Anatomic Site for Proximal Tibial Nerve Compression

Williams, Eric H.; Williams, Colin J.; Rosson, Gedge D.; Dellon, Lee A.

doi:10.1097/sap.0b013e31817e9d81

Cited by 40 publications

(20 citation statements)

References 27 publications

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“…[27][28][29] Tibial nerve injury in Zone III, i.e. the soleal sling, did emerge as one of the zones independently associated with the clinical score.…”

Section: Zones Of Injurymentioning

confidence: 99%

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Reddy

Amrami

Howe

et al. 2015

FOC

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OBJECT Knee dislocations are often accompanied by stretch injuries to the common peroneal nerve (CPN). A small subset of these injuries also affect the tibial nerve. The mechanism of this combined pattern could be a single longitudinal stretch injury of the CPN extending to the sciatic bifurcation (and tibial division) or separate injuries of both the CPN and tibial nerve, either at the level of the tibiofemoral joint or distally at the soleal sling and fibular neck. The authors reviewed cases involving patients with knee dislocations with CPN and tibial nerve injuries to determine the localization of the combined injury and correlation between degree of MRI appearance and clinical severity of nerve injury. METHODS Three groups of cases were reviewed. Group 1 consisted of knee dislocations with clinical evidence of nerve injury (n = 28, including 19 cases of complete CPN injury); Group 2 consisted of knee dislocations without clinical evidence of nerve injury (n = 19); and Group 3 consisted of cases of minor knee trauma but without knee dislocation (n = 14). All patients had an MRI study of the knee performed within 3 months of injury. MRI appearance of tibial and common peroneal nerve injury was scored by 2 independent radiologists in 3 zones (Zone I, sciatic bifurcation; Zone II, knee joint; and Zone III, soleal sling and fibular neck) on a severity scale of 1–4. Injury signal was scored as diffuse or focal for each nerve in each of the 3 zones. A clinical score was also calculated based on Medical Research Council scores for strength in the tibial and peroneal nerve distributions, combined with electrophysiological data, when available, and correlated with the MRI injury score. RESULTS Nearly all of the nerve segments visualized in Groups 1 and 2 demonstrated some degree of injury on MRI (95%), compared with 12% of nerve segments in Group 3. MRI nerve injury scores were significantly more severe in Group 1 relative to Group 2 (2.06 vs 1.24, p < 0.001) and Group 2 relative to Group 3 (1.24 vs 0.13, p < 0.001). In both groups of patients with knee dislocations (Groups 1 and 2), the MRI nerve injury score was significantly higher for CPN than tibial nerve (2.72 vs 1.40 for Group 1, p < 0.001; 1.39 vs 1.09 for Group 2, p < 0.05). The clinical injury score had a significantly strong correlation with the MRI injury score for the CPN (r = 0.75, p < 0.001), but not for the tibial nerve (r = 0.07, p = 0.83). CONCLUSIONS MRI is highly sensitive in detecting subclinical nerve injury. In knee dislocation, clinical tibial nerve injury is always associated with simultaneous CPN injury, but tibial nerve function is never worse than peroneal nerve function. The point of maximum injury can occur in any of 3 zones.

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“…[27][28][29] Tibial nerve injury in Zone III, i.e. the soleal sling, did emerge as one of the zones independently associated with the clinical score.…”

Section: Zones Of Injurymentioning

confidence: 99%

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Reddy

Amrami

Howe

et al. 2015

FOC

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“…Moreover, the finding offers promise for those patients who have persistent plantar numbness after tarsal tunnel decompression [9,19].…”

Section: Discussionmentioning

confidence: 99%

“…In 2009, Williams et al [19] dissected 36 cadaver extremities and found that in 8 % (three of 36) of specimens a focal narrowing existed directly under this tendinous arch. Their anatomical study demonstrated that the tendinous arch of the soleus muscle may act as a potential compression site of the tibial nerve.…”

Section: Discussionmentioning

confidence: 99%

Earthquake generated proximal tibial nerve compression treated by surgery

Tang¹,

He²,

Chen³

et al. 2013

International Orthopaedics (SICOT)

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Purpose This article reports on nine cases of proximal tibial nerve compression by the soleal tendinous arch caused by unsuitable treatment of acute compartment syndrome (ACS). Also, we report the clinical results of neurolysis and analyse the cause of this special type of neurological compression. Methods There were nine extremities in nine patients included in the study. All patients were among the victims of the Wenchuan earthquake in 2008. All patients had a previous lower extremity ACS. Pain level, numbness in the sole, muscle strength of the flexor hallucis longus and Tinel's sign were evaluated pre-and post-operatively. Each proximal tibial nerve compression was subjected to neurolysis with division of the soleal tendinous arch. Results At a mean follow-up of 22 months, eight patients (87 %) with weakness of the flexor hallucis longus showed improvement in flexor strength and seven patients (78 %) exhibited improved sensory function in the sole. All patients experienced pain relief. Subjective pain was reduced from an average score of 2.7 to 0.7 based on a visual analogue scale. Physical examination for Tinel's sign revealed all patients experienced relief of radiating pain, but two patients still retained a positive Tinel's sign (mild) over the soleal tendinous arch. In summary, four patients were highly satisfied, four were satisfied and one was neither satisfied nor dissatisfied with functional recovery after neurolysis. Conclusions Unsuitable treatment of lower extremity ACS can lead to tibial nerve compression beneath the soleal tendinous arch. Neurolysis may improve pain and sensory and motor function.

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“…The SA is usually found around 9 cm distally to the medial tibia plateau [13], where cross-section areas and regional blurring/loss of fascicular texture of the TN can be evaluated. The TN Fig 1. Illustration of the course of the tibial nerve along the popliteal artery to the soleus arcade, where compression of the nerve occurred -complicated by a ganglionic cyst (blue colour) extending along the neurovascular bundle (a).…”

Section: Discussionmentioning

confidence: 99%

A rare case of an acute soleus arcade syndrome complicated by a ganglion cyst: diagnosis by dynamic ultrasound

et al. 2017

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The soleus arcade syndrome is a rare compression neuropathy of the tibial nerve that often remains undiagnosed due to low clinical awareness and difficult diagnosis. We present the case of a female patient admitted with acute worsening of a pre-existing sensory tibial neuropathy and acute tibial nerve palsy after knee joint injection. After a knee magnetic resonance imaging remained non-diagnostic, dynamic ultrasonography was performed. Constriction by the soleus arcade and proximal swelling of the tibial nerve could be demonstrated during plantarflexion of the ankle by means of a dynamic examination in the standing patient. The patient underwent surgery and recovered fully. This proposed diagnostic approach can be used to identify soleus arcade syndrome by ultrasound.

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Anatomic Site for Proximal Tibial Nerve Compression

Cited by 40 publications

References 27 publications

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Earthquake generated proximal tibial nerve compression treated by surgery

A rare case of an acute soleus arcade syndrome complicated by a ganglion cyst: diagnosis by dynamic ultrasound

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