2024 Workshop Handout Bundle-W102RFC NCS of the Foot Del Toro

W102RFC NCS of the Foot Del Toro

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The document is a comprehensive guide on nerve conduction studies (NCS) focused on diagnosing entrapment neuropathies in the lower extremities, particularly the peroneal and posterior tibial nerves. The guide outlines the anatomy, mechanisms of injury, clinical manifestations, and electrodiagnostic evaluation techniques for these conditions.<br /><br /><strong>Introduction:</strong><br />Entrapment neuropathies, caused by mechanical impingement at vulnerable anatomical sites, often involve the peripheral nerves passing through fibrous or osseofibrous tunnels. They can manifest through sensory, motor, or mixed symptoms, influenced by various factors including age and systemic diseases. Nerve conduction studies (NCS) are crucial in diagnosing these neuropathies by detecting focal demyelination and axonal degeneration.<br /><br /><strong>Common Peroneal Nerve:</strong><br />The peroneal nerve, prone to injury around the fibular head, can suffer from acute compression, traction, laceration, or compression due to several mechanisms. Distinct techniques for evaluating peroneal neuropathy include surface recordings from specific muscles and stimulation across the fibular head. This evaluation can reveal conduction block or axonal loss through varied electrodiagnostic patterns.<br /><br /><strong>Peroneal Nerve Electrophysiology:</strong><br />Standard procedures involve surface electrodes over the Extensor Digitorum Brevis (EDB) muscle and testing motor responses following distal and proximal stimulations. Techniques for recording from anterior tibialis or peroneus brevis muscles provide supplementary information in cases of severe denervation or anomalous innervations.<br /><br /><strong>Posterior Tibial Nerve:</strong><br />The posterior tibial nerve, rarely compressed externally due to its deep anatomical position, can mimic Tarsal Tunnel Syndrome (TTS) when compressed. Electrodiagnostic evaluation involves both motor and sensory conduction studies as well as mixed nerve conduction techniques.<br /><br /><strong>Superficial Peroneal Nerve:</strong><br />Involving the superficial peroneal nerve can occur at various anatomical points, particularly the fibular head or ankle. Detailed nerve conduction techniques for evaluating this nerve consider different branches and points of stimulation for precise diagnostic results.<br /><br /><strong>Recent Study Comparison:</strong><br />A study comparing four NCS techniques for the superficial fibular nerve found all methods reliable, with higher accuracy when comparing different parameters such as distal latency and amplitude. The Spartan technique was noted for its lower required stimulation current, while the Daube technique yielded the highest amplitude.<br /><br /><strong>Conclusion:</strong><br />The document emphasizes the need for precise electrodiagnostic techniques to effectively diagnose entrapment neuropathies. Advanced studies refine these methods, ensuring reliable detection of nerve involvement and aiding in targeted therapeutic approaches.

Keywords

nerve conduction studies

ncs

entrapment neuropathies

peroneal nerve

posterior tibial nerve

electrodiagnostic evaluation

sensory conduction

motor responses

fibular head

Tarsal Tunnel Syndrome

Spartan technique

nerve conduction studies

nerve conduction study

ncs