The digital nerve stretch test: A sensitive indicator of Morton's neuroma and neuritis

Cloke, David; Greiss, M.E.

doi:10.1016/j.fas.2006.04.002

Cited by 15 publications

(10 citation statements)

References 8 publications

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“…The Tinel test over the affected web space can also precipitate pain. Cloke and Greiss 21 have described the digital nerve stress test, which they found to have 100% sensitivity and a 95% positive predictive value. In comparison, the Mulder maneuver in their hands had 95% sensitivity and 100% specificity.…”

Section: Morton Neuromamentioning

confidence: 99%

Sonography of Common Peripheral Nerve Disorders With Clinical Correlation

Jacobson

Wilson

Yang

2016

J of Ultrasound Medicine

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onography has been shown to be an excellent method to assess peripheral nerves, showing high accuracy in the diagnosis of many nerve disorders. With sonography, the peripheral nerves of an entire extremity can be visualized in high resolution in less time than is required with magnetic resonance imaging. With real-time examination of a peripheral nerve, direct feedback can be obtained from the patient, as transducer pressure over an abnormal nerve or neuroma commonly elicits symptoms, which serves to increase diagnostic accuracy. Evaluation of peripheral nerves dynamically either during joint movement or muscle contraction is easily completed using sonography. 1 The purpose of this article is to review the normal sonographic appearance of peripheral nerves and to review common nerve disorders, including nerve entrapment, intraneural ganglion cyst, nerve trauma, and peripheral nerve sheath tumors. Sonography of Normal Peripheral NervesThe characteristic appearance of peripheral nerves on sonography is best appreciated in the short axis relative to the nerve, where the individual nerve fascicles will appear hypoechoic, surrounded by hyperechoic connective tissue (Figure 1). 2 This appearance is likened to a honeycomb. The more proximal nerve trunks are surrounded by hyperechoic fat, and each nerve trunk can be followed distally until only one nerve fascicle remains. In the long axis relative to the nerve, the fascicular appearance can also be appreciated, with REVIEW ARTICLESonography is now considered an effective method to evaluate peripheral nerves. Low cost, high resolution, the ability to image an entire limb in a short time, and dynamic assessment are several of the positive attributes of sonography. This article will review the normal appearance of peripheral nerves as shown with sonography. In addition, the most common applications for sonography of the peripheral nerves will be reviewed, which include entrapment neuropathies, intraneural ganglion cyst, nerve trauma, and peripheral nerve sheath tumors. Clinical information related to nerve disorders is also included, as it provides valuable information that can be obtained during sonographic examinations, increasing diagnostic accuracy.

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Section: Morton Neuromamentioning

confidence: 99%

Sonography of Common Peripheral Nerve Disorders With Clinical Correlation

Jacobson

Wilson

Yang

2016

J of Ultrasound Medicine

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“…This is a very common and typical report from those suffering with PDN. 11,13,15,20 100% of the patients in this study reported substantial decreases in their VAS readings, with 81% reporting being entirely pain-free by the conclusion of their 6 treatments. Where the clinician felt there remained a loss of normal motion in the affected joint, the manipulation was repeated even if the patient reported a VAS score of zero.…”

Section: Discussionmentioning

confidence: 71%

“…The test is positive if the patient complains of discomfort in the web space of the affected foot." 20 The authors of this paper further commented "the digital nerve stretch test was positive in all cases in which lesions of the nerve were found, unlike all other clinical signs recorded. We believe this sign to be sensitive, and have a high positive predictive value."…”

Section: Interventionmentioning

confidence: 88%

“…20,24 Mulder's click test has long been established as a reliable test for the presence of PDN. 20,21,24,27 Most cases of PDN can be diagnosed clinically 5,8,15 with those being considered for surgical or invasive intervention having the diagnosis confirmed by ultrasound or magnetic resonance imaging (MRI) if necessary. 9 This said, clinical tests may be just as useful especially in detecting smaller lesions which can be missed by ultrasound and MRI, yet which cause the sufferer just as much discomfort.…”

Section: Discussionmentioning

confidence: 99%

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Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases

Cashley

Cochrane

2015

Journal of Chiropractic Medicine

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Objective: The purpose of this retrospective case series is to describe treatment outcomes for patients with plantar digital neuralgia (PDN) (Morton's neuroma) who were treated using foot manipulation. Methods: Charts were reviewed retrospectively for patients with a diagnosis of PDN and who received a minimum of 6 treatments consisting of manipulation alone. Visual analogue pain scales (VAS) and pressure threshold meter readings (PTM) were extracted as outcome measures. Results: Thirty-eight cases met inclusion criteria. Mean pretreatment duration of pain was 28 months. Mean pretreatment VAS was 69.5/100 mm. Mean pretreatment PTM was 2.54 Kp. By the sixth treatment, 30 (79%) of the 38 patients scored a VAS of 0 mm and a further 4 (10%) were below 10 mm. Contralateral limb PTM showed a mean pre-treatment score of 5.5 Kp, which rose slightly to 5.85 Kp. This compared to a pre-treatment score of 2.54 Kp rising to 5.86 Kp in the affected limb. This represents a 126% increase in the affected side compared to 6.5% in the unaffected limb. Statistical analysis demonstrated a significant linear trend between decreasing VAS and manipulation (P b .001). Conclusion: The patients with PDN who were included in this case series improved with conservative care that included only foot manipulation.

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“…An anatomical study examining the relationship between the location of interdigital neuromas and the DTML demonstrated that the interdigital neuromas were located more distally than the DTML in both the mid-stance and the heel-off stage during walking, which raised an objection against an entrapment by the DTML and supported chronic repetitive trauma by the metatarsal heads as an etiology [28]. The eliciting procedure known as Mulder's click, which has high sensitivity and specificity in diagnosing interdigital neuroma, is considered to replicate the compression of neuromas by the metatarsal heads [5, 29, 30]. The neuroma in our case was located between the metatarsal heads distally apart from the DTML and showed the peculiar configuration suggesting mechanical compression by the adjacent metatarsal heads.…”

Section: Discussionmentioning

confidence: 99%

Interdigital Neuroma in the Second Intermetatarsal Space Associated with Metatarsophalangeal Joint Instability

Matsumoto

Chang

Izawa

et al. 2016

Case Reports in Orthopedics

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The entrapment theory is the most commonly accepted theory concerning the development of interdigital neuroma; it incriminates the deep transverse metatarsal ligament as the major causative factor of the condition. This report presents a patient with interdigital neuroma in the second intermetatarsal space, which was strongly suspected to be caused by the metatarsophalangeal joint instability due to plantar plate injury. Surgical intervention revealed that the neuroma was located more distally and dorsally than the deep transverse metatarsal ligament and was pinched between the adjacent metatarsal heads, suggesting the involvement of the metatarsophalangeal joint instability and chronic trauma as etiologies in this case.

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The digital nerve stretch test: A sensitive indicator of Morton's neuroma and neuritis

Cited by 15 publications

References 8 publications

Sonography of Common Peripheral Nerve Disorders With Clinical Correlation

Sonography of Common Peripheral Nerve Disorders With Clinical Correlation

Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases

Interdigital Neuroma in the Second Intermetatarsal Space Associated with Metatarsophalangeal Joint Instability

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