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Sural Nerve Injury

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Other Names

  • Sural Neuropraxia
  • Sural Mononeuropathy

Background

History

Epidemiology

  • Poorly described in the literature

Pathophysiology

  • 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

Pathoanatomy

  • 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


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

Evaluation

Radiograph

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

Complications and Prognosis

Prognosis

  • Unknown

Complications

  • Chronic neuropathic pain
  • Chronic paresthesia

See Also


References

  1. 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.
  2. Reisin R, Pardal A, Ruggieri V, Gold L. Sural neuropathy due to external pressure: report of three cases. Neurology 1994;44: 2408-9.
  3. Perlman, M. D. "Os peroneum fracture with sural nerve entrapment neuritis." The Journal of foot surgery 29.2 (1990): 119-121.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. Nakano KK. Entrapment neuropathy from Baker’s cyst. JAMA 1978;239:135.
  9. Schottland JR. Sural neuropathy. Neurology 1995;45:2301.
  10. 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:
2 August 2021 14:34:03
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