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Lower Extremity

  • Andrew I. ElkwoodEmail author
  • Lisa F. Schneider
  • Michael I. Rose
Chapter

Abstract

We present our approach to the patient with lower extremity nerve injury or dysfunction. First, we have a step-by-step description of lower extremity anatomy, including nerve anatomy. We then present nerve compression syndromes from proximal to distal on the extremity, explaining how to evaluate and treat the patient. These syndromes include pudendal neuralgia, piriformis syndrome, femoral and obturator syndromes, peroneal compression, and tarsal tunnel syndrome. We also discuss lower extremity neuropathy in great detail, ranging from basic science to release of compression, as well as diabetic foot wounds and their reconstruction.

Keywords

Pudendal neuralgia Piriformis syndrome Femoral nerve compression Obturator nerve Compression syndromes Peroneal compression Tarsal tunnel syndrome Lower extremity Neuropathy Diabetic foot wounds 

References

  1. 1.
    Robert R, Raoul S, Leborgne J, Prat-Pradal D, Labat J, Bensignor M, Thiodet J. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat. 1998;20:93–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Pereira A, Pérez-Medina T, Rodríguez-Tapia A, Rutherford S, Millan I, Iglesias E, Ortiz-Quintana L. Chronic perineal pain: analyses of prognostic factors in pudendal neuralgia. Clin J Pain. 2014;30:577–5.PubMedGoogle Scholar
  3. 3.
    Hibner M, Desai N, Robertson LJ, Nour M. Review Article: pudendal neuralgia. J Minimally Invasive Gynecology. 2010;17:148–53.CrossRefGoogle Scholar
  4. 4.
    Possover M, Forman A. Voiding Dysfunction Associated with Pudendal Nerve Entrapment. Curr Bladder Dysfunct Rep. 2012;7:281–5.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Leibovitch I, Mor Y. Review: the vicious cycling: bicycling related urogenital disorders. Eur Urol. 2005;47:277–87.CrossRefPubMedGoogle Scholar
  6. 6.
    Labat J, Rigaud J, Riant T, Robert R, Amarenco G, Lefaucheur J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes Criteria). Neurourol Urodyn. 2008;27:306–10.CrossRefPubMedGoogle Scholar
  7. 7.
    Mamlouk MD, VanSonnenberg E, Dehkharghani S. CT-guided nerve block for pudendal neuralgia: diagnostic and therapeutic implications. AJR Am J Roentgenol. 2014;203:196–200.CrossRefPubMedGoogle Scholar
  8. 8.
    Robert R, Labat J, Bensignor M, Glemain P, Deschamps C, Raoul S, Hamel O. Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation. Eur Urol. 2005;47:403–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Cass SP. Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep. 2015;14:41–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Sivrioglu AK, Ozyurek S, Mutlu H, Sonmez G. Piriformis syndrome occurring after pregnancy. BMJ Case Rep. 2013;26:2013.Google Scholar
  11. 11.
    Hamdi W, Ghannouchi MM, Kaffel D, Kchir MM. Piriformis muscle syndrome: an unusual adverse effect of atorvastatin. J Clin Rheumatol. 2013;19:156–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Menu P, Fouasson-Chaillou A, Dubois C, Dauty M. Piriformis syndrome diagnosis: on two professional cyclists. Ann Phys Rehabil Med. 2014;57:268–74.CrossRefPubMedGoogle Scholar
  13. 13.
    Drampalos E, Sadiq M, Thompson T, Lomax A, Paul A. Intrapiriformis lipoma: an unusual cause of piriformis syndrome. Eur Spine J. 2014;24:551– 4.Google Scholar
  14. 14.
    Kitagawa Y, Yokoyama M, Tamai K, Takai S. Chronic expanding hematoma extending over multiple gluteal muscles associated with piriformis syndrome. J Nippon Med Sch. 2012;79:478–83.CrossRefPubMedGoogle Scholar
  15. 15.
    Toda T, Koda M, Rokkaku T, Watanabe H, Nakajima A, Yamada T, Murakami K, Nakajima H, Murakami M. Sciatica caused by pyomyositis of the piriformis muscle in a pediatric patient. Orthopedics. 2013;36:e257–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Misirlioglu TO, Akgun K, Palamar D, Erden MG, Erbilir T. Piriformis syndrome: comparison of the effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study. Pain Physician. 2015;18:163–71.PubMedGoogle Scholar
  17. 17.
    Michel F, Decavel P, Toussirot E, Tatu L, Aleton E, Monnier G, Garbuio P, Parratte B. Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med. 2013;56:371–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Yildirim P, Guler T, Misirlioglu TO, Ozer T, Gunduz OH. A case of drop foot due to piriformis syndrome. Acta Neurol Belg. 2015;115(4):847–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Jankovic D, Peng P, van Zundert A. Brief review: piriformis syndrome: etiology, diagnosis, and management. Can J Anaesth. 2013;60:1003–12.CrossRefPubMedGoogle Scholar
  20. 20.
    Al-Al-Shaikh M, Michel F, Parratte B, Kastler B, Vidal C, Aubry S. An MRI evaluation of changes in piriformis muscle morphology induced by botulinum toxin injections in the treatment of piriformis syndrome. Diagn Interv Imaging. 2015;96:37–43.CrossRefPubMedGoogle Scholar
  21. 21.
    Craig A. Entrapment neuropathies of the lower extremity. PMR. 2013;5(5 Suppl):S31–40.CrossRefGoogle Scholar
  22. 22.
    Maneschi F, Nale R, Tozzi R, Biccirè D, Perrone S, Sarno M. Femoral nerve injury complicating surgery for gynecologic cancer. Int J Gynecol Cancer. 2014;24:1112–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Kuntzer T, van Melle G, Regli F. Clinical and prognostic features in unilateral femoral neuropathies. Muscle Nerve. 1997;20:205–11.CrossRefPubMedGoogle Scholar
  24. 24.
    Mackinnon SE, Dellon AL. Surgery of the peripheral nerve, Chapter 13. New York: Thieme Pub; 1988. p. 320–36.Google Scholar
  25. 25.
    Mont MA, Dellon AL, Chen F, Hungerford MW, Krackow KA, Hungerford DH. Operative treatment of peroneal nerve palsy. J Bone Joint Surg. 1996;78A:863–9.CrossRefGoogle Scholar
  26. 26.
    Steinau HU, Tofaute A, Huellmann K, Goertz O, Lehnhardt M, Kammler J, Steinstraesser L, Daigeler A. Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and pedobarographic measurements. Arch Orthop Trauma Surg. 2011;131:903–10.CrossRefPubMedGoogle Scholar
  27. 27.
    Mackinnon SE, Dellon AL, Tarsal tunnel syndrome, surgery of the peripheral nerve, Chapter 12. New York: Thieme Pub; 1988.Google Scholar
  28. 28.
    Mullick T, Dellon AL. Results of treatment of four medial ankle tunnels in tarsal tunnels syndrome. J Reconstr Microsurg. 2008;24:119–26.CrossRefPubMedGoogle Scholar
  29. 29.
    Dellon AL. Treatment of symptoms of diabetic neuropathy by peripheral nerve decompression. Plast Reconstr Surg. 1992;89:689–97.CrossRefPubMedGoogle Scholar
  30. 30.
    Valdivia JMV, Dellon AL, Weinand MD, Maloney Jr CT. Surgical treatment of peripheral neuropathy: outcomes from 100 consecutive decompressions. J Am Podiatr Med Assoc. 2005;95:451–4.CrossRefPubMedGoogle Scholar
  31. 31.
    Aszmann OC, Kress K, Dellon AL. Results of decompression of peripheral nerves in diabetics: a prospective, blinded study utilizing computer-assisted sensorimotor testing. Plast Reconstr Surg. 2000;106:816–22.CrossRefPubMedGoogle Scholar
  32. 32.
    Aszmann OC, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure, accepted. Ann Plast Surg. 2004;53(517):22.Google Scholar
  33. 33.
    Dellon AL, Swier P, Levingood M, Maloney CT. Cisplatin/Taxol neuropathy: treatment by decompression of peripheral nerve. Plast Reconstr Surg. 2004;114:478–83.CrossRefPubMedGoogle Scholar
  34. 34.
    Dellon AL, Dellon ES, Seiler IV WA. Effect of tarsal tunnel decompression in the streptozotocin-induced diabetic rat. Microsurgery. 1994;15:265.CrossRefPubMedGoogle Scholar
  35. 35.
    Kale B, Yuksel F, Celikoz B, et al. Effect of various nerve decompression procedures on the functions of distal limbs in streptozotocin-induced diabetic rats: further optimism in diabetic neuropathy. Plast Reconstr Surg. 2003;111:2265.CrossRefPubMedGoogle Scholar
  36. 36.
    Tassler P, Dellon AL, Lesser GJ, Grossman S. Utility of decompressive surgery in the prophylaxis and treatment of cisplatin neuropathy in adult rats. J Reconstr Microsurg. 2000;16:457.CrossRefPubMedGoogle Scholar
  37. 37.
    Lee CH, Dellon AL. Prognostic ability of Tinel sign in determining outcome for decompression surgery in diabetic and nondiabetic neuropathy. Ann Plast Surg. 2004;53:523.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Andrew I. Elkwood
    • 1
    Email author
  • Lisa F. Schneider
    • 1
  • Michael I. Rose
    • 1
  1. 1.The Plastic Surgery CenterInstitute for Advanced ReconstructionShrewsburyUSA

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