No abstract available.
Tibial Nerve*

OBJECTIVE: The sural nerve is a sensory nerve in the lower extremity which is formed by the union of the medial sural cutaneous nerve of tibial nerve and the communicating branch of the common peroneal nerve. The objective of this study is to standardize the electrodiagnostic technique of proximal conduction of sural nerve and to investigate the usefulness of the technique in evaluation for the patients with peripheral neuropathy. METHOD: Fifty eight extremities in 29 normal adults without the clinical signs and symptoms of peripheral neuropathy were evaluated with sural nerve conduction study. The active recording electrode was placed over 14 cm proximal to the lateral malleolus, and the reference electrode was placed over 4cm distal to the active electrode. The antidromic evoked responses were recorded with stimulation at points 7, 14, 21 cm proximal to the recording electrode and directly over the sural nerve. RESULTS: The mean values of proximal conduction study of sural nerve in normal adults were 2.40 1.03 msec for peak latency, 11.55 +/-7.31 microvolt in amplitude with stimulation at 7 cm proximal to the recording electrode; 3.43 +/-0.78 msec for peak latency, 10.87 5.86 microvolt in amplitude with stimulation at 14 cm; 4.51 +/-0.83 msec for peak latency, 8.78+/- 4.10 microvolt in amplitude with stimulation at 21 cm. CONCLUSION: A method of proximal conduction study of sural nerve was introduced which could be used as a valuable technique for the evaluation of peripheral neuropathy.
Adult ; Electrodes ; Extremities ; Humans ; Lower Extremity ; Peripheral Nervous System Diseases ; Peroneal Nerve ; Sural Nerve* ; Tibial Nerve

OBJECTIVES: This study is a case report of 2,5-hexanedione induced occupational peripheral polyneuropathy. We also investigated the peripheral nerve function of all workers who had been exposed to 2,5-hexanedione in the same process. METHODS: In June, 2006, a 2,5-hexanedione exposed worker complained of both hand numbness. He received neurologic, radiologic, laboratorial and electrophysiologic evaluation, including measurements of workplace environment. Five months after cessation of exposure to 2,5-hexanedione, a follow-up electrophysiologic examination was done. We evaluated the peripheral nerve function of 2,5-hexanedione exposed workers by comparing 13 male 2,5-hexanedione exposed workers who were in same company with the patient and 5 male workers who had not been exposed to 2,5-hexanedione. RESULTS: Under electrophysiologic examination, there were abnormalities in sensory and motor nerve velocity, terminal latency, and F-latency of both median nerve and ulnar nerve. After 5 months, the patient symptoms and the results of follow-up electrophysiologic examinations were improved. Comparing the 2,5-hexanedione exposed group with the unexposed group, the sensory nerve velocity of the median and ulnar nerves in the exposed group was decreased. The motor nerve velocity of the peroneal nerve, and sensory nerve velocity of the median and sural nerves were decreased. Terminal latency of median, ulnar, peroneal, and tibial nerves in the exposed group were increased compared with the unexposed group(<0.05). CONCLUSIONS: 2.5-hexandione can induce peripheral polyneuropathy in male workers.
Follow-Up Studies ; Hand ; Humans ; Hypesthesia ; Male ; Median Nerve ; Peripheral Nerves ; Peroneal Nerve ; Polyneuropathies* ; Sural Nerve ; Tibial Nerve ; Ulnar Nerve

PURPOSE: In the 1990s, skin island flap supplied by the vascular axis of the sensitive superficial nerves had been introduced. For example, neurocutaneous flaps supplied by the vascular axis of the sural nerve and saphenous nerve have been used. But the flap supplied by the vascular axis of superficial peroneal nerve has not been used commonly. Because there have been few anatomical reports about the superficial peroneal nerve accessory artery(SPNAA), we could not apply the neurocutaneous flap supplied by SPNAA. The aim of this study is to investigate the anatomy of SPNAA, number and location of its perforators, and septocutaneous perforators from the anterior tibial artery in anterior intermuscular septum. METHODS: So, we dissected a total of eight cadavers. Measurements were made of the positions of the dissected arteries and perforators from the head of the fibula. RESULTS: In all cadavers the superior lateral peroneal artery was originated from the anterior tibial artery and contributed SPNAA. Arising from the anterior tibial artery an average of 5.63 cm inferior to the fibular head, it varied from 10 cm to 16 cm in length. SPNAA gave off an average of 4.38 perforators to supply lateral aspect. In one case the inferior lateral peroneal artery was present and arose from the anterior tibial artery 18 cm inferior to the fibular head. There were an average of 3.38 direct septocutaneous perforators from the anterior tibial artery. CONCLUSION: Septocutaneous perforators from SPNAA mainly exist from proximal 1/6 to 3/5 of lower leg. In the distal 1/3 of lower leg where the accessory artery was disappeared, exist mainly direct septocutaneous perforators from the anterior tibial artery. Our results can be helpful to applications of the neurocutaneous flap using SPNAA or fasciocutaneous flap based on direct septocutaneous perforators.
Arteries* ; Axis, Cervical Vertebra ; Cadaver* ; Fibula ; Head ; Leg* ; Peroneal Nerve* ; Skin ; Sural Nerve ; Tibial Arteries

PURPOSE: In the 1990s, skin island flap supplied by the vascular axis of the sensitive superficial nerves had been introduced. For example, neurocutaneous flaps supplied by the vascular axis of the sural nerve and saphenous nerve have been used. But the flap supplied by the vascular axis of superficial peroneal nerve has not been used commonly. Because there have been few anatomical reports about the superficial peroneal nerve accessory artery(SPNAA), we could not apply the neurocutaneous flap supplied by SPNAA. The aim of this study is to investigate the anatomy of SPNAA, number and location of its perforators, and septocutaneous perforators from the anterior tibial artery in anterior intermuscular septum. METHODS: So, we dissected a total of eight cadavers. Measurements were made of the positions of the dissected arteries and perforators from the head of the fibula. RESULTS: In all cadavers the superior lateral peroneal artery was originated from the anterior tibial artery and contributed SPNAA. Arising from the anterior tibial artery an average of 5.63 cm inferior to the fibular head, it varied from 10 cm to 16 cm in length. SPNAA gave off an average of 4.38 perforators to supply lateral aspect. In one case the inferior lateral peroneal artery was present and arose from the anterior tibial artery 18 cm inferior to the fibular head. There were an average of 3.38 direct septocutaneous perforators from the anterior tibial artery. CONCLUSION: Septocutaneous perforators from SPNAA mainly exist from proximal 1/6 to 3/5 of lower leg. In the distal 1/3 of lower leg where the accessory artery was disappeared, exist mainly direct septocutaneous perforators from the anterior tibial artery. Our results can be helpful to applications of the neurocutaneous flap using SPNAA or fasciocutaneous flap based on direct septocutaneous perforators.
Arteries* ; Axis, Cervical Vertebra ; Cadaver* ; Fibula ; Head ; Leg* ; Peroneal Nerve* ; Skin ; Sural Nerve ; Tibial Arteries

OBJECTIVE: The purposes of this study were to obtain the reference values of latency and amplitude of the medial plantar sensory nerve action potential(SNAP) in normal controls and to evaluate the diagnostic sensitivity of medial plantar sensory nerve conduction study(NCS) in diabetic neuropathy. METHOD: Thirty healthy controls(mean age, 48.7 years; range, 38~59 years) and 33 diabetic patients(mean age, 50.8 years; range, 37~64 years) were included in this study. The inclusion criteria for diabetic patients were subjects with the normal peroneal and tibial compound muscle action potentials, obtainable sural SNAPs and intact pressure-perception to Semmes-Weinstein monofilament 5.07. RESULTS: The medial plantar sensory nerve action potentials were obtainable in all control subjects and the reference values of onset latency and peak to peak amplitude were 4.29+/-0.49 msec and 3.1+/-1.34 V, respectively. All 33 diabetic patients showed the normal latency and 3 of them showed the low amplitude in sural SNAPs. The medial plantar SNAPs were obtainable in 24 diabetic patients. Among 9 patients with unobtainable medial plantar SNAPs, 6 showed the normal sural SNAPs and 3 showed the low sural SNAPs. The sensitivities of medial plantar SNAPs to sural nerve and sural SNAPs to medial plantar sensory nerve were 100%(3/3) and 27.3%(3/11) respectively. CONCLUSION: We concluded that medial plantar sensory NCS was more valuable in the early diagnosis of diabetic neuropathy than the sural NCS and Semmes-Weinstein monofilament (North Coast Medical Inc, USA).
Action Potentials ; Diabetic Neuropathies ; Early Diagnosis ; Humans ; Neural Conduction* ; Reference Values ; Sural Nerve ; Tibial Nerve

OBJECTIVE: To determine the sensitivity of electrodiagnostic parameters in the patients with asymptomatic diabetic neuropahty. METHOD: The subjects were 26 patients with asymptomatic diabetic neuropathy and 40 healthy adults as control group. All subjects underwent electrodiagnostic evaluation of the following motor nerves: median, ulnar, tibial, and peroneal. Sensory nerves included: median, ulnar, radial, superficial peroneal, sural, lateral dorsal cutaneous branch of the sural nerve (LDSN) and medial plantar. And other studies were the sural/radial amplitude ratio, LDSN/sural amplitude ratio, peroneal and tibial F-responses, and H-reflex recorded from the soleus muscle. The frequency of abnormal parameters in the patients with asymptomatic diabetic neuropathy was obtained by comparison with the normative limits obtained from the control group. RESULTS: The most frequent abnormal electrodiagnostic parameters were the LDSN onset latency and the amplitude ratio of LDSN/sural (84.6%, respectively) followed by the LDSN peak latency, LDSN amplitude, and medial plantar onset and peak latency (80.8%, respectively). CONCLUSION: We concluded that the LDSN and medial plantar nerve conduction studies are useful for early detection of neuropathy in diabetes mellitus.
Adult ; Diabetes Mellitus ; Diabetic Neuropathies* ; H-Reflex ; Humans ; Muscle, Skeletal ; Sural Nerve ; Tibial Nerve

STUDY DESIGN: Prospective cohort study. PURPOSE: This study was to investigate interside asymmetries of three lower extremity somatosensory evoked potentials (SSEPs) in anesthetized patients with unilateral lumbosacral radiculopathy. OVERVIEW OF LITERATURE: Although interside asymmetry is an established criterion of abnormal SSEP, little is known which of the lower SSEPs is more sensitive in detecting interside asymmetry in anesthetized patients. METHODS: Superficial peroneal nerve SSEP (SPN-SSEP), posterior tibial nerve SSEP (PTN-SSEP), and sural nerve SSEP were obtained in 31 lumbosacral surgery patients with unilateral lumbosacral radiculopathy, and compared with a group of 22 control subjects. RESULTS: The lumbosacral group showed significant larger interside asymmetry ratios of P37 latencies in SPN-SSEP and PTN-SSEP, and significant larger interside asymmetry ratio of P37-N45 amplitude in SPN-SSEP, when comparing with the control group. Within the lumbosacral group but not the control group, SPN-SSEP displayed significant larger interside asymmetry ratio in P37 latency. When referencing to the control group, more patients in the lumbosacral group displayed abnormal interside SPN-SSEP latency asymmetries which corroborated the symptom laterality. CONCLUSIONS: The data suggested that SPN-SSEP was more sensitive in detecting interside latency asymmetry in anesthetized patients.
Cohort Studies ; Evoked Potentials, Somatosensory* ; Humans ; Lower Extremity* ; Peroneal Nerve ; Prospective Studies ; Radiculopathy* ; Sural Nerve ; Tibial Nerve

OBJECTIVE: To investigate the effect of distant muscle contraction on the sensory and motor nerve conduction and F-wave studies. METHOD: During isometric contraction (10%, 25% and 50% of maximal voluntary contraction) of dominant hand using hand held dynamometer, sensory nerve action potentials (SNAPs), compound muscle action potentials (CMAPs) and F-waves were examined on contralateral upper and ipsilateral lower extremities in 20 healthy adult subjects. SNAPs of median and sural nerves, CMAPs and F-waves of median and tibial nerves were recorded with submaximal and supramaximal intensity stimulation. RESULTS: At submaximal stimulation the amplitudes and areas of median and sural SNAPs and median nerve CMAPs were significantly increased during distant muscle contraction (p<0.05). Distant muscle contraction did not effect on the parameters of SNAPs and CMAPs at supramaximal stimulation. The latencies of F-waves were significantly shortened and amplitudes of F-waves were increased during distant muscle contraction (p<0.05). Especially the amplitudes of F-waves were significantly positive correlated with the level of muscle contraction (p<0.05). CONCLUSION: SNAPs and CMAP were augmented by the distant muscle contraction only submaximal stimulation. Due to facilitation, the distant muscle contraction should be considered during routine F-wave studies.
Action Potentials* ; Adult ; Hand ; Humans ; Isometric Contraction ; Lower Extremity ; Median Nerve ; Muscle Contraction* ; Neural Conduction ; Sural Nerve ; Tibial Nerve

We present a case of medial plantar nerve injury by screw tip after open reduction and internal fixation of intraarticular calcaneus fracture. We reviewed the risk and prevention technique of medial plantar nerve injury in fixing the calcaneus fracture.
Calcaneus* ; Tibial Nerve*