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Ronald S Adler - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound guided therapeutic injection and cryoablation of the Medial Plantar proper digital Nerve joplin s Nerve sonographic findings technique and clinical outcomes
    Academic Radiology, 2020
    Co-Authors: Christopher J Burke, William R. Walter, Julien Sanchez, Luis S Beltran, Ronald S Adler
    Abstract:

    Rationale and Objectives The Medial Plantar proper digital Nerve, also called Joplin's Nerve, arises from the Medial Plantar Nerve, courses along the Medial hallux metatarsophalangeal joint, and can be a source of neuropathic pain due to various etiologies, following acute injury including bunion surgery and repetitive microtrauma. We describe our clinical experience with diagnostic ultrasound assessment of Joplin's neuropathy and technique for ultrasound-guided therapeutic intervention including both injection and cryoablation over a 6-year period. Materials and Methods Retrospective review of all diagnostic studies performed for Joplin's neuropathy and therapeutic Joplin's Nerve ultrasound-guided injections and cryoablations between 2012 and 2018 was performed. Indications for therapeutic injection and cryoablation, were recorded. Studies were assessed for sonographic abnormalities related to the Nerve and perineural soft tissues. Post-treatment outcomes including immediate pain scores, clinical follow-up, and periprocedural complications were documented. Results Twenty-four ultrasound-guided procedures were performed, including 15 perineural injections and nine cryoablations. With respect to sonographic abnormalities, Nerve thickening (33%) and perineural hypoechoic scar tissue (27%) were the most common findings. The mean pain severity score prior to the therapeutic injection was 6.4/10 (range 4–10) and 0.25/10 (range 0–2) following the procedure; mean follow-up was 26.2 months (range 3–63 months). All of the cryoablation patients experienced sustained pain relief with a mean length follow-up of 3.75 months (range 0.2–10 months). Conclusion Therapeutic injection of Joplin's Nerve is a safe and easily performed procedure under ultrasound guidance, with high rates of immediate symptom improvement. For those experiencing a relapse or recurrent symptoms, cryoablation offers an effective secondary potential treatment option.

  • Ultrasound-guided therapeutic injections for neural pathology about the foot and ankle: a 4 year retrospective review
    Skeletal Radiology, 2017
    Co-Authors: William R. Walter, Christopher J Burke, Ronald S Adler
    Abstract:

    Objective To describe a 4-year clinical experience with ultrasound-guided therapeutic perineural injections of peripheral Nerves about the foot and ankle. Materials and methods Retrospective analysis of foot and ankle perineural injections performed between January 2012 and August 2016. Demographics, clinical indications, presence of structural pathology, immediate and interval pain relief, as well as complications were recorded. Results Fifty-nine therapeutic injections were performed among 46 patients, accounting for multiple injections in a single visit or multiple visits [mean age = 43 years (range 18–75), 31 female (67%) and 15 male (33%)]. Most commonly, perineural injections involved the hallux branch of the Medial Plantar Nerve ( n  = 17, 22%). Least commonly, perineural injections involved the saphenous Nerve ( n  = 3, 4%). Other injections in our series include sural (10), superficial (11) and deep (7) peroneal, Medial (5) and lateral (3) Plantar Nerves, and the posterior tibial Nerve (3). Ultrasound evaluation revealed structural abnormality associated with the Nerve in 30 cases (51%)—most commonly thickening with perineural scarring ( n  = 14). Of 45 injections with complete documentation, immediate relief of symptoms was reported in 43 (96%) cases. Interval symptom relief was achieved in 23 injections [short term ( n  = 12), intermediate ( n  = 6), and long term ( n  = 5)] out of 38 for which follow-up was available (61%). Complications are rare, occurring in only one case. Conclusion Ultrasound-guided perineural injections about the foot and ankle are safe and provide lasting symptomatic relief for many indications. Concomitant sonographic evaluation identifies structural abnormalities that may contribute to neuropathic symptoms, allowing targeting of injection or clinical therapy.

  • Tibial Nerve Block Using an Ultrasound‐Guided Inframalleolar Medial Plantar Nerve Perineural Injection: A Technical Note
    Journal of Clinical Ultrasound, 2017
    Co-Authors: Christopher J Burke, Ronald S Adler
    Abstract:

    Sonographic-guided tibial Nerve block allows for rapid anesthetization of the heel and Plantar regions of the foot. We describe a variant technique for tibial Nerve regional anesthesia utilizing perineural injection of the Medial Plantar Nerve proximal to the sustentaculum tali where the Nerve is superficial and readily accessed, with resultant retrograde flow of local anesthetic proximally. Perineural injection of the Medial Plantar Nerve at the inframalleolar level provides a simple, safe, and effective alternative method to achieve tibial Nerve block for regional anesthesia in a variety of procedures. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound, 2017

  • tibial Nerve block using an ultrasound guided inframalleolar Medial Plantar Nerve perineural injection a technical note
    Journal of Clinical Ultrasound, 2017
    Co-Authors: Christopher J Burke, Ronald S Adler
    Abstract:

    Sonographic-guided tibial Nerve block allows for rapid anesthetization of the heel and Plantar regions of the foot. We describe a variant technique for tibial Nerve regional anesthesia utilizing perineural injection of the Medial Plantar Nerve proximal to the sustentaculum tali where the Nerve is superficial and readily accessed, with resultant retrograde flow of local anesthetic proximally. Perineural injection of the Medial Plantar Nerve at the inframalleolar level provides a simple, safe, and effective alternative method to achieve tibial Nerve block for regional anesthesia in a variety of procedures. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound, 2017

David N Herrmann - One of the best experts on this subject based on the ideXlab platform.

  • yield of the sural radial ratio versus the Medial Plantar Nerve in sensory neuropathies with a normal sural response
    Journal of Clinical Neurophysiology, 2008
    Co-Authors: John P Sullivan, Eric L Logigian, Naira Kocharian, David N Herrmann
    Abstract:

    Abstract:The electrodiagnostic yield of the Medial Plantar Nerve action potential (NAP) amplitude versus the sural/radial amplitude ratio (SRAR) was determined in 110 consecutive patients with clinically diagnosed distal sensory polyneuropathy (SN) and normal sural responses. Forty-five consecutive

  • Plantar Nerve ap and skin biopsy in sensory neuropathies with normal routine conduction studies
    Neurology, 2004
    Co-Authors: David N Herrmann, Michele Ferguson, Valerie Pannoni, Richard L Barbano, Michael Stanton, Eric L Logigian
    Abstract:

    Objective: To assess the Medial Plantar Nerve action potential (NAP) and skin biopsy in the evaluation of suspected distal sensory neuropathies (SN) with normal routine Nerve conduction studies (NCS). Methods: A total of 110 consecutive patients with suspected distal SN and normal routine NCS underwent Medial Plantar NAP testing and punch skin biopsy. Patients were clinically stratified as having pure small fiber sensory neuropathy (SFSN), or distal SN with large fiber involvement (SN-LFI). Results: A total of 56 patients were classified as SN-LFI and 54 SFSN. The Medial Plantar NAP, a measure of large fiber function, was abnormal in 31.8% of patients, more frequently in SN-LFI than SFSN. Distal leg epidermal Nerve fiber (ENF) density, a measure of small fibers, was reduced in 47.3% of biopsies, with isolated ENF morphologic changes in 29.1% and normal findings in 23.6%. Biopsy abnormalities were more severe and prevalent in SN-LFI than in SFSN. In patients with a normal Medial Plantar NAP, distal leg biopsy showed reduced ENF density in 34.7%, and isolated morphologic changes in a further 37% of cases. Conclusions: The Medial Plantar Nerve action potential and skin biopsy are complementary in evaluation of distal SN with normal routine NCS. Small sensory Nerve fibers are affected early in SN, and more severely so when large fiber involvement is apparent clinically.

  • class of Nerve fiber involvement in sensory neuropathies clinical characterization and utility of the Plantar Nerve action potential
    Muscle & Nerve, 2002
    Co-Authors: Hiroyuki Nodera, Eric L Logigian, David N Herrmann
    Abstract:

    Precise classification of distal sensory polyneuropathies (SN) according to fiber type involvement is desirable for clinical and research purposes. The sural sensory response has served as an electrophysiologic gold standard for the assessment of large-fiber sensory dysfunction. However, patients labeled as having small-fiber sensory neuropathies on the basis of a normal sural response frequently have clinical evidence of large-fiber dysfunction. The surface-recorded Medial Plantar potential has shown promise as a more sensitive indicator of large-fiber sensory dysfunction, but is not widely accepted because of concerns about age effects and a lack of large well-controlled studies in SN. We have thus correlated clinical type of SN: large-fiber sensory neuropathies (LFSN), small-fiber sensory neuropathies (SFSN), and mixed (large- and small-fiber) sensory neuropathies (MFSN) with sural and Medial Plantar Nerve conduction studies in 133 consecutive patients with distal SN and 108 control subjects. A combination of stringent clinical characterization and electrophysiologic features, especially the surface-recorded Medial Plantar rather than sural potential, was complementary, and permitted a more clear separation of LFSN, MFSN, and SFSN than with either approach used alone.

Yoshihide Sunada - One of the best experts on this subject based on the ideXlab platform.

  • whole Plantar Nerve conduction study with disposable strip electrodes
    Muscle & Nerve, 2016
    Co-Authors: Shoji Hemmi, Katsumi Kurokawa, Taiji Nagai, Toshio Okamoto, Tatsufumi Murakami, Yoshihide Sunada
    Abstract:

    Introduction: A new method to evaluate whole Plantar Nerve conduction with disposable strip electrodes (DSEs) is described. Methods: Whole Plantar compound Nerve action potentials (CNAPs) were recorded at the ankle. DSEs were attached to the sole for simultaneous stimulation of Medial and lateral Plantar Nerves. We also conducted Medial Plantar Nerve conduction studies using an established method and compared the findings. Results: Whole Plantar CNAPs were recorded bilaterally from 32 healthy volunteers. Mean baseline to peak amplitude for CNAPs was 26.9 ± 11.8 μV, and mean maximum conduction velocity was 65.8 ± 8.3 m/s. The mean amplitude of CNAPs obtained by our method was 58.2% higher than that of CNAPs obtained by the Saeed method (26.9 μV vs. 17.0 μV; P < 0.0001). Conclusions: The higher mean amplitude of whole Plantar CNAPs obtained by our method suggests that it enables CNAPs to be obtained easily, even in elderly people. Muscle Nerve, 2015

  • simple and novel method to measure distal sensory Nerve conduction of the Medial Plantar Nerve
    Muscle & Nerve, 2007
    Co-Authors: Shoji Hemmi, Tatsufumi Murakami, Ken Inoue, Yoshihide Sunada
    Abstract:

    A simple and reliable method for recording sensory Nerve action potentials (SNAPs) of the Medial Plantar Nerve is described. Medial Plantar SNAPs were recorded by placing surface electrodes on the sole. Ring electrodes were used for orthodromic stimulation at the big toe. Sixty-four healthy subjects ranging in age from 13 to 81 years were examined to establish normal values. Mean amplitude for the Medial Plantar SNAP was 4.7 ± 2.8 μV and mean maximum conduction velocity was 43.5 ± 6.4 m/s. The normal values for amplitude obtained for the Medial Plantar SNAPs were higher than those obtained by the method of Guiloff and Sherratt, and the sensitivity of our method for diagnosis of early sensory neuropathy was relatively higher. The method should therefore be useful in the diagnosis of early sensory neuropathy. Muscle Nerve, 2007

H Hirano - One of the best experts on this subject based on the ideXlab platform.

  • Medial Plantar Nerve conduction velocities among patients with vibration syndrome due to chain saw work
    International Archives of Occupational and Environmental Health, 1999
    Co-Authors: Mamoru Hirata, Hisataka Sakakibara, Shinya Yamada, Toshinori Hashiguchi, Norikuni Toibana, H Koshiyama, H Hirano
    Abstract:

    Objective: The present study examined the effect of the vibration syndrome (VS) on the peripheral nervous system in the lower extremities. Methods: Thirty-eight patients with VS due to previous exposure to vibration from chain-saw work and 55 age-matched controls were examined for sensory Nerve conduction velocities in the Medial Plantar Nerve (SCV-P). The patient group was divided into two subgroups, one with (n=19) and the other without vibration-induced white finger (VWF; n=19). Results: Analysis of variance of SCV-P for the three groups showed significant difference (F 2,89=10.65, P < 0.0001). A significant difference was found between the controls and the VWF+ group (P < 0.0001) but not between the controls and the VWF− group (P=0.0508) by multiple comparison using Scheffe's method. Conclusion: These findings suggest that VS affects the peripheral nervous system function in the lower extremities via mediation of circulatory disturbance manifested as VWF.

Eric L Logigian - One of the best experts on this subject based on the ideXlab platform.

  • yield of the sural radial ratio versus the Medial Plantar Nerve in sensory neuropathies with a normal sural response
    Journal of Clinical Neurophysiology, 2008
    Co-Authors: John P Sullivan, Eric L Logigian, Naira Kocharian, David N Herrmann
    Abstract:

    Abstract:The electrodiagnostic yield of the Medial Plantar Nerve action potential (NAP) amplitude versus the sural/radial amplitude ratio (SRAR) was determined in 110 consecutive patients with clinically diagnosed distal sensory polyneuropathy (SN) and normal sural responses. Forty-five consecutive

  • Plantar Nerve ap and skin biopsy in sensory neuropathies with normal routine conduction studies
    Neurology, 2004
    Co-Authors: David N Herrmann, Michele Ferguson, Valerie Pannoni, Richard L Barbano, Michael Stanton, Eric L Logigian
    Abstract:

    Objective: To assess the Medial Plantar Nerve action potential (NAP) and skin biopsy in the evaluation of suspected distal sensory neuropathies (SN) with normal routine Nerve conduction studies (NCS). Methods: A total of 110 consecutive patients with suspected distal SN and normal routine NCS underwent Medial Plantar NAP testing and punch skin biopsy. Patients were clinically stratified as having pure small fiber sensory neuropathy (SFSN), or distal SN with large fiber involvement (SN-LFI). Results: A total of 56 patients were classified as SN-LFI and 54 SFSN. The Medial Plantar NAP, a measure of large fiber function, was abnormal in 31.8% of patients, more frequently in SN-LFI than SFSN. Distal leg epidermal Nerve fiber (ENF) density, a measure of small fibers, was reduced in 47.3% of biopsies, with isolated ENF morphologic changes in 29.1% and normal findings in 23.6%. Biopsy abnormalities were more severe and prevalent in SN-LFI than in SFSN. In patients with a normal Medial Plantar NAP, distal leg biopsy showed reduced ENF density in 34.7%, and isolated morphologic changes in a further 37% of cases. Conclusions: The Medial Plantar Nerve action potential and skin biopsy are complementary in evaluation of distal SN with normal routine NCS. Small sensory Nerve fibers are affected early in SN, and more severely so when large fiber involvement is apparent clinically.

  • class of Nerve fiber involvement in sensory neuropathies clinical characterization and utility of the Plantar Nerve action potential
    Muscle & Nerve, 2002
    Co-Authors: Hiroyuki Nodera, Eric L Logigian, David N Herrmann
    Abstract:

    Precise classification of distal sensory polyneuropathies (SN) according to fiber type involvement is desirable for clinical and research purposes. The sural sensory response has served as an electrophysiologic gold standard for the assessment of large-fiber sensory dysfunction. However, patients labeled as having small-fiber sensory neuropathies on the basis of a normal sural response frequently have clinical evidence of large-fiber dysfunction. The surface-recorded Medial Plantar potential has shown promise as a more sensitive indicator of large-fiber sensory dysfunction, but is not widely accepted because of concerns about age effects and a lack of large well-controlled studies in SN. We have thus correlated clinical type of SN: large-fiber sensory neuropathies (LFSN), small-fiber sensory neuropathies (SFSN), and mixed (large- and small-fiber) sensory neuropathies (MFSN) with sural and Medial Plantar Nerve conduction studies in 133 consecutive patients with distal SN and 108 control subjects. A combination of stringent clinical characterization and electrophysiologic features, especially the surface-recorded Medial Plantar rather than sural potential, was complementary, and permitted a more clear separation of LFSN, MFSN, and SFSN than with either approach used alone.