A positive Tinel sign as predictor of pain relief or sensory recovery after decompression of chronic tibial nerve compression in patients with diabetic neuropathy.
نویسندگان
چکیده
Predictive ability of a positive Tinel sign over the tibial nerve in the tarsal was evaluated as a prognostic sign in determining sensory outcomes after distal tibial neurolysis in diabetics with chronic nerve compression at this location. Outcomes were evaluated with a visual analog score (VAS) for pain and measurements of the cutaneous pressure threshold/two-point discrimination. A multicenter prospective study enrolled 628 patients who had a positive Tinel sign. Of these patients, 465 (74%) had VAS >5. Each patient had a release of the tarsal tunnel and a neurolysis of the medial and lateral plantar and calcaneal tunnels. Subsequent, contralateral, identical surgery was done in 211 of the patients (152 of which had a VAS >5). Mean VAS score decreased from 8.5 to 2.0 (p <0.001) at 6 months, and remained at this level for 3.5 years. Sensibility improved from a loss of protective sensation to recovery of some two-point discrimination during this same time period. It is concluded that a positive Tinel sign over the tibial nerve at the tarsal tunnel in a diabetic patient with chronic nerve compression at this location predicts significant relief of pain and improvement in plantar sensibility.
منابع مشابه
The Dellon approach to neurolysis in the neuropathy patient with chronic nerve compression.
Impaired glucose tolerance creates a peripheral nervous system that is susceptible to chronic nerve compression. While it is accepted that surgical decompression of the median nerve at the wrist, for carpal tunnel syndrome, is appropriate in the diabetic, application of this concept to the lower extremity has not yet gained widespread recognition. Traditional electrodiagnostic studies demonstra...
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ورودعنوان ژورنال:
- Journal of reconstructive microsurgery
دوره 28 4 شماره
صفحات -
تاریخ انتشار 2012