scholarly journals Chronic Expanding Hematoma in the Extremities: A Clinical Problem of Adhesion to the Surrounding Tissues

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Akio Sakamoto ◽  
Takeshi Okamoto ◽  
Shuichi Matsuda
Keyword(s):  
Magnetic Resonance ◽  
Lower Extremity ◽  
Peroneal Nerve ◽  
Subcutaneous Tissue ◽  
Common Peroneal Nerve ◽  
Clinical Problem ◽  
Blood Collection ◽  
Continuous Growth ◽  
Chronic Expanding Hematoma ◽  
The Common

Chronic expanding hematoma is characterized by continuous growth of a blood collection. We analyzed the clinical features of 7 patients with chronic expanding hematomas in the extremities, with an average age of 65.6 years. All lesions occurred in the lower extremities, with 4 seen in the thigh and 3 in the knee region. Six patients had subcutaneous hematomas, while 1 was deep-seated in the thigh. The magnetic resonance features of the lesion were compatible with those of a standard hematoma. A low signal intensity on T1- and T2-weighted imaging at the pseudocapsule was also characteristic. Cystic features were seen in 5 of 7 patients. All lesions were resected together with their pseudocapsule. In the subcutaneous lesions, it was necessary to resect adherent fascia, with or without involved skin. In the deep-seated thigh lesion, the common peroneal nerve was completely adherent to the pseudocapsule, a phenomenon from absence of the common peroneal nerve which appeared after resection. Chronic expanding hematomas of the extremities are predominantly located in the subcutaneous tissue of the lower extremity. The surrounding pseudocapsule is adherent to the adjacent tissues, and clinicians must be aware of this, especially when resecting a deep-seated lesion.

Matched-Pair Analysis of Magnetic Resonance Images for Location of the Common Peroneal Nerve in Valgus Knees: Comparison with the Varus Knees

2020 ◽  
Author(s):  
Kwang Am Jung ◽  
Oog-Jin Shon ◽  
Mohd Irfan Banday ◽  
Abhishek Patil ◽  
Gi Beom Kim
Keyword(s):  
Magnetic Resonance ◽  
Subgroup Analysis ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Matched Pair ◽  
Soft Tissue Release ◽  
Control Group ◽  
Matched Pair Analysis ◽  
The Common ◽  
Pair Analysis

AbstractThis study aimed to assess the distance and angular location of the common peroneal nerve (CPN) on axial magnetic resonance imaging (MRI) in the valgus knees and compare the measurements with those obtained from the control group. We compared the location of the CPN according to the type of alignment by performing a subgroup analysis. From January 2009 to December 2019, we identified 41 knees with preoperative MRI in patients who underwent total knee arthroplasty (TKA) for valgus deformity (valgus group). We performed one-to-two matched-pair analysis to a cohort of patients who underwent MRI but were not candidates for TKA (control group), according to sex and age. The valgus group was classified according to the grading system reported by Ranawat et al, and the control group was also subdivided according to the hip-knee-ankle (HKA) angle obtained from lower extremity scanography: neutral (–3 to +3 degrees from the neutral mechanical axis), valgus (> +3 degrees), and varus alignment (< –3 degrees). Distance between the CPN and posterolateral cortex of the tibia at the knee joint (distance J) and tibial cut level (distance C) were measured. Angle of the CPN from the central anteroposterior axis of the tibia (angle α) was measured. We compared the measurements between the groups. Distance J was significantly closer in the valgus group (p < 0.001), whereas angle α was significantly smaller in the valgus group (p < 0.001). However, no significant differences were found in the subgroup analysis. Moreover, a significant correlation was found between distance J and the HKA angle (p < 0.001). The location of the CPN in the valgus knees was closer to the posterolateral cortex of the tibia at the joint level and showed a smaller angle than that in the other aligned knees. We recommend that lateral soft tissue release for valgus knees should not be performed at the joint line. The results of this study suggest that this would be less safe than a release performed at the level of the proximal tibial bone resection.

scholarly journals Establishment of a Sheep Model for Hind Limb Peripheral Nerve Injury: Common Peroneal Nerve

2021 ◽  
Vol 22 (3) ◽  
pp. 1401
Author(s):  
Rui D. Alvites ◽  
Mariana V. Branquinho ◽  
Ana C. Sousa ◽  
Federica Zen ◽  
Monica Maurina ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Small Sample ◽  
Therapeutic Options ◽  
Nerve Injuries ◽  
Sheep Model ◽  
The Common

Thousands of people worldwide suffer from peripheral nerve injuries and must deal daily with the resulting physiological and functional deficits. Recent advances in this field are still insufficient to guarantee adequate outcomes, and the development of new and compelling therapeutic options require the use of valid preclinical models that effectively replicate the characteristics and challenges associated with these injuries in humans. In this study, we established a sheep model for common peroneal nerve injuries that can be applied in preclinical research with the advantages associated with the use of large animal models. The anatomy of the common peroneal nerve and topographically related nerves, the functional consequences of its injury and a neurological examination directed at this nerve have been described. Furthermore, the surgical protocol for accessing the common peroneal nerve, the induction of different types of nerve damage and the application of possible therapeutic options were described. Finally, a preliminary morphological and stereological study was carried out to establish control values for the healthy common peroneal nerves regarding this animal model and to identify preliminary differences between therapeutic methods. This study allowed to define the described lateral incision as the best to access the common peroneal nerve, besides establishing 12 and 24 weeks as the minimum periods to study lesions of axonotmesis and neurotmesis, respectively, in this specie. The post-mortem evaluation of the harvested nerves allowed to register stereological values for healthy common peroneal nerves to be used as controls in future studies, and to establish preliminary values associated with the therapeutic performance of the different applied options, although limited by a small sample size, thus requiring further validation studies. Finally, this study demonstrated that the sheep is a valid model of peripheral nerve injury to be used in pre-clinical and translational works and to evaluate the efficacy and safety of nerve injury therapeutic options before its clinical application in humans and veterinary patients.

Displacement of the common peroneal nerve in posterolateral corner injuries of the knee

2005 ◽  
Vol 87-B (9) ◽  
pp. 1225-1226 ◽  
Author(s):  
N. Bottomley ◽  
A. Williams ◽  
R. Birch ◽  
A. Noorani ◽  
A. Lewis ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Posterolateral Corner ◽  
The Common

scholarly journals Dynamic neuropathy of the common peroneal nerve at the level of the fibular head (literature review and case report)

2019 ◽  
Vol 21 (1) ◽  
pp. 54-59
Author(s):  
M. G. Bashlachev ◽  
G. Yu. Evzikov ◽  
V. A. Parfenov ◽  
N. B. Vuitsyk ◽  
F. V. Grebenev
Keyword(s):  
Ankle Joint ◽  
Peroneal Nerve ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Common Peroneal Nerve ◽  
Diagnostic Methods ◽  
Fibular Head ◽  
Study Objective ◽  
The Common ◽  
The Right

The study objective is to report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head and to discuss diagnostic methods and neurosurgical treatment. Materials and methods. We report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head in a female patient. The patient was treated in the Neurology Clinic of I.M. Sechenov First Moscow State Medical University. We analyzed clinical manifestations and compared them with the data described in research literature. Results. Upon admission, the patient complained of pain in the anterolateral surface of the right shin and in the dorsum of the foot during walking. At rest, the patient experienced no pain. We observed no motor or sensory disorders typical of nerve root disorders at the level of L5. Lasegue’s test was negative. The patient had a positive Tinel’s sign in the area of the right fibular head. In order to clarify the diagnosis, we performed a repeated extension test in the right ankle joint and it was positive. The patient underwent surgery that included peroneal nerve decompression and neurolysis at the level of the fibular head. In the postoperative period, the patient had complete pain relief. Conclusion. Due to the difficulties in the diagnostics of dynamic neuropathy of the common peroneal nerve, this disease is often mistaken for radiculopathy at the level of L5. Thorough clinical examination, testing for Tinel’s sign in the area of the fibular head, and repeated extension test in the ankle joint ensure the correct diagnosis and reduce the frequency of ineffective surgeries on the lumbar spine. Surgical decompression of the common peroneal nerve at the level of the fibular head with obligatory opening of the entrance to the nerve canal is an effective method of treatment in such patients.

scholarly journals Establishment of a Sheep Model for Hind limb Peripheral Nerve Injury: Common Peroneal Nerve

2020 ◽  
Author(s):  
Rui D. Alvites ◽  
Mariana V. Branquinho ◽  
Ana Catarina Sousa ◽  
Federica Zen ◽  
Monica Maurina ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Peroneal Nerve ◽  
Hind Limb ◽  
Common Peroneal Nerve ◽  
Therapeutic Options ◽  
Large Animal ◽  
Sheep Model ◽  
The Common

Thousands of people worldwide suffer from injuries in the peripheral nerve and deal daily with the resulting physiological and functional deficits. Recent advances in this field are still insufficient to guarantee effective outcomes, and the development of new and effective therapeutic options requires the use of valid preclinical models that effectively replicate the characteristics and challenges associated with these injuries in humans. In this study, we established a sheep model for common peroneal nerve injuries that can be applied in preclinical research with the advantages associated with the use of large animal models. In an integrative way, this article includes a detailed description of the anatomy and functionality of the peripheral nerves of sheep&rsquo;s hind limb, the surgical protocol for accessing the common peroneal nerve, the induction of different types of nerve damage and the application of possible therapeutic options. A neurological exam protocol directed to the common peroneal nerve was also established, allowing to identify the changes and deficits related with the nerve injury and to evaluate the functional progression over time. Finally, a preliminary stereological study was carried out to establish control values for the healthy peroneal common nerves of this model and to identify preliminary differences between therapeutic methods. The ultimate goal is to demonstrate that sheep is a valid model of peripheral nerve injury to be used in pre-clinical and translational works and to evaluate the efficacy and safety of nerve injury therapeutic options before its clinical application in human and veterinary patients.

scholarly journals Effect of graded nerve pressure injuries on motor function

2015 ◽  
Vol 122 (6) ◽  
pp. 1438-1443 ◽  
Author(s):  
Mika Karasawa ◽  
Kumiko Yokouchi ◽  
Akira Kakegawa ◽  
Kyutaro Kawagishi ◽  
Tetsuji Moriizumi ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Motor Function ◽  
Lower Limb ◽  
Peroneal Nerve ◽  
Tibialis Anterior Muscle ◽  
Common Peroneal Nerve ◽  
Nerve Fibers ◽  
Walking Ability ◽  
Significant Difference ◽  
The Common

OBJECT The purpose of this study was to determine the minimum amount of nerve fibers required to maintain normal motor function after nerve injury in rats. METHODS The authors first confirmed that a common peroneal nerve injury caused more aggravating effects on lower limb motor function than tibial nerve injury, as assessed by the static sciatic index (SSI). Thereafter, rats were subjected to varying degrees of crush injury to the common peroneal nerve. At 48 hours after the injury, motor function was assessed using the SSI and slope-walking ability (with slope angles of 30° and 45°). The tibialis anterior muscle, a main muscle innervated by the common peroneal nerve, was removed. Muscle sections were co-labeled with neuronal class III β-tubulin polyclonal antibody to identify the presence of axons and Alexa Fluor 488-conjugated α-bungarotoxin to identify the presence of motor endplates. RESULTS The evaluation of neuromuscular innervation showed a correlation between SSI scores and ratios of residual axons (rs = 0.68, p < 0.01), and there was a statistically significant difference between slope-walking ability and ratios of residual axons (p < 0.01). Moreover, the ratios of residual axons in the nerve-crushed rats with normal motor function (SSI above −20) ranged from 36.5% to 88.7%, and those ratios in the success group with slope-walking angles of 30° and 45° ranged from 14.7% to 88.7% and from 39.8% to 88.7%, respectively. CONCLUSIONS In this study of rodents, less than half of the motor axons were sufficient to maintain normal motor function of the lower limb.

Iatrogenic common peroneal nerve injury during harvesting of semitendinosus tendon for anterior cruciate ligament reconstruction

2021 ◽  
Vol 14 (4) ◽  
pp. e240736
Author(s):  
Raf Mens ◽  
Albert van Houten ◽  
Roy Bernardus Gerardus Brokelman ◽  
Roy Hoogeslag
Keyword(s):  
Anterior Cruciate Ligament ◽  
Nerve Injury ◽  
Peroneal Nerve ◽  
Cruciate Ligament ◽  
Common Peroneal Nerve ◽  
Peroneal Nerve Injury ◽  
The Common ◽  
Anterior Cruciate ◽  
Incision Technique

We present a case of iatrogenic injury to the common peroneal nerve (CPN) occurring due to harvesting of a hamstring graft, using a posterior mini-incision technique. A twitch of the foot was noted on retraction of the tendon stripper. After clinically diagnosing a CPN palsy proximal to the knee, the patient was referred to a neurosurgeon within 24 hours. An electromyography (EMG) was not obtained since it cannot accurately differentiate between partial and complete nerve injury in the first week after injury. Because the nerve might have been transacted by the tendon stripper, surgical exploration within 72 hours after injury was indicated. An intraneural haematoma was found and neurolysis was performed to decompress the nerve. Functioning of the anterior cruciate ligament was satisfactory during follow-up. Complete return of motor function of the CPN was observed at 1-year follow-up, with some remaining hypoaesthesia.

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