Peripheral Nerve Vein Wrapping For Intractable Lower Extremity Pain

2000 ◽  
Vol 21 (6) ◽  
pp. 492-500 ◽  
Author(s):  
Mark E. Easley ◽  
Lew C. Schon
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Saphenous Vein ◽  
Peripheral Nerves ◽  
Average Length ◽  
Umbilical Vein ◽  
Substantial Improvement ◽  
Pain Scores ◽  
Lower Extremity Pain

Hypothesis/Purpose: The purpose of this study was to determine the effectiveness of lower extremity peripheral nerve vein wrapping procedures in the management of patients with intractable lower extremity pain. The hypothesis was that nerve insulation through vein wrapping is effective in treating symptoms related to adhesive neuralgia, but not those secondary to intraneural damage. Methods: We retrospectively reviewed 25 consecutive patients whose intractable chronic lower extremity peripheral neuralgia had been treated with revision neurolysis and vein wrapping. The 14 women and 11 men had an average age of 39 years (range, 21 to 53 years). Vein wrapping was performed using a saphenous vein autograft in 19 patients and a fetal umbilical vein in six patients. The average length of follow-up after vein wrapping was 24 months (range, 12 to 63 months). Assessment of pain and dysfunction was on a scale of 0 (no pain/dysfunction) to 10 (severe enough to prompt request for amputation and required use of a wheelchair). Results: Pain scores improved from a preoperative average of 8.7 points (range, 6 to 10 points) to a postoperative average of 4.6 points (range, 0 to 10 points); dysfunction improved from a preoperative average of 7.3 points (range, 3 to 10 points) to a postoperative average of 4.4 points (range, 0 to 9 points). Although 17/25 patients were satisfied with the procedure, only 14/25 stated they would undergo the surgery again. All eight patients who exhibited no improvement had preoperative and intraoperative evidence of an idiopathic etiology and/or intraneural damage. Preoperatively, 18/25 patients could not work; postoperatively, that number improved to 8/25. Conclusions: Vein wrapping of lower extremity peripheral nerves is most effective in relieving symptoms related to adhesive neuralgia and less beneficial in the presence of intraneural damage. Although symptoms are rarely relieved completely, vein wrapping typically results in a substantial improvement in symptoms related to scar entrapment of peripheral nerves.

scholarly journals Ankle Arthrodesis Through an Anterior Approach

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0026
Author(s):  
Kathleen Jarrell ◽  
Marek Denisiuk ◽  
Elizabeth McDonald ◽  
Steven Raikin
Keyword(s):  
Anterior Approach ◽  
Average Length ◽  
Ankle Arthrodesis ◽  
Small Subset ◽  
Pain Scores ◽  
Level Of Satisfaction ◽  
Extensor Hallucis Longus ◽  
Patient Reported ◽  
Functional Scores

Category: Ankle Introduction/Purpose: Ankle arthrodesis can be approached anteriorly, laterally, medially, or posteriorly, and debate remains as to which approach is most advantageous. Although an anterior approach using the interval between the extensor hallucis longus and tibialis anterior is commonly performed, there is a paucity of studies showing the clinical outcomes after this procedure. This study aims to evaluate the functional outcomes and patient satisfaction at mid-term follow-up after ankle arthrodesis via an anterior approach. Methods: All isolated primary ankle arthrodeses performed with the anterior approach by a single fellowship-trained foot and ankle surgeon between May of 2011 and December of 2015 were retrospectively included. Chart review was performed and patient reported outcomes were collected including FAAM ADL, FAAM Sports, VAS, and SF-12 scores pre-operatively and at a minimum of two-years post-operatively. At final follow-up, a survey was distributed via phone or email inquiring about level of satisfaction and whether they would undergo the procedure again. A total of 108 patients were included, of which only 45 (41.67%) had pre-operative functional scores, 24 (22.2%) completed both pre- and post-operative functional scores, and 20 patients (18.5%) had satisfaction results. The average length of follow-up was 4.4 years (range: 1.7 – 7.9, SD 1.6). Results: FAAM ADL scores improved from a mean of 48.1 to 67.6, FAAM Sports increased from 18.1 to 34.9, VAS Pain decreased from 73.2 to 44.9, SF-12 MCS changed from 44.2 to 46.7, and SF-12 PCS increased from 31.0 to 42.2. Using a linear mixed effects model and controlling for length of follow-up, all functional and pain score improvements were significant except SF- 12 MCS (Table 1). Overall, 65% of patients were satisfied with their results and 85% of patients would consider the same surgery if needed. Patients who were more satisfied with their surgery were more likely to say that they would consider the same surgery given similar circumstances (p = 0.001). Conclusion: Post-operative functional scores were significantly improved and pain scores were significantly decreased compared to pre-operative scores in a cohort of patients who underwent ankle arthrodesis using an anterior approach. Satisfaction with the surgery was lower than expected given the improvement in functional scores. Further study is indicated to determine methods to improve satisfaction. Our study suggests that an anterior approach to ankle arthrodesis is an effective technique to improve function and pain in patients with ankle arthritis, however satisfaction after surgery is no guarantee. The study is limited by the small subset of patients with pre- and post-operative functional scores.

Progression of low back and lower extremity pain in a cohort of patients with achondroplasia

2010 ◽  
Vol 13 (3) ◽  
pp. 335-340 ◽  
Author(s):  
Michael C. Ain ◽  
Madeel A. Abdullah ◽  
Beverlie L. Ting ◽  
Richard L. Skolasky ◽  
Emily Streyer Carlisle ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Back Pain ◽  
Lower Extremity ◽  
Spinal Stenosis ◽  
Healthcare Utilization ◽  
Functional Disability ◽  
Pain Severity ◽  
Low Back ◽  
Lower Extremity Pain

Object The aim of this study was to assess the natural history of pain associated with spinal stenosis in individuals with achondroplasia and to characterize pain patterns and associated functional and psychological effects. Methods The authors measured pain severity, spatial distribution of pain, functional disability, psychological distress, physical symptoms other than pain, and healthcare utilization in 181 individuals with achondroplasia. They also assessed low back and/or lower extremity pain at the initial visit and 1-year follow-up via self-rated patient questionnaires, calculated composite scores from responses via component analyses, and used repeated measures linear regression analyses for score changes (significance, p ≤ 0.05). Results At the follow-up, back pain severity was unchanged. Patients reported significant progression of pain toward involvement of the lower extremities and significant increases in lower extremity pain severity overall. There were also significant increases in healthcare utilization overall. Compared with patients with back pain only, those with back pain and proximal or distal leg pain had higher self-rated pain severity; higher functional disability; and more bowel and bladder dysfunction symptoms, sleep disturbances, extremity numbness, and psychological distress. Conclusions Individuals with achondroplasia and symptomatic spinal stenosis often experience back pain, which may progress to lower extremity pain and debilitating consequences. A more thorough understanding of the progression of spatial pain characteristics and pain severity may aid clinical decision making regarding the optimal timing for intervention.

scholarly journals Associations of objectively measured total duration and maximum bout length of standing at work with lower-extremity pain intensity: a 2-year follow-up of construction and healthcare workers

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lars-Kristian Lunde ◽  
Suzanne Merkus ◽  
Markus Koch ◽  
Stein Knardahl ◽  
Morten Wærsted ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Pain Intensity ◽  
Healthcare Workers ◽  
Total Duration ◽  
Construction Workers ◽  
Bout Length ◽  
Lower Extremity Pain ◽  
European Working ◽  
Objectively Measured

Abstract Background Musculoskeletal disorders are among the major reasons for years lived with disability. Approximately one third of the European working population report lower-extremity discomfort and many attribute these discomforts to work-related factors. Employees in the healthcare and construction sectors reports high levels of lower-extremity pain and commonly relate the pain to their profession. These workers spend a large part of their workday standing. Periods of prolonged standing is suggested to increase lower-extremity symptoms, but this cannot be concluded on, since limited evidence is available from longitudinal studies using objective measures. This study aimed to determine possible associations between objectively measured total duration and maximum bout length of static- and dynamic standing at work and lower-extremity pain intensity (LEPi) among Norwegian construction- and healthcare workers. Methods One-hundred and twenty-three construction and healthcare workers wore two accelerometers for up to four consecutive days, to establish standing behavior at baseline. The participants reported LEPi (Likert scale 0–9) for the preceding 4 weeks at baseline and after 6, 12, 18, and 24 months. We investigated associations between standing at work and average and change in LEPi using linear mixed models with significance level p ≤ 0.05. Results Total duration of static- and dynamic standing showed weak associations with average LEPi, for the total sample and for construction workers. Maximum bout of static- and dynamic standing was associated with average LEPi in construction workers, but not in healthcare workers. Furthermore, we found no associations between standing and change in LEPi over the 2-year follow-up in any of our analyses. Conclusions This study indicate that objectively measured standing is associated with average LEPi over 2-years follow-up in construction workers, and that maximal bout of standing have a stronger association to LEPi than total duration. For every 10 min added to the maximal length of continuous standing during an average workday, we found approximately one unit increase in pain on a 0–9 scale. The lack of significant findings in analyses on healthcare workers suggest that the association between standing and LEPi depend on work-tasks, gender and/or other sector-specific factors.

scholarly journals Intralipid Therapy for Inadvertent Peripheral Nervous System Blockade Resulting from Local Anesthetic Overdose

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Ihab Kamel ◽  
Gaurav Trehan ◽  
Rodger Barnette
Keyword(s):  
Nervous System ◽  
Lower Extremity ◽  
Peripheral Nerve ◽  
Local Anesthetic ◽  
Safety Profile ◽  
Local Anesthetics ◽  
Peripheral Nerves ◽  
Significant Morbidity ◽  
Intravascular Injection ◽  
Local Anesthetic Systemic Toxicity

Although local anesthetics have an acceptable safety profile, significant morbidity and mortality have been associated with their use. Inadvertent intravascular injection of local anesthetics and/or the use of excessive doses have been the most frequent causes of local anesthetic systemic toxicity (LAST). Furthermore, excessive doses of local anesthetics injected locally into the tissues may lead to inadvertent peripheral nerve infiltration and blockade. Successful treatment of LAST with intralipid has been reported. We describe a case of local anesthetic overdose that resulted in LAST and in unintentional blockade of peripheral nerves of the lower extremity; both effects completely resolved with administration of intralipid.

Surgical Treatment of Peripheral Neuropathy

2005 ◽  
Vol 95 (5) ◽  
pp. 451-454 ◽  
Author(s):  
Juan M. V. Valdivia ◽  
A. Lee Dellon ◽  
Martin E. Weinand ◽  
Christopher T. Maloney
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerves ◽  
Tibial Nerve ◽  
Diabetic Patients ◽  
Analog Scale ◽  
Postoperative Results ◽  
Patients With Diabetes ◽  
A Prospective Study ◽  
Balance Problems

Since 1992 it has been reported that patients with diabetes mellitus recover sensibility and obtain relief of pain from neuropathy symptoms by decompression of lower-extremity peripheral nerves. None of these reports included a series with more than 36 diabetic patients with lower-extremity nerves decompressed, and only recently has a single report appeared of the results of this approach in patients with nondiabetic neuropathy. No previous report has described a change in balance related to restoration of sensibility. A prospective study was conducted of 100 consecutive patients (60 with diabetes and 40 with idiopathic neuropathy) operated on by a single surgeon, other than the originator of this approach, and with the postoperative results reviewed by someone other than these two surgeons. Each patient had neurolysis of the peroneal nerve at the knee and the dorsum of the foot, and the tibial nerve released in the four medial ankle tunnels. After at least 1 year of follow-up, 87% of patients with preoperative numbness reported improved sensation, 92% with preoperative balance problems reported improved balance, and 86% whose pain level was 5 or greater on a visual analog scale from 0 (no pain) to 10 (the most severe pain) before surgery reported an improvement in pain. Decompression of compressed lower-extremity nerves improves sensation and decreases pain, and should be recommended for patients with neuropathy who have failed to improve with traditional medical treatment. (J Am Podiatr Med Assoc 95(5): 451–454, 2005)

Rating Peripheral Nerves of the Lower Extremities Using the AMA Guides, Sixth Edition

2021 ◽  
Vol 26 (2) ◽  
pp. 13-17
Author(s):  
James B. Talmage ◽  
Jay Blaisdell ◽  
Christopher R. Brigham
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Physical Examination ◽  
Clinical Studies ◽  
Peripheral Nerves ◽  
Motor Nerve ◽  
Traumatic Events ◽  
Motor Deficits ◽  
Nerve Lesions ◽  
Sixth Edition

Abstract Nerve lesions caused by traumatic events to the lower extremity's peripheral nerves are rated using Section 16.4 of the sixth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). Results from sensory and motor nerve tests are used to assign the impairment class within Table 16-12, Peripheral Nerve Impairment (6th ed, 534). The default rating may be modified with the functional history and clinical studies modifiers, but not the physical examination modifier, because it is used to assign the impairment class and define the degree of neurologic severity. Impairment for both sensory and motor deficits are assigned and then combined at the lower extremity level.

Ultrasound‐Guided Percutaneous Peripheral Nerve Stimulation for the Treatment of Lower Extremity Pain: A Rare Case Report

Pain Practice ◽  
2019 ◽  
Vol 19 (8) ◽  
pp. 861-865 ◽  
Author(s):  
Guilherme Ferreira‐Dos‐Santos ◽  
Mark Friedrich B. Hurdle ◽  
Sahil Gupta ◽  
Steven R. Clendenen
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Rare Case ◽  
Peripheral Nerve Stimulation ◽  
Ultrasound Guided ◽  
Lower Extremity Pain ◽  
Rare Case Report

scholarly journals Nerve grafting in peripheral nerve injuries

2003 ◽  
Vol 50 (1) ◽  
pp. 47-54
Author(s):  
Danica Grujicic ◽  
Miroslav Samardzic ◽  
Lukas Rasulic ◽  
Dragan Savic ◽  
Irena Cvrkota ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Peripheral Nerves ◽  
Nerve Repair ◽  
Soft Tissue Injuries ◽  
Nerve Grafting ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Upper And Lower Extremities ◽  
Nerve Recovery

Autologous nerve grafting is the most commnly used operative technique in delayed primary, or secondary nerve repair after the peripheral nerve injuries. The aim of this procedure is to overcome nerve gaps that results from the injury itself, fibrous and elastic retraction forces, resection of the damaged parts of the nerve, position of the articulations and mobilisation of the nerve. In this study we analyse the results of operated patients with transections and lacerations of the peripheral nerves from 1979 to 2000 year. Gunshot injuries have not been analyzed in this study. The majority of the injuries were in the upper extremity (more than 87% of cases). Donor for nerve transplantation had usually been sural nerve, and only occasionally medial cutaneous nerve of the forearm was used. In about 93% of cases we used interfascicular nerve grafting, and cable nerve grafting was performed in the rest of them. Most of the grafts were 1 do 5 cm long (70% of cases). Functional recovery was achieved in more than 86% of cases, which is similar to the results of the other authors. Follow up period was minimum 2 years. We analyzed the influence of different factors on nerve recovery after the operation: patient?s age, location and the extent (total or partial) of nerve injury, the length of the nerve graft, type of the nerve, timing of surgery, presence of multiple nerve injuries and associated osseal and soft tissue injuries of the upper and lower extremities.

Pattern and types of non-saphenous vein reflux

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 51-54 ◽  
Author(s):  
R D Malgor ◽  
N Labropoulos
Keyword(s):  
Sciatic Nerve ◽  
Lower Extremity ◽  
Saphenous Vein ◽  
Peripheral Nerves ◽  
Varicose Veins ◽  
Popliteal Fossa ◽  
Skin Damage ◽  
Venous Reflux ◽  
Saphenous Veins ◽  
Vein Reflux

Venous reflux often originates from saphenous trunks and their tributaries. In about 10% of the patients reflux derived from non-saphenous veins (NSV) such as those located in the buttock, posterolateral thigh, vulva, lower posterior thigh, popliteal fossa, knee or along the peripheral nerves such as the tibial and sciatic nerve. It is also important to note that patients who had saphenous vein stripping or ablation have higher odds of presenting with NSV reflux. The majority of patients with NSV reflux have varicose veins and lower extremity oedema; however, about 10% of those patients present with skin damage. This paper analyses the patterns and types of NSV reflux for diagnosis and treatment purposes.

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