The sural nerve is not always a pure sensory nerve

Haupts, M.; Amoiridis, Georgios

doi:10.1002/mus.20767

Cited by 4 publications

(4 citation statements)

References 4 publications

(6 reference statements)

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“…Nevertheless, some authors have suggested that the SN is not only sensorial, and in a few cases has motor fibers that give to abductor digiti minimi of the foot and possibly other intrinsic foot muscles and the gastrocnemius muscle when it pierces the medial head as previously reported by our group (Pimentel et al,;Haupts & Amoiridis, 2007;Amoiridis et al, 1997;George & Nayak). The motor fibers in SN are present in 6.2% of individuals (Haupts & Amoiridis;Amoiridis et al, 1997).…”

Section: Introductionsupporting

confidence: 78%

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Entrapment of the Sural Nerve on Gastrocnemius Muscle: Histological Analysis

et al. 2011

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SUMMARY:Anatomical variations in the formation of the sural nerve are common, although the topographical localization of this nerve is constant. In this report, we describe the histological analysis of anomalous course of the medial sural cutaneous nerve which descended through the gastrocnemius via a tunnel formed within the muscle and fascia. This anatomical curiosity are clinically important when evaluating sensory axonal loss in distal axonal neuropathies since sural nerve mononeuropathy is less likely to occur.

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Section: Introductionsupporting

confidence: 78%

“…The motor fibers in SN are present in 6.2% of individuals (Haupts & Amoiridis;Amoiridis et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

Entrapment of the Sural Nerve on Gastrocnemius Muscle: Histological Analysis

et al. 2011

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“…An Aα/β peak corresponding to the activation of large‐diameter myelinated axons occurred at short latency in response to low stimulus strengths (stimulus duration 0.1 ms). This peak is designated Aα/β because, while in the majority of people the sural nerve is exclusively sensory, in some individuals it may contain both cutaneous Aβ afferents as well as Aα axons comprising efferent motoneurons and Ia and Ib muscle afferents (Haupts and Amoiridis, 2007). At slightly higher stimulus intensities, small‐diameter thinly myelinated axons were activated producing an Aδ peak at slightly longer latency.…”

Section: Resultsmentioning

confidence: 99%

Low concentrations of amitriptyline inhibit nicotinic receptors in unmyelinated axons of human peripheral nerve

Freysoldt¹,

Fleckenstein²,

Lang³

et al. 2009

British J Pharmacology

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Background and purpose: Amitriptyline is often prescribed as a first-line treatment for neuropathic pain but its precise mode of analgesic action remains uncertain. Amitriptyline is known to inhibit voltage-dependent ion channels and also to act as an antagonist at ligand-gated ion channels, such as nicotinic acetylcholine receptors (nAChRs). In the present study, we tested the effect of amitriptyline on nicotinic responses of unmyelinated axons in isolated segments of human peripheral nerve. In particular, a comparison was made between the concentrations of amitriptyline necessary for inhibition of nAChRs and those required for inhibition of the compound C-fibre action potential. Experimental approach: Isolated axon fascicles were prepared from short segments of human sural nerve, and multiple measures of axonal excitability were recorded using computer-controlled threshold tracking software. Key results: Amitriptyline (EC50 2.6 mM) reduced the nicotine-induced increase in C-fibre excitability but only slightly altered the amplitude and latency to onset of the compound action potential. In contrast, tetrodotoxin produced a clear reduction in the amplitude and a prolongation of action potential onset latency but was without effect on the nicotine-induced increase in axonal excitability. Conclusions and implications:These data demonstrate that low concentrations of amitriptyline suppress the response of human peripheral C-type axons to nicotine by directly inhibiting nAChRs. Blockade of tetrodotoxin-sensitive, voltagedependent sodium channels does not contribute to this effect. An inhibitory action of amitriptyline on nAChRs in unmyelinated nociceptive axons may be an important component of amitriptyline's therapeutic effect in the treatment of neuropathic pain.

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“…The sural nerve is purely sensory, although rare variants that contribute sensorimotor innervations have been described. 17,18 It comprises the union between the medial cutaneous sural nerve (a branch of the tibial nerve) and the lateral cutaneous sural nerve (a branch of the common peroneal nerve). Initially, the medial cutaneous sural nerve alone courses subfascially between the 2 bellies of the gastrocnemius until reaching the musculotendinous junction, where it re-emerges subcutaneously after penetrating a fibrous arcade.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Ultrasound-Guided Hydrodissection of a Symptomatic Sural Neuroma

Fader¹,

Mitchell²,

Chadayammuri³

et al. 2015

Orthopedics

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Symptomatic neuromas of the sural nerve are a rare but significant cause of pain and debilitation in athletes. Presentation is usually in the form of chronic pain and dysesthesias or paresthesias of the lateral foot and ankle. Treatment traditionally ranges from conservative measures, such as removing all external compressive forces, to administration of nonsteroidal anti-inflammatory drugs, vitamin B6, tricyclic antidepressants, antiepileptics, or topical anesthetics. This article reports a case of sural nerve entrapment in a 34-year-old male triathlete with a history of recurrent training-induced right-sided gastrocnemius strains. The patient presented with numbness in the right lateral foot and ankle that had persisted for 3 months, after he was treated unsuccessfully with extensive nonoperative measures, including anti-inflammatory drugs, activity modification, and a dedicated physical therapy program of stretching and strengthening. Orthopedic assessment showed worsening pain with forced passive dorsiflexion and manual pressure applied over the distal aspect of the gastrocnemius. Plain radiographs showed normal findings, but in-office ultrasound imaging showed evidence of sural nerve entrapment with edema and neuromatous scar formation in the absence of gastrocnemius or soleus pathology. Percutaneous ultrasound-guided hydrodissection of the sural nerve at the area of symptomatic neuroma and neural edema was performed the same day. The patient had complete relief of symptoms and full return to the preinjury level of participation in competitive sports. This case report shows that hydrodissection, when performed by an experienced physician, can be an effective, minimally invasive technique for neurolysis in the setting of sural nerve entrapment, resulting in improvement in clinical symptoms.

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The sural nerve is not always a pure sensory nerve

Cited by 4 publications

References 4 publications

Entrapment of the Sural Nerve on Gastrocnemius Muscle: Histological Analysis

Entrapment of the Sural Nerve on Gastrocnemius Muscle: Histological Analysis

Low concentrations of amitriptyline inhibit nicotinic receptors in unmyelinated axons of human peripheral nerve

Percutaneous Ultrasound-Guided Hydrodissection of a Symptomatic Sural Neuroma

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