Etiology and Treatment Outcomes for Sural Neuroma

2019 ◽  
Vol 40 (5) ◽  
pp. 545-552 ◽  
Author(s):  
Jonathan Lans ◽  
Linda Gamo ◽  
Christopher W. DiGiovanni ◽  
Neal C. Chen ◽  
Kyle R. Eberlin
Keyword(s):  
Postoperative Pain ◽  
Lower Extremity ◽  
Complete Resolution ◽  
Symptomatic Relief ◽  
Case Series ◽  
Symptom Improvement ◽  
Level Of Evidence ◽  
Initial Surgery ◽  
Pain Symptoms ◽  
Pain Improvement

Background: Neuroma results from disorganized regeneration following nerve injury and may be symptomatic. The aim of this study was to investigate the causes, treatment, and outcomes of operatively treated sural neuromas, and to describe the factors associated with persistent or unchanged postoperative pain symptoms. Methods: Consecutive patients with surgically treated sural neuromas in a 14-year period were identified using Current Procedural Terminology (CPT) codes ( n = 49), followed by a chart review to collect patient and treatment characteristics. Postoperative pain symptoms were categorized as complete resolution of pain, improvement of pain, no change in pain, or worse pain. The median patient age was 46.5 years (interquartile range [IQR], 39.1-51.3), and median follow-up was 4.0 years (IQR, 1.9-9.2). Results: Ninety percent of symptomatic sural neuromas developed as a result of previous lower extremity surgery. Initial surgery of sural neuroma led to improvement in pain in 63% of patients, and an additional 8.2% of the patients had improvement after secondary neuroma surgery. Pain relief after diagnostic injection showed a trend toward an association with postoperative pain improvement. Neuroma excision and implantation in muscle was the most common surgical technique used (67%). Four of the 7 patients that underwent a second neuroma operation reported symptom improvement. Conclusion: Sural neuromas may arise from prior surgery or trauma to the lower extremity. Surgical intervention resulted in either improvement or complete resolution of pain symptoms in 71% of patients, although occasionally more than one procedure was required to obtain symptomatic relief. Preoperative anesthetic injection may help identify patients that benefit from neuroma surgery. Level of Evidence: Level IV, retrospective case series.

Upper Extremity and Hip Range of Motion Changes Throughout a Season in Professional Baseball Players

2019 ◽  
Vol 48 (2) ◽  
pp. 481-487
Author(s):  
Justin M. Chan ◽  
John Zajac ◽  
Brandon J. Erickson ◽  
David W. Altchek ◽  
Christopher Camp ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Range Of Motion ◽  
External Rotation ◽  
Significant Risk ◽  
Case Series ◽  
Significant Risk Factor ◽  
Professional Baseball ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Shoulder Flexion

Background: Loss of upper and lower extremity range of motion (ROM) is a significant risk factor for injuries in professional baseball players. Purpose/Hypothesis: The purpose was to determine changes in ROM in professional baseball players over the course of a single season and their careers. We hypothesized that pitchers and position players would lose ROM, specifically total shoulder motion (total ROM [TROM]) and hip internal rotation (IR), over the course of a season and their careers. Study Design: Case series; Level of evidence, 4. Methods: Upper and lower extremity ROM measurements were recorded during pre-, mid-, and postseason on all professional baseball players for a single organization between 2011 and 2018. ROM measurements were compared for pitchers and position players over the course of the season and their careers. Also, ROM measurements over the pre-, mid-, and postseason were compared between pitchers and position players. Results: A total of 166 professional baseball players (98 pitchers, 68 position players) were included. Pitcher hip external rotation (ER; P < .001), IR ( P = .010), and TROM ( P < .001) for lead and trail legs decreased over the course of the season. Pitcher shoulder ER ( P = .005), TROM ( P = .042), and horizontal adduction ( P < .001) significantly increased over the course of the season. Position player shoulder flexion ( P = .046), hip ER ( P < .001, lead leg; P < .001, trail leg), and hip TROM ( P = .001; P = .002) decreased over the course of the season. Position player shoulder ER ( P = .031) and humeral adduction ( P < .001) significantly increased over the course of the season. Over the course of pitchers’ careers, there was decreased shoulder IR ( P = .014), increased shoulder horizontal adduction ( P < .001), and hip IR ( P = .042) and hip TROM ( P = .027) for the lead leg. Position players experienced loss of hip TROM ( P = .010, lead leg; P = .018, trail leg) over the course of their careers. Pitchers started with and maintained more shoulder ER and gained more shoulder TROM over a season as compared with position players. Conclusion: Pitchers and position players saw overall decreases in hip ROM but increases in shoulder ROM over the course of the season and career.

scholarly journals Retears of the Rotator Cuff: An Ultrasonographic Assessment During the First Postoperative Year

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988904 ◽  
Author(s):  
Giussepe Aguado ◽  
Daniel Vernaza Obando ◽  
Gilberto A. Herrera ◽  
Alejandro Ramirez ◽  
Paulo J. Llinás
Keyword(s):  
Rotator Cuff ◽  
Surgical Repair ◽  
Statistical Significance ◽  
Case Series ◽  
Level Of Evidence ◽  
Double Row ◽  
Initial Surgery ◽  
The Difference ◽  
Clinical Records ◽  
Massive Tears

Background: Surgical repair of rotator cuff (RC) tears is an effective treatment option. However, the prevalence of recurrent ruptures is high. Hypothesis: Recurrent tears are a frequent complication of surgical repair of RC tears. Their incidence might be influenced by factors such as the patient’s age and size of the initial tear. Study Design: Case series; Level of evidence, 4. Methods: Data from 90 adult patients who underwent arthroscopic RC repair between 2014 and 2017 and underwent an ultrasound examination 6 to 12 months after surgery were analyzed retrospectively. Massive tears were repaired using a double-row technique, and nonmassive tears were repaired with a single-row technique. Clinical records were reviewed for demographic information. Results: All patients (57.8% women; 42.2% men) were older than 18 years (mean, 58.9 years). Of these patients, 30.0% (27/90) had massive tears, which were primarily found in patients ≥60 years (74.1%; 20/27). Complete healing was seen in 74.5% of all repairs during follow-up. A total of 23 patients (25.5%) had retears (13 complete; 10 partial), which were diagnosed by ultrasound imaging 6 to 12 months after the initial surgery. The occurrence of retears was more prevalent in patients with massive tears than in patients with nonmassive tears (40.7% vs 19.0%, respectively); the difference was statistically significant ( P = .03). Reruptures occurred in 50.0% of patients older than 60 years with massive tears. Although patients older than 60 years had more recurrent tears (32.6%) compared with younger patients (18.2%), the difference was not statistically significant ( P = .12). Conclusion: One-quarter of the patients who had undergone surgical repair of an RC tear had recurrent ruptures. There was a statistically significant association between the initial massive tear and a retear. Patients older than 60 years showed a higher recurrence rate, but this difference lacked statistical significance. Reruptures occurred in 50.0% of patients older than 60 years with massive tears.

Intradural spinal arachnoid cyst resection: implications of duraplasty in a large case series

2018 ◽  
Vol 28 (5) ◽  
pp. 548-554
Author(s):  
Ziev B. Moses ◽  
Gabriel N. Friedman ◽  
David L. Penn ◽  
Isaac H. Solomon ◽  
John H. Chi
Keyword(s):  
Case Series ◽  
Signs And Symptoms ◽  
Symptom Improvement ◽  
Preoperative Pain ◽  
Lumbosacral Region ◽  
Duration Of Symptoms ◽  
Large Patient ◽  
Large Case Series ◽  
Pain Symptoms ◽  
Large Case

OBJECTIVEOptimal diagnosis and management strategies for intradural spinal arachnoid cysts (SACs) are still unresolved given the rare nature of this entity, with few large case series and virtually no statistical analyses of patient characteristics in the literature. Here, the authors studied a large patient cohort with these lesions to determine whether pre- or postoperative attributes could be used to aid in either diagnosis or prognosis.METHODSA chart review was completed at a single institution for the period from 2002 to 2016 to determine the preoperative characteristics and postoperative outcomes of 21 patients with exclusively intradural SACs. Patients were assessed for symptoms such as weakness, pain, sensory changes, bowel and/or bladder dysfunction, and gait changes. Postoperatively, patients were analyzed for symptom improvement, complication occurrence, and duration of follow-up.RESULTSApproximately two-thirds of the patients in this series had developed SACs idiopathically, and the mean duration of symptoms prior to diagnosis was 15 months among all patients. A slight majority (57%) underwent CT myelography in the course of diagnosis, and a quarter of the patients had a syrinx. There was a statistically significant association between location of the SAC and number of presenting signs and symptoms; that is, patients with cysts in the lumbosacral region had more symptoms than those with cysts at the cervical or thoracic levels (p = 0.031). Overall, outcomes were largely positive, with approximately 60%–70% of patients experiencing postoperative improvement in symptoms, with motor weakness showing the highest response rate (71%) and pain symptoms the least likely to subside (50%). In the cohort with preoperative pain, those who had undergone expansile duraplasty were significantly more likely to experience relief of their pain symptoms (p = 0.028), which may have been a result of the superior restoration of cerebrospinal fluid pathways allowing for more adequate reduction in compression.CONCLUSIONSIn this large case series on intradural SACs, new light has been shed on aspects of both pre- and postoperative care for patients with these rare lesions. Specifically, the authors revealed that lumbosacral intradural SACs may be associated with a higher disease burden and that patients who undergo expansile duraplasty may have an increased likelihood of experiencing postoperative pain relief.

Treatment of Postoperative Lower Extremity Wounds Using Human Fibroblast–Derived Dermis

2014 ◽  
Vol 7 (2) ◽  
pp. 102-107 ◽  
Author(s):  
Russell M. Carlson ◽  
Nicholas C. Smith ◽  
Katherine Dux ◽  
Rodney M. Stuck
Keyword(s):  
Lower Extremity ◽  
Surface Area ◽  
Retrospective Review ◽  
Diabetic Foot ◽  
Human Fibroblast ◽  
Case Series ◽  
Skin Substitute ◽  
Surgical Wound ◽  
Level Of Evidence ◽  
Surgical Wound Dehiscence

Human fibroblast–derived dermis skin substitute is a well-studied treatment for diabetic foot ulcers; however, no case series currently exist for its use in healing postoperative wounds of the lower extremity. A retrospective analysis was conducted on 32 lower extremity postoperative wounds treated weekly with human fibroblast–derived dermis skin substitute. Postoperative wounds were defined as a wound resulting from an open partial foot amputation, surgical wound dehiscence, or nonhealing surgical wound of the lower extremity. Wound surface area was calculated at 4 and 12 weeks or until wound closure if prior to 12 weeks. Postoperative wounds treated with weekly applications showed mean improvement in surface area reduction of 63.6% at 4 weeks and 96.1% at 12 weeks. More than 56% of all wounds healed prior to the 12-week endpoint. Additionally, only one adverse event was noted in this group. This retrospective review supports the use of human fibroblast–derived dermis skin substitute in the treatment of postoperative lower extremity wounds. This advanced wound care therapy aids in decreased total healing time and increased rate of healing for not only diabetic foot wounds but also postoperative wounds of the lower extremity, as demonstrated by this retrospective review. Level of Evidence: Therapeutic, Level IV: Case series, retrospective

scholarly journals Effect of plantar incision for metatarsal head resection arthroplasty of the small toes

2018 ◽  
Vol 12 (2) ◽  
pp. 117-122
Author(s):  
Léllande Do Couto Canêdo ◽  
Miguel Viana Pereira Filho ◽  
Mauro César Mattos e Dinato ◽  
Márcio De Faria Freitas ◽  
Rodrigo Gonçalves Pagnano
Keyword(s):  
Rheumatoid Arthritis ◽  
Wound Healing ◽  
Analogue Scale ◽  
Case Series ◽  
Metatarsal Head ◽  
Resection Arthroplasty ◽  
Effective Technique ◽  
Level Of Evidence ◽  
Plantar Incision ◽  
Pain Improvement

Objective: To evaluate the clinical outcome of metatarsal head resection arthroplasty of the small toes using a plantar approach in patients with severe forefoot deformities. Methods: Twelve patients (15 feet), 10 females and two males, age 53 to 81 years old, with diabetes and rheumatoid arthritis were evaluatedbetween January 2014 and September 2017. All patients underwent the same surgical technique – metatarsal head resection arthroplasty of the small toes via a plantar approach. The evaluation was based on pain according to the visual analogue scale, the type of footwear used and the index of patient satisfaction with the surgery. Results: In the series studied, all 12 patients (15 feet) presented significant pain improvement. Regarding wound healing, only one patient had a calloused scar, but without painful or functional impairment. Eleven individuals (14 feet) could wear all types of footwear, and only one had touse custom footwear. Conclusion: Metatarsal head resection arthroplasty of the smaller toes using a plantar approach is a safe, reliable and effective technique for the treatment of patients with severe forefoot deformities.  Level of Evidence IV; Therapeutic Studies, Case series.

scholarly journals Muscle Strains in the Lower Extremity of Japanese Professional Baseball Players

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095656
Author(s):  
Takeshi Kokubu ◽  
Yutaka Mifune ◽  
Noriyuki Kanzaki ◽  
Yuichi Hoshino ◽  
Kenichiro Kakutani ◽  
...  
Keyword(s):  
Lower Extremity ◽  
High Intensity ◽  
Case Series ◽  
Return To Play ◽  
Professional Baseball ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Musculotendinous Junction ◽  
Lower Extremity Muscle

Background: Predicting when athletes can return to play after muscle strains is not always simple because of difficulties in evaluating the severity of such injuries. Purpose/Hypothesis: The purpose of this study was to evaluate the use of magnetic resonance imaging (MRI) to classify lower extremity muscle strains in Japanese professional baseball players. The hypothesis was that MRI grading can be used to diagnose the severity of muscle strains in the lower extremity and predict return to play in athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 55 muscle strains occurred in the lower extremity of players on a professional baseball team between the 2006 and 2015 seasons; all players had undergone MRI examination. Age, player position, location of injury, cause of injury, and duration until return to play (in days) were extracted from the medical records. MRI scans were classified using the following system: grade 0, no abnormal findings; grade 1a, T2-weighted high intensity only between muscles; grade 1b, T2-weighted high intensity between muscles and in muscle belly; grade 2, injury of musculotendinous junction; and grade 3, rupture of tendon insertion. Results: The sites of injuries were distributed as follows: hamstrings (n = 33), quadriceps (n = 6), hip adductors (n = 6), and calves (n = 10). MRI findings revealed 9 muscle strains (16%), 19 grade 1a (34%), 19 grade 1b (34%), and 8 grade 2 muscle strains (16%). The length of time until return to training and competition, respectively, was 15 and 26 days for grade 1a injuries, 19 and 36 days for grade 1b injuries, and 55 and 69 days for grade 2 injuries. Conclusion: Players with grade 1 injuries took 4 to 5 weeks to return to play, whereas players with grade 2 injuries took 10 weeks to return. MRI can be useful for diagnosing lower extremity muscle strains and predicting the time to return to play.

Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study

2021 ◽  
pp. 194173812110110
Author(s):  
Mattia Alessio-Mazzola ◽  
Lamberto Felli ◽  
Roberto Trentini ◽  
Matteo Formica ◽  
Andrea Giorgio Capello ◽  
...  
Keyword(s):  
Platelet Rich Plasma ◽  
Symptomatic Relief ◽  
Case Series ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Level Of Evidence ◽  
Meniscal Lesions ◽  
Activity Scale ◽  
Tegner Activity Scale

Background: Platelet-rich plasma (PRP) injections have been proposed as a biologic option to provide symptomatic relief and delay surgery in patients with degenerative joint disease of osteoarthritis (OA). The efficacy of autologous PRP on symptomatic degenerative meniscal lesions (DMLs) has never been investigated. Hypothesis: We hypothesized that patients with symptomatic DMLs without OA undergoing autologous PRP injections experience a significant clinical improvement at 12 months. Study Design: Prospective case series. Level of Evidence: Level 4. Methods: A total of 69 patients with symptomatic DMLs without radiographic evidence of knee OA (Kellgren-Lawrence radiographic grading scale 0-1) received 4 autologous PRP injections once a week. Patients were prospectively evaluated before the injection and then at 1, 3, 6, and 12 months. Evaluation was based on Lysholm knee scoring scale (primary outcome), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Tegner activity scale, and visual analogue scale scores. Results: Patients treated with PRP injections demonstrated an improving knee function and symptoms over the duration of the study. A significant improvement from baseline to 12 months was observed in all the outcome measures, and no patients experienced failure or required surgery during the follow-up. Patients younger than 50 years reported lower subjective level of pain and higher Tegner activity scale at baseline and had significantly better Lysholm knee scoring scale ( P = 0.03) and WOMAC ( P = 0.03) scores at 6 months, as well as better range of motion at 3, 6, and 12 months ( P < 0.001). Thirty-three (47.8%) patients were very satisfied, 26 (37.7%) satisfied, 8 (11.6%) partially satisfied, and 2 (2.9 %) not satisfied, with 62 (89.8%) patients willing to repeat the same treatment. No patient was lost to follow-up and no patient experienced adverse reaction, infection, failure, recurrence or underwent further surgery. Conclusion: PRP injections provide short-term benefits in symptomatic DMLs. Although promising results were evident at 12 months, this is a preliminary study and no definitive recommendation can be made based, for example, on longer follow-up. Clinical Relevance: This research supports the use of autologous PRP injections for symptomatic DMLs.

scholarly journals Partial plantar fasciectomy for the treatment of plantar fibromatosis

2021 ◽  
Vol 15 (2) ◽  
pp. 124-127
Author(s):  
Lucas Plens de Britto Costa ◽  
Lucas Furtado da Fonseca ◽  
André Vitor Kerber Cavalcanti Lemos ◽  
Vinicius Felipe Pereira ◽  
César de César Netto ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Case Series ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Symptom Improvement ◽  
Surgical Wound ◽  
Level Of Evidence ◽  
Moderate Rate ◽  
Partial Fasciectomy ◽  
Plantar Fibromatosis

Objective: We describe a series of patients treated with resection of the affected band. We assessed functional outcome, recurrence  rate, and surgical wound complications, comparing these data with the available literature. Methods: This retrospective study (level of evidence IV) included 14 patients (17 feet) diagnosed with plantar fibromatosis in the medial portion of the fascia that was refractory to conservative treatment. All operations were performed between December 2016 and November 2018. All patients were assessed for symptom improvement and major and minor complications, in addition to recurrence during the study period.Results: Our sample included 9 men and 5 women, whose mean age was 40.6 years (15-63). All of the patients underwent partial fasciectomy of the medial fascial band with margins of at least 2 cm. There was recurrence in 5 of the 17 feet (29%), but only two required further intervention. Wound dehiscence occurred in 3 patients (17%), and one of the cases was severe, requiring plastic surgery. Two feet showed signs of injury to the digital branch of the medial plantar nerve. Conclusion: Partial plantar fasciectomy is an alternative treatment for plantar fibromatosis (Ledderhose’s disease). Our results agree with the literature in terms of recurrence and postoperative complications. The moderate rate of complications must be taken into account when indicating this procedure. Level of Evidence IV; Therapeutic Studies; Case Series.

Outcomes and Predictors of Postoperative Pain Improvement Following Particulated Juvenile Cartilage Allograft Transplant for Osteochondral Lesions of the Talus

2020 ◽  
Vol 41 (5) ◽  
pp. 572-581 ◽  
Author(s):  
Kenneth A. Heida ◽  
Mikel C. Tihista ◽  
Nicholas A. Kusnezov ◽  
John C. Dunn ◽  
Justin D. Orr
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Behavioral Health ◽  
Tobacco Use ◽  
Clinical Success ◽  
Case Series ◽  
Osteochondral Lesions ◽  
Ankle Pain ◽  
Preoperative Pain ◽  
Level Of Evidence

Background: Particulated juvenile cartilage allograft transfer (PJCAT) is an emerging treatment option for management of osteochondral lesions of the talus (OCLTs). This series reports on outcomes and identifies predictors for success following PJCAT for isolated OCLTs. Methods: We reviewed 33 consecutive patients who underwent PJCAT by a single surgeon from 2013 to 2017. Preoperative demographic factors (age, body mass index [BMI], tobacco use, behavioral health comorbidity, and ankle pain visual analog score [VAS]) and OCLT morphologic data were collected. Outcomes included postoperative improvements in VAS and American Orthopaedic Foot & Ankle Society (AOFAS) score and clinical success/failure. Results of 7 second-look arthroscopies and complications are provided. Categorical data are reported as frequencies, and statistical means with P values are reported for continuous variables. We had a mean 3.5 years of follow-up. Results: Improvement in ankle pain VAS following isolated PJCAT was 51% ( P < .001). For the first 16 consecutive patients in whom complete AOFAS scores were available, 40% ( P < .001) improvement occurred. Presence of 1 or more behavioral health diagnoses was a risk factor for decreased pain relief, while moderate to severe preoperative pain (VAS >5.9) predicted improved postoperative pain relief. Age, BMI, tobacco use, and OCLT morphology did not affect outcomes. Conclusion: For treatment of large, high-stage OCLTs, PJCAT resulted in 40% to 50% improvement in ankle pain and disability within 3.5 years. The results may be better in patients with moderate to severe preoperative pain but worse in those with preexisting behavioral health diagnoses. Level of Evidence: Level IV, retrospective case series.

scholarly journals Retroperitoneal approach for the treatment of diaphragmatic crus syndrome: technical note

2020 ◽  
Vol 33 (1) ◽  
pp. 114-119
Author(s):  
Zach Pennington ◽  
Bowen Jiang ◽  
Erick M. Westbroek ◽  
Ethan Cottrill ◽  
Benjamin Greenberg ◽  
...  
Keyword(s):  
Blood Flow ◽  
Lower Extremity ◽  
Complete Resolution ◽  
Vascular Malformations ◽  
Acute Onset ◽  
Technical Note ◽  
Symptom Improvement ◽  
Artery Of Adamkiewicz ◽  
Full Neurological Recovery ◽  
Flow Through

OBJECTIVEMyelopathy selectively involving the lower extremities can occur secondary to spondylotic changes, tumor, vascular malformations, or thoracolumbar cord ischemia. Vascular causes of myelopathy are rarely described. An uncommon etiology within this category is diaphragmatic crus syndrome, in which compression of an intersegmental artery supplying the cord leads to myelopathy. The authors present the operative technique for treating this syndrome, describing their experience with 3 patients treated for acute-onset lower-extremity myelopathy secondary to hypoperfusion of the anterior spinal artery.METHODSAll patients had compression of a lumbar intersegmental artery supplying the cord; the compression was caused by the diaphragmatic crus. Compression of the intersegmental artery was probably producing the patients’ symptoms by decreasing blood flow through the artery of Adamkiewicz, causing lumbosacral ischemia.RESULTSAll patients underwent surgery to transect the offending diaphragmatic crus. Each patient experienced substantial symptom improvement, and 2 patients made a full neurological recovery before discharge.CONCLUSIONSDiaphragmatic crus syndrome is a rare or under-recognized cause of ischemic myelopathy. Patients present with episodic acute-on-chronic lower-extremity paraparesis, gait instability, and numbness. Angiography confirms compression of an intersegmental artery that gives rise to a dominant radiculomedullary artery. Transecting the offending diaphragmatic crus can produce complete resolution of neurological symptoms.

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