Neurological Flashcards
Interdigital neuroma Tarsal tunnel syndrome anterior tarsal tunnel syndrome SPN entrapment Diabetic foot Poliomyelitis Diabetic foot
What is Poliomyelitis?
- VIRAL DESTRUCTION OF THE ANTERIOR HORN CELLS IN THE SPINAL CORD AND BRAIN STEM MOTOR NUCLEI
-
Hallmark
- MOTOR WEAKNESS with NORMAL SENSATION
What is polio’s clinical features ?
- MOTOR WEAKNESS NORMAL SENSATION
- Flaccid, Asymmetrical Muscle weakness
- Flexion, abduction contracture hip
- Flexure contracture knee, valgus deformity and genorecurvatum
- ankle -equinus, foot- valgus/varus
What is the epidemiology of polio?
- Present in developing countries- WHO tried to erradicate it in 2006 endemic in 6 countried
- Eliminated in US and UK due to vaccination
What is its treatment of polio foot deformities?
non operative
-
lightweight orthosis
- first line
- Help pt maintain functional independence
Surgery
-
Contracture release, Tendon transfer, Arthrodesis
- if orthosis not achieving satifiactory ADL’s
Name associated conditions of Polio? What is it?
- Post Polio Syndrome
- AN aging phenomenon when more nerve cells become inactive with time.
- Characterised by Muscle weakness, myalgia & fatigue
- Doesn’t represent reactivation of virus
- Occurs in middle age (20-40 yrs after inital infection)
- Occurs in up to 50% cases of polio
- Leads to difficulties of ADL
- Patients should exercise at sub-exhaustion levels to tone affected muscles groups without causing muscle breakdown
What is post polio syndrome tx?
Non operative
-
Limited exercise with periods of rest and lightweight orthosis
- first line of tx
- Maintain but not overuse muscles
Operative
- Tendon transfers, contracture releases & arthrodesis
- To optimise funcitonal capacity
Define Tarsal Tunnel syndrome?
- Compression neuropathy caused by compression of TIBIAL nerve
What is the aetiology of tarsal tunnel syndrome?
-
Intrinsic
- Ganglionic cyst
- Tendonopathy
- Tenosynovitis
- Lipoma/tumour
- Peri-neural fibrosis
- Osteophytes
-
Extrinsic
- Shoes
- Trauma
- Anatomical deformity- tarsal coalition/valgus hindfoot
- Systemic inflammatory disease
- Oedema of the lower extremity
- IN 80% cases no cause for compression is found
Describe the prognosis of tarsal tunnel syndrome?
- Result vary between 50-90%
- Worse results with ‘Double crush injury’ and post operative scarring
- Revision surgery less successful than index operation
Define the anatomy of the tarsal tunnel?
Anatomy defined by
- Flexor retinaculum- Lacinate ligament
- Calcaneus - medial
- Talus- medial
- Adbuctor hallucis- inferior
What is in the tarsal tunnel?
- Tibial Nerve- posterior
- Posterior tibial artery
- FHL tendon
- FDL tendon
- tibialis posterior tendon
What does the tibial nerve divide into?
- Medial plantar
- Lateral Plantar
- Medical Calcaneal
- The medial and lateral plantar nerves can be compressed in their own sheaths, distal to tarsal tunnel
- Bifurcation of tibial nerve in 5% cases occurs proximal to tarsal tunnel
Describe the signs and symptoms of tarsal tunnel syndrome?
Hx of previous trauma/ surgery
Symptoms
- Pain with prolonged standing/walking
- Often vague medial foot pain
- Sharp burning pains in foot
- Intermittent numbness in plantar of foot
Signs
- Tenderness of tibial n- Tinel’s sign
- Pes planus
- Muscle wasting of foot instrinsics- abductor digit quntini, or abductor hallucis
- Pain with dorsiflexion & eversion of ankle
- Compression test
- compression over tarsal tunnel= pain - sensitive and specific
- Compression with plantarflexion & inversion
What investigations are helpful to aid diagnosis of tarsal tunnel syndrome?
- Weight bearing radiographs- osseoud
-
MRI
- exclude accessoty muscle/ soft tissue tumour
-
EMG
- positive finding
- distal motor latencies of >7.0ms
- prolonged sensory latencies of >2.3msec
- Sensory more likely abnormal cf motor
- Decreased amplitude of motor action potentials of abductor hallucis or abductor digiti minimi
What is the treatment of tarsal tunnel syndrome?
- Non operative
-
Lifestyle modifications. medications
- usually ineffective
- NSAIDS/ SSRIs
-
Bracing
- orthosis/ foot wear changes to adress aligment of hindfoot
- try a period of short leg cast
-
Lifestyle modifications. medications
- Operative
-
Surgical Release of Tarsal Tunnel
- 3-6 months after failed consx
- compressive mass identified
- reproducible findings
- best outcomes- where a compressing anatomic stricture ganglionic cyst is identified and removed
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Surgical Release of Tarsal Tunnel