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Sural Nerve Injury
From WikiSM
Contents
Other Names
- Sural Neuropraxia
- Sural Mononeuropathy
Background
- This page refers injuries to the Sural Nerve
History
Epidemiology
- Poorly described in the literature
Introduction
- General
- Sensory nerve of the posterolateral calf and ankle, lateral foot
- No motor component
- Entrapment site
- Most cases in literature involve entrapment at the ankle
- Can occur as proximal as popliteal fossa
- As distal as base of fifth metatarsal
Etiology
- Entrapment neuropathy
- At the crural fascia
- Mass lesions at the level of the gastrocnemius aponeurosis
- Myositis Ossificans[1]
- Lipoma
- Ganglion
- Osteochondroma
- Scar Tissue
- External Compression[2]
- Ski Boots
- Heel straps
- Casts
- Tightly laced boots
- Fractures
- Proximal Fibular Fracture
- Fifth Metatarsal Fracture
- Fracture of the Os Peroneum[3]
- Surgical repair of Achilles Tendon Rupture
- Ranges from 1.7% to 23% after percutaneous repair[4]
- As high as 60% when considering all surgical approaches
- Surgical repair of Calcaneus Fracture
- Ranges from 5% to 8%[5]
- More proximal neuropathies including
- Case reports following
- Lateral Ankle Sprain[6]
- Calf Strain[7]
- Bakers Cyst[8]
- Single, direct blow[9]
Anatomy of the Sural Nerve
- Cutaneous nerve that supplies sensory input to the lateral margin of the hindfoot and midfoot and the ankle joint[10]
- Formed by the union of the medial sural cutaneous nerve (MSCN) (from Tibial Nerve) and the lateral sural cutaneous nerve (LSCN), (from Common Fibular Nerve)
Risk Factors
- Unknown
Differential Diagnosis
- Fractures & Dislocations
- Muscle and Tendon Injuries
- Neurological
- Vascular
- Other
- Pediatric Considerations
- Tibial Tubercle Avulsion Fracture
- Tibial Tuberosity Apophysitis
- Toddlers Fracture (Tibial Shaft Fracture)
Clinical Features
History
- Patient will report paresthesia on the posterolateral side of leg and foot
- They may also endorse burning pain
Physical Exam
- Point of maximal tenderness can potentially reproduce symptoms
- Sensory deficits: posterolateral side of the lower leg, lateral border of the foot, small area under the heel
- Motor exam should be normal
Special Tests
- Tinels Test: Tapping the the nerve may help confirm the diagnosis
- Sural Nerve Neurodynamic Test: foot in dorsiflexion, inversion while passively flexing hip
Evaluation
Radiograph
- Standard Radiograph Ankle, Standard Radiograph Foot
- Typically normal
EMG/NCS
- Can be used to confirm diagnosis
Classification
- Not applicable
Management
Nonoperative
- Most cases
- Treat underlying etiology (i.e. bakers cyst, calf strain)
- Discontinue offending activity
Operative
- Indications
- Remove space occupying lesions
- Fascia related compression
- Technique
- Neurolysis
Rehab and Return to Play
Rehabilitation
- Unknown
Return to Play/ Work
- Unknown
Prognosis and Complications
Prognosis
- Unknown
Complications
- Chronic neuropathic pain
- Chronic paresthesia
See Also
References
- ↑ Husson, J. L., J. M. Blouet, and A. Masse. "Le syndrome du défilé de l'aponévrose superficielle postérieure surale." International orthopaedics 11.3 (1987): 245-248.
- ↑ Reisin R, Pardal A, Ruggieri V, Gold L. Sural neuropathy due to external pressure: report of three cases. Neurology 1994;44: 2408-9.
- ↑ Perlman, M. D. "Os peroneum fracture with sural nerve entrapment neuritis." The Journal of foot surgery 29.2 (1990): 119-121.
- ↑ Blackmon, Joseph A., et al. "Locating the sural nerve during calcaneal (Achilles) tendon repair with confidence: a cadaveric study with clinical applications." The Journal of Foot and Ankle Surgery 52.1 (2013): 42-47.
- ↑ Haugsdal, Jaclyn, Jeremiah Dawson, and Phinit Phisitkul. "Nerve injury and pain after operative repair of calcaneal fractures: a literature review." The Iowa orthopaedic journal 33 (2013): 202.
- ↑ Jotwani, Vijay, Kathleen Weber, and Simon Lee. "Cutaneous sural nerve injury after lateral ankle sprain: a case report: conducting a thorough neurological examination is a key to evaluation." The Journal of Musculoskeletal Medicine 25.3 (2008): 126-126.
- ↑ Bryan III, Blackshear M., Gregory E. Lutz, and Stephen J. O'Brien. "Sural nerve entrapment after injury to the gastrocnemius: a case report." Archives of physical medicine and rehabilitation 80.5 (1999): 604-606.
- ↑ Nakano KK. Entrapment neuropathy from Baker’s cyst. JAMA 1978;239:135.
- ↑ Schottland JR. Sural neuropathy. Neurology 1995;45:2301.
- ↑ Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy, ed 6, Lippincott Williams & Wilkins, Baltimore, 2010. p 619
Created by:
John Kiel on 7 July 2019 07:26:20
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Last edited:
24 March 2023 05:57:32
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