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Considerations about the multidimensional evaluation of a stab wound tibial neuropathy: a case report Cover

Considerations about the multidimensional evaluation of a stab wound tibial neuropathy: a case report

Journal of Ultrasonography
Volume 23 (2023): Issue 93 (June 2023)
By: Pietro Antenucci,  Domenico Carlucci,  Maura Pugliatti and  Marta Lucchetta  
Open Access
|May 2023

Figures & Tables

Fig. 1.

Long-axis ultrasound imaging of the left sciatic nerve through a posterior, sovra-popliteal approach of the left thigh with a longitudinally orientated linear multifrequency probe (12–15 mHz). Sciatic nerve (black arrowheads) in continuity with two hypoechoic neuromas (black asterisks). The cranial neuroma is located at a depth of around 4.2 cm from the cutaneous surface, with a long axis length of 0.9 cm and a short axis cross sectional area up to around 59 mm2 in its largest part. The caudal neuroma is located at a depth of around 3.7 cm from the cutaneous surface, with a long axis length of 1.2 cm and a short axis cross sectional area up to around 65 mm2 in its largest part. Between them, intact fascicles on the nerve course (white arrowheads). Superiorly, one stab wound lesion (white asterisk)
Long-axis ultrasound imaging of the left sciatic nerve through a posterior, sovra-popliteal approach of the left thigh with a longitudinally orientated linear multifrequency probe (12–15 mHz). Sciatic nerve (black arrowheads) in continuity with two hypoechoic neuromas (black asterisks). The cranial neuroma is located at a depth of around 4.2 cm from the cutaneous surface, with a long axis length of 0.9 cm and a short axis cross sectional area up to around 59 mm2 in its largest part. The caudal neuroma is located at a depth of around 3.7 cm from the cutaneous surface, with a long axis length of 1.2 cm and a short axis cross sectional area up to around 65 mm2 in its largest part. Between them, intact fascicles on the nerve course (white arrowheads). Superiorly, one stab wound lesion (white asterisk)

Sensory nerve conduction study_ Sensory action potentials (SAPs) of the left sural nerve are non-significantly reduced compared to the right lower limb_ SAPs of bilateral superficial peroneal nerves are within normal limits

Nerve/ PositionsSiteLatencyPeak amplitude 2–3 μVDistance cmVelocity m/s
Sural – Lateral malleolus
Left suraLateral malleolus2,5514,011,545,1
Right suraLateral malleolus2,4522,61144,9
Superficial peroneal – foot
Left lateral legFoot1,7528,41057,1
Right lateral legFoot1,8027,61055,6

Motor nerve conduction study_ At the level of the left medial malleolus and fibular head, compound motor action potentials (CMAPs) of the left tibial nerve are not elicited_ CMAPs of the left common peroneal nerve and CMAPs of the right lower limb are within normal limits

Left tibial nerveNerve/ PositionsLatency msPeak amplitude 2–4 mVDistance cmVelocity m/s
Medial malleolus 1Right common peroneal nerve
50 ms 5 mVAnkle (1)5,1515,7
Fibular head (2)10,8514,72747,4
(3)13,0514,01045,5
Left common peroneal nerve
Ankle (1)5,357,4
Medial malleolus (2)5,2510,0
Fibular head (3)11,958,93044,8
Fibular head 2(4)14,308,71042,6
50 ms 5 mVRight tibial nerve
Medial malleolus (1)5,5021,1
Fibular head (2)4,8521,8

Needle Electromyography_ Significant hallmarks of denervation without recruitment patterns of motor units of the lower muscles innervated by the left tibial nerve at rest and during voluntary contraction_ Muscles of the left anterior leg show normal activity

SpontaneousMotor unit action potentialRecruitment
Insertion activityFibrillationsPositive sharp waveFasciculationsHigh frequencyAmplitudeDurationsPolyphasic potentialsPattern
Left tibialis anteriorNormalNoneNoneNoneNoneNormalNormalNormal-
Left vastus lateralisNormalNoneNoneNoneNoneNormalNormalNormalNormal
Left gastrocnemius (MED)+++++++None0000
Left tibialis posterior++++++None0000
DOI: https://doi.org/10.15557/jou.2023.0017 | Journal eISSN: 2451-070X | Journal ISSN: 2084-8404
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Language: English
Page range: e97 - e100
Submitted on: Oct 19, 2022
Accepted on: Jan 12, 2023
Published on: May 11, 2023
Published by: MEDICAL COMMUNICATIONS Sp. z o.o.
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
peripheral nerve diagnosis,
nerve ultrasound,
sciatic nerve,
tibial nerve,
mononeuropathy
Related subjects:
Medicine,
Basic medical science,
Basic medical science, other

© 2023 Pietro Antenucci, Domenico Carlucci, Maura Pugliatti, Marta Lucchetta, published by MEDICAL COMMUNICATIONS Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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