Tarsal Tunnel Syndrome Secondary to Suture Material Within the Tibial Artery

Norbury, John W.; Warren, Kelly M; Moore, Daniel P.

doi:10.1097/phm.0b013e318282e9a3

Cited by 6 publications

(4 citation statements)

References 2 publications

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“…10 Tibial nerve compression related to posterior tibial artery lesions also occurs as the neurovascular complexes are bundled tightly together within the closed space of the tarsal tunnel. A perforating branch of the posterior tibial artery penetrating the nerve, 12 kinking of the tibial artery trapping the nerve, 13 suture material within the tibial artery impinging on the nerve, 14 as well as a pulsating tibial artery compressing the nerve, 7 similar to our case, have been reported. The advantage of dynamic analysis and color/ power Doppler ultrasound can be particularly useful in assessing arterial pulsation and ascertaining positional relationships of the vascular lesions and the nerve within the tarsal tunnel.…”

Section: Discussionsupporting

confidence: 78%

Distal Tibial Mononeuropathy From Compression by the Posterior Tibial Artery: Clinical–Electrophysiological–Ultrasonographic Correlations

Beecher

Chompoopong

Litchy

et al. 2022

Journal of Clinical Neurophysiology

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Summary: The tibial nerve is bound tightly to the posterior tibial artery in the tarsal tunnel where expansion capacity is limited. Therefore, the nerve may be vulnerable to, and damaged by chronic pulsatile trauma from an atypically positioned overriding artery, labeled “punched-nerve syndrome”. In this article, we present a 49-year-old woman who presented with two months of severe burning pain in the left medial ankle and sole of the foot without antecedent trauma. Neurological examination identified dysesthetic sensation to light touch in the left medial sole of the foot, and both active and passive dorsiflexion worsened the painful paresthesia. Nerve conduction studies demonstrated a reduced left medial plantar mixed nerve action potential amplitude, 50% less than the right. High-resolution ultrasound (HRUS) showed an increased left tibial nerve cross-sectional area of 26 mm2 (normal <22.3 mm2) at the level of the ankle with side-to-side difference of 6 mm2 (normal <5.7 mm2). The distal tibial nerve and its medial plantar branch were atypically positioned immediately deep to the left posterior tibial artery and abnormally flattened with focal enlargement of the nerve on longitudinal view. Dynamic analysis demonstrated the nerve being compressed with each pulsation of the tibial artery immediately above. Active dorsiflexion of the ankle narrowed the space underneath the flexor retinaculum resulting in further compression of the nerve against the artery. In conclusion, HRUS as an adjunct to electrophysiological studies identified punched-nerve arterial compression as an etiology of tarsal tunnel syndrome.

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Section: Discussionsupporting

confidence: 78%

Distal Tibial Mononeuropathy From Compression by the Posterior Tibial Artery: Clinical–Electrophysiological–Ultrasonographic Correlations

Beecher

Chompoopong

Litchy

et al. 2022

Journal of Clinical Neurophysiology

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“…Nageoka et al studied preoperatively with ultrasound 17 patients with TTS and documented among the most frequent causes ganglia, talocalcaneal coalition, talocalcaneal coalition associated with ganglia and varicose veins . The later causes of TTS have been also reported in various case reports …”

Section: Tarsal Tunnel Syndromementioning

confidence: 96%

Nerve Ultrasound in Peripheral Neuropathies: A Review

Kerasnoudis

Tsivgoulis

2015

Journal of Neuroimaging

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Peripheral neuropathies are one of the most common reasons for seeking neurological care in everyday practice. Electrophysiological studies remain fundamental for the diagnosis and etiological classification of peripheral nerve impairment. The recent technological development though of high resolution ultrasound has allowed the clinician to obtain detailed structural images of peripheral nerves. Nerve ultrasound mainly focuses on the evaluation of the cross sectional area, cross sectional area variability along the anatomical course, echogenity, vascularity and mobility of the peripheral nerves. An increase of the cross sectional area, hypervascularity, disturbed fascicular echostructure and reduced nerve mobility are some of the most common findings of entrapments neuropathies, such as the carpal or cubital tunnel syndrome. Both the cross-sectional area increase and the hypervascularity detected with the Doppler technique seem to correlate significantly with the clinical and electrophysiological severity of the later mononeuropathies. Significantly greater cross sectional area values of the clinically affected cervical nerve root are often detected in cases of cervical radiculopathy. In such cases, the ultrasound findings seem also to correlate significantly with disease duration. On the other hand, multifocal cross sectional area enlargement of cervical roots and/or peripheral nerves is often documented in cases of immune-mediated neuropathies. None of the later pathological ultrasound findings seem to correlate significantly with the electrophysiological parameters or the functional disability. The aim of this review is to provide a timely update on the role of neuromuscular ultrasound in the diagnostic of the most common entrapment and immune-mediated peripheral neuropathies in clinical practice.

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“…2 TTS may be due to several causes including traumaassociated conditions, metabolic causes (diabetes mellitus, gout, hypothyroidism, hyperlipidemia), and space-occupying lesions (schwannoma, ganglion cysts, and vessels). [3][4][5][6][7][8] Recent advances in ultrasound have resulted in high-resolution display of the contents of the tarsal tunnel as well as of the tibial nerve. 4,9,10 Due to the superficial location of the tunnel, the resolution obtained with ultrasound is considerably better than what is achieved with MRI.…”

Section: Accepted 6 November 2015mentioning

confidence: 99%

“…However, the Tinel test is not standardized and has considerable intra‐ and inter‐examiner differences in the range of forces generated by the different techniques used in clinical practice . TTS may be due to several causes including trauma‐associated conditions, metabolic causes (diabetes mellitus, gout, hypothyroidism, hyperlipidemia), and space‐occupying lesions (schwannoma, ganglion cysts, and vessels) . Recent advances in ultrasound have resulted in high‐resolution display of the contents of the tarsal tunnel as well as of the tibial nerve .…”

mentioning

confidence: 99%