Neuropathy of the Sural Nerve Caused by External Pressure

Birbilis, Theodosios; Ludwig, Hans; Markakis, E.

doi:10.1007/s007010070085

Cited by 11 publications

(11 citation statements)

References 3 publications

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“…A search of our database containing over 50,000 electrodiagnostic studies resulted in the 36 cases of sural neuropathy described herein, which represents the largest reported sample of sural mononeuropathies, at least to our knowledge. Trauma is the most frequently cited cause of sural neuropathy in the literature and neuropathies secondary to ankle fracture,10, 16, 24 trauma,4, 7, 18, 20, 21, 24 and external compression at the ankle have been reported 2, 5, 11, 19, 22, 24. Structural lesions secondary to Baker's cyst15 and intraneural ganglions1, 17 have also been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Trauma is the most frequently cited cause of sural neuropathy in the literature and neuropathies secondary to ankle fracture, 10,16,24 trauma, 4,7,18,20,21,24 and external compression at the ankle have been reported. 2,5,11,19,22,24 Structural lesions secondary to Baker's cyst 15 and intraneural ganglions 1,17 have also been reported. Sural neuropathy is also an uncommon complication of ankle surgery, and cases similar to our vein-stripping neuropathy 14,24,26 and neuropathy following sural harvesting for nerve graft 25 have been reported.…”

Section: Discussionmentioning

confidence: 99%

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Sural neuropathy: Etiologies and predisposing factors

2006

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Isolated sural neuropathy is an uncommon diagnosis. We identified 36 patients with isolated sural neuropathy. Sixteen had various forms of ankle trauma, in three of whom the associated sural neuropathies developed following medical intervention. Three patients developed sural neuropathy associated with vasculitis, and there were single patients with schwannoma and ganglionic cyst. In patients without a history of trauma, structural causes, such as schwannoma or ganglionic cysts and vasculitis, should be considered and managed as appropriate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sural neuropathy: Etiologies and predisposing factors

2006

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“…The provocation of a painful nerve is confirmed when the provoked symptoms are changed when the neck is flexed while the modified straight leg raise position is maintained (see Figure 9). In addition, the sural nerve can be irritated by external pressure against the nerve, 201 after achilles tendon rupture or repair, 202,203 or after inversion trauma, resulting in posteror lateral ankle pain. This affliction can mimic peroneal tenosynovitis 204 and is provoked with a modified straight leg raise procedure similar to the superficial peroneal nerve, only with the ankle/foot positioned in dorsiflexion and inversion (see Figure 10).…”

Section: Diagnostic Interpretation and Managementmentioning

confidence: 99%

Diagnosis and Management of the Painful Ankle/Foot. Part 2: Examination, Interpretation, and Management

Sizer

Phelps²,

Dedrick

et al. 2003

Pain Practice

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Diagnosis, interpretation, and subsequent management of ankle/foot pathology can be challenging to clinicians. A sensitive and specific physical examination is the strategy of choice for diagnosing selected ankle/foot injuries and additional diagnostic procedures, at considerable cost, may not provide additional information for clinical diagnosis and management. Because of a distal location in the sclerotome and the reduced convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns are low and the localization of symptoms is trustworthy. Effective management of the painful ankle/foot is closely linked to a tissue-specific clinical examination. The examination of the ankle/foot should include passive and resistive tests that provide information regarding movement limitations and pain provocation. Special tests can augment the findings from the examination, suggesting compromises in the structural and functional integrity of the ankle/foot complex. The weight bearing function of the ankle/foot compounds the clinician's diagnostic picture, as limits and pain provocation are frequently produced only when the patient attempts to function in weight bearing. As a consequence, clinicians should consider this feature by implementing numerous weightbearing components in the diagnosis and management of ankle/foot afflictions. Limits in passive motion can be classified as either capsular or non-capsular patterns. Conversely, patients can present with ankle/foot pain that demonstrates no limitation of motion. Bursitis, tendopathy, compression neuropathy, and instability can produce ankle/foot pain that is challenging to diagnose, especially when they are the consequence of functional weight bearing. Numerous non-surgical measures can be implemented in treating the painful ankle/foot, reserving surgical interventions for those patients who are resistant to conservative care.

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“…Isolated sural neuropathy occurs infrequently, but trauma is the most common reason. Possible causes of trauma include ankle fracture, stretch injuries during ankle sprains, laceration of the ankle, or external compression …”

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confidence: 99%

“…Possible causes of trauma include ankle fracture, stretch injuries during ankle sprains, laceration of the ankle, or external compression. [6][7][8][9] Although sural neuropathy is often diagnosed clinically and confirmed by electrodiagnosis, such testing can be challenging. A sensory nerve action potential (SNAP) may be absent in elderly patients or those with mild neuropathy, and lesions distal to the ankle may not be detected.…”

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confidence: 99%