The lesional spindle cells were negative for SMA, CD10, CD68, EMA, S100, PGP9.5, CD34, CD56, and beta-catenin. Colloidal iron stain highlighted marked intralesional mucin deposition. This detailed immunohistochemical profile is a useful diagnostic aid and to our knowledge has not been previously described.
Topics: Adult; Diagnosis, Differential; Hamartoma; Humans; Male; Neck; Peripheral Nervous System Neoplasms
PubMed: 25033011
DOI: 10.1097/DAD.0000000000000129 -
Annals of Anatomy = Anatomischer... Feb 2023Various mouse and rat models of neuropathic pain after nerve injury exist. Whilst some models involve a proximal nerve lesion or ligation of the sciatic trifurcation in...
INTRODUCTION
Various mouse and rat models of neuropathic pain after nerve injury exist. Whilst some models involve a proximal nerve lesion or ligation of the sciatic trifurcation in mice and rats, others consists of a transection or ligation of distal nerves at the tibial bifurcation in mice or rats. The level of nerve cut directly affects the magnitude of hypersensitivity, and anatomical differences between mice and rats might therefore impact the development of hypersensitivity after distal tibial nerve transection as well.
METHODS
The bifurcation of the distal tibial nerve into the medial and lateral plantar nerve (MPN and LPN), and the presence of anatomical differences in sural and tibial nerve distribution between mice and rat was evaluated. Sural mechanical sensitivity after transection of the MPN or whole tibial nerve was assessed using von Frey test until 8 weeks after surgery in 48 rats and 16 mice.
RESULTS
The bifurcation of the tibial nerve into the MPN and LPN is situated proximal to the ankle in both mice and rats. The sural nerve joins the LPN in mice, but not in rats. A proximal communicating branch is present between the LPN and MPN in rats, but not in mice. MPN transection in mice caused hypersensitivity of the hindpaw innervated by the sural nerve, but not in rats. In rats, sural hypersensitivity only developed when both MPN and LPN were cut.
CONCLUSION
Inter-species variation in nerve anatomy should be taken in consideration when performing surgery to induce plantar hypersensitivity in rodents.
Topics: Rats; Animals; Tibial Nerve; Sural Nerve; Foot; Neurosurgical Procedures; Sciatic Nerve
PubMed: 36436721
DOI: 10.1016/j.aanat.2022.152038 -
Clinical Neurophysiology Practice 2019The purpose of this report is to recommend evidence-based strategies for polyneuropathy (PNP) electrodiagnosis based on a large cohort of patients examined... (Review)
Review
The purpose of this report is to recommend evidence-based strategies for polyneuropathy (PNP) electrodiagnosis based on a large cohort of patients examined prospectively. Nerve conduction studies (NCS) of bilateral tibial, peroneal and sural nerves, the latter with both near-nerve-technique (NNT) and surface recordings, were done in 313 patients with clinically suspected PNP. Bilateral dorsal sural and medial plantar nerves, and unilateral median and ulnar nerves were further examined in a subgroup of patients. The final clinical diagnosis retrieved from the patientś medical records 1-6 years after the neurophysiological investigation served as diagnostic reference standard. The clinical follow-up diagnosis confirmed PNP in 219 patients. The tibial nerve was the most sensitive nerve (75%), with prolonged tibial F-wave as the most sensitive parameter (72%). Sural NNT recordings were more sensitive (66%) than surface recordings (49%) (p < 0.05), however, dorsal sural (68%) and medial planter (70%) nerves had similar sensitivities as NNT. There was no side difference in the incidence of abnormality for any nerve. Based on these results, we recommend a strategy starting with tibial and sural NCS on one side for electrophysiological screening for distal symmetric PNP. If one of these is abnormal, we recommend examining the other lower and upper extremity nerves, including distal sensory nerves, particularly if NNT is not applicable. While one abnormal parameter is sufficient to interpret a nerve as abnormal, we recommend at least two abnormal nerves for PNP diagnosis, preferentially one being the sural nerve. We believe that the strategies recommended in this study may improve PNP electrodiagnosis.
PubMed: 31886447
DOI: 10.1016/j.cnp.2019.10.005 -
American Journal of Veterinary Research Jun 2024The objective of this study was to optimize an MRI-based diffusion tensor imaging (DTI) protocol for imaging the plantar nerves at the level of the tarsus in normal...
OBJECTIVE
The objective of this study was to optimize an MRI-based diffusion tensor imaging (DTI) protocol for imaging the plantar nerves at the level of the tarsus in normal equine limbs.
SAMPLE
12 pelvic cadaver limbs from horses without evidence of proximal suspensory pathology were imaged with a 3T MRI system.
METHODS
For diffusion-weighted imaging, b values of 600, 800, and 1,000 s/mm2 were tested. Data were processed with DSI Studio. Cross-sectional areas of the medial and lateral plantar nerve along the plantar tarsus were recorded. The length and number of fiber tracts, signal-to-noise ratio, and DTI variables were recorded.
RESULTS
At the level of interest, the mean cross-sectional areas of the plantar nerves ranged from 5.03 to 7.42 mm2. The DTI maps consistently generated tracts in the region of the lateral and medial plantar nerves with DTI values in the range of values reported for peripheral nerves in humans. Our findings demonstrate that DTI of the medial and lateral plantar nerves can be performed successfully and used to generate quantitative parameters including fractional anisotropy and mean, axial, and radial diffusivity.
CLINICAL RELEVANCE
Quantitative data generated with this imaging technique can be used to noninvasively characterize the microstructural integrity of neural tissue with possible applications in the evaluation of pathologic changes to the plantar tarsal and metatarsal nerves of horses with proximal suspensory desmopathy.
PubMed: 38889743
DOI: 10.2460/ajvr.24.03.0092 -
Journal of Neurology, Neurosurgery, and... Dec 1977A method for recording the medial plantar sensory nerve action potential at the ankle with surface electrodes is described. Normal values in 69 control subjects are... (Comparative Study)
Comparative Study
Sensory conduction in medial plantar nerve: normal values, clinical applications, and a comparison with the sural and upper limb sensory nerve action potentials in peripheral neuropathy.
A method for recording the medial plantar sensory nerve action potential at the ankle with surface electrodes is described. Normal values in 69 control subjects are given and compared with the sural sensory nerve action potential in the same limb in the same subjects. Clinical applications were studied in 33 patients. The procedure may be applied in the diagnosis of L4-5 nerve plexus or root lesions, lesions of the sciatic, posterior tibial, and medial plantar nerves, and is a more sensitive test than other sensory nerve action potentials in the diagnosis of peripheral neuropathy.
Topics: Action Potentials; Adolescent; Adult; Aged; Ankle; Electromyography; Female; Foot; Humans; Leg; Male; Middle Aged; Motor Neurons; Neural Conduction; Neuromuscular Diseases; Peripheral Nervous System Diseases; Sciatic Nerve; Sensory Receptor Cells; Spinal Nerve Roots; Spinal Nerves; Sural Nerve
PubMed: 201733
DOI: 10.1136/jnnp.40.12.1168 -
The International Journal of... Apr 2017We proposed a new electrophysiological parameter medial plantar (MP)-to-radial amplitude ratio (MPRAR), similar to sural-to-radial amplitude ratio (SRAR), in the...
PURPOSE OF THE STUDY
We proposed a new electrophysiological parameter medial plantar (MP)-to-radial amplitude ratio (MPRAR), similar to sural-to-radial amplitude ratio (SRAR), in the diagnosis of distal sensory polyneuropathy (DSP), based on the concept that distal nerves are affected more and earlier than proximal nerves in axonal neuropathies. We aimed to investigate the diagnostic sensitivity of this parameter in diabetic DSP, together with sensitivities of SRAR and MP nerve action potential (NAP) amplitude.
MATERIALS AND METHODS
In 124 healthy controls and 87 diabetic patients with clinically defined DSP and normal sural responses, we prospectively performed sensory nerve conduction studies (NCS), and evaluated the MP NAP amplitude, MPRAR and SRAR values. We determined the lower limits of normal (LLN) of these parameters in the healthy controls and calculated their sensitivities and specificities in detecting DSP in diabetic patients.
RESULTS
MP nerve amplitude and MPRAR values were significantly lower in the patient group, compared to controls. However, SRAR values did not differ significantly between the two groups. The LLN of MP NAP amplitude was found to be 4.1 μV. The cutoff values for SRAR and MPRAR were determined as 0.24 and 0.16, respectively. MPRAR was abnormal in 21.8% of patients. However, the most sensitive parameter in detection of DSP was MP NAP amplitude, which showed a sensitivity of 31% and a specificity of 100%.
CONCLUSIONS
Although MPRAR is more sensitive than SRAR in detecting DSP, it does not provide additional diagnostic yield to the assessment of MP NCS alone in diabetic DSP patients with normal sural responses.
Topics: Action Potentials; Adult; Aged; Diabetic Neuropathies; Electric Stimulation; Electrodiagnosis; Female; Foot; Humans; Male; Middle Aged; Neural Conduction; Sural Nerve
PubMed: 27043973
DOI: 10.3109/00207454.2016.1174119 -
Muscle & Nerve Mar 2018In this study we report the diagnostic value of the near-nerve needle sensory nerve conduction study (NNN-SNCS) in sensory inflammatory demyelinating polyneuropathy...
INTRODUCTION
In this study we report the diagnostic value of the near-nerve needle sensory nerve conduction study (NNN-SNCS) in sensory inflammatory demyelinating polyneuropathy (IDP) in which the routine nerve conduction study was normal or non-diagnostic.
METHODS
The NNN-SNCS was performed to identify demyelination in the plantar nerves in 14 patients and in the median or ulnar nerve in 2 patients with sensory IDP.
RESULTS
In 16 patients with sensory IDP, routine NCSs were either normal or non-diagnostic for demyelination. Demyelination was identified by NNN-SNCS by dispersion and/or slow nerve conduction velocity (NCV) below the demyelination marker. Immunotherapy was initiated in 11 patients, 10 of whom improved or remained stable.
DISCUSSION
NNN-SNCS played an essential role in identifying demyelinaton in 16 patients with sensory IDP, leading to proper treatment. Muscle Nerve 57: 414-418, 2018.
Topics: Adult; Demyelinating Diseases; Electrodiagnosis; Female; Humans; Male; Median Nerve; Middle Aged; Neural Conduction; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Sensory Receptor Cells; Ulnar Nerve
PubMed: 28796344
DOI: 10.1002/mus.25761 -
Journal of Reconstructive Microsurgery Feb 2006The search for better surgical repair of nerve injuries should be aimed at uncovering alternatives that not only are efficient, but also enhance nerve growth. The...
The search for better surgical repair of nerve injuries should be aimed at uncovering alternatives that not only are efficient, but also enhance nerve growth. The purpose of this study was to compare functional nerve responses following repair with either a traditional microsuture technique or Quixil human fibrin sealant. Thirty female Lewis rats received transection of the right sciatic nerve. Nerve repair was achieved with either epineurial microsuture (n = 15) or Quixil fibrin glue (n = 15). Functional results were assessed at 2, 6, and 12 weeks postoperatively with walking-track analysis. Electrophysiologic nerve recordings were also performed 12 weeks postoperatively. Rats receiving Quixil nerve repair returned to baseline performance on the walking-track analysis significantly faster than those with microsuture repairs (6 and 12 weeks postoperatively; p < 0.0001). Recovery of nerve conduction velocities and wave amplitudes was also significantly better in the nerves repaired with Quixil than in those repaired with microsuture (p's < 0.0001). Quixil human fibrin sealant is a good alternative to traditional microsuture nerve repair techniques.
Topics: Animals; Electrophysiology; Female; Fibrin Tissue Adhesive; Microsurgery; Nerve Regeneration; Neural Conduction; Peripheral Nerve Injuries; Peripheral Nerves; Rats; Rats, Inbred Lew; Suture Techniques
PubMed: 16456772
DOI: 10.1055/s-2006-932506 -
Foot (Edinburgh, Scotland) Sep 2014Plexiform neurofibromas are benign tumors of the peripheral nerve. Diagnosis may be challenging, if they present mimicking other peripheral nerve pathologies. We report...
Plexiform neurofibromas are benign tumors of the peripheral nerve. Diagnosis may be challenging, if they present mimicking other peripheral nerve pathologies. We report the case of a patient who had severe foot pain, which progressively hampered her walking ability, erroneously attributed to recurrent Morton's neuroma. Diagnosis of plexiform neurofibroma of her right medial plantar nerve was made 15 years after the appearance of symptoms. Pain and function recovered after radical neurotomy of the medial plantar nerve. A correct diagnosis is an essential starting point in the treatment of neurofibromas and a misdiagnosis may lead to an inappropriate treatment.
Topics: Adult; Diagnosis, Differential; Diagnostic Errors; Female; Foot; Humans; Magnetic Resonance Imaging; Neurofibroma, Plexiform; Peripheral Nerves; Peripheral Nervous System Neoplasms
PubMed: 25024003
DOI: 10.1016/j.foot.2014.06.001