Syndrome of the tibial nerve

Damage to the infraspinatus nerve prevents abduction of the shoulder, atrophy of the deltoid muscle occurs, and sensory disturbances occur on the outer and posterior surfaces of the shoulder. Damage to the musculocutaneous nerve prevents simultaneous extension of the forearm and supination of the wrist.

Damage to nerve roots and nerve plexuses

Mononeuropathy – is damage to a main nerve, Multiple mononeuropathy – Lesions affecting multiple major nerves.
Pathomorphologically, mononeuropathy and multiple mononeuropathy show damage to the vasa nervorum.

Many lesions of nerve roots and nerve plexuses develop as compression neuropathies as a result of external, single or intermittent compression. The most common causes are trauma, external compression (impingement), or volumetric compression.
Nerves and roots that are not surrounded by soft tissue are most susceptible to compression damage. Once external compression is removed, root, nerve, and plexus function usually recover on their own.

Tunnel syndrome – Compression of a peripheral nerve by surrounding anatomical structures (very often of metabolic origin).
Compression of the nerve, root, or nerve plexus is usually constant, but the severity may vary depending on tissue swelling and muscle tension in the limb. In clinical practice, ulnar nerve neuropathy due to compression in the ulnar sulcus or ankle tunnel and median nerve neuropathy due to compression in the carpal tunnel are common.

Neuralgia of the lateral cutaneous nerve on the thigh – The most common cause is trauma, wearing a corset or bandage.

Compression of the tibial nerve – causes tunnel syndrome in metabolic disorders, arthropathies and trauma.

Neuropathy is usually accompanied by pain. Sometimes cranial nerves are affected, more commonly the VII nerve, the V nerve and the oculomotor nerve.

Bell's palsy – Acute unilateral paralysis or paresis of the facial muscles as a result of peripheral damage to the facial nerve. Bell's palsy can cause pain in or behind the ear, loss of sensation on the affected side of the face, hyperacusis, and impaired taste on the front of the tongue on the affected side.

classification

2. infectious-allergic (in childhood infections: measles, rubella, vaccinia, scleroderma, serum, etc.).

3. toxic – in chronic poisoning (alcoholism, lead, etc.).
4. dysmetabolic: with vitamin deficiency, endocrine disorders (diabetes), etc.

7. traumatic lesions of nerve roots and nerve plexuses.
8. Compressive-ischemic lesions of certain peripheral nerves (carpal tunnel syndrome, tarsal tunnel syndrome, etc.).

5. Multiple neuropathies or multiple mononeuropathies, in which several peripheral nerves are affected, often asymmetrically.

Clinical examination of tibial neuropathy

Neurological examination for tibial neuropathy. Loss of sensitivity usually only occurs on the sole of the foot. Motor deficits may be limited to weakness of the toe flexors or, if proximal muscles are affected, weakness of dorsiflexion and inversion of the foot.

General examination of tibial nerve neuropathy. Careful palpation should be performed along the nerve, especially in the popliteal fossa. The discovery of masses and the appearance of paresthesia or pain on palpation not only helps to determine the location of the lesion, but also allows suspicion of the cause of the disease, since a neoplastic process may make the tibial nerve more susceptible to these techniques.

Differential diagnosis of tibial nerve neuropathy. Because tibial nerve neuropathy is rare, any suspected neuropathy should be investigated to rule out other pathologic causes or to identify a more proximal lesion. Radiculopathies, plexopathies or sciatic neuropathies can present clinically as isolated tibial neuropathies. Careful examination of the more proximal muscles and reflexes, as well as sensory testing, can help diagnose these conditions.

Examination of tibial neuropathy

Electrodiagnostics plays a key role in confirming or excluding the diagnosis of tibial neuropathy. Involvement of other nerves in the nerve stimulation test (NSS), EMG results showing involvement of other muscles not innervated by the tibial nerve, or involvement of the peroneal muscles suggest a different etiology of the disease. Sometimes damage to the infraspinatus nerve can be identified as the cause of sensory or motor deficits, rather than injury to the more proximal tibial nerve.

visualization techniques. Identification of volumetric changes or points of pain in cases of unclear etiology may require MRI scanning to determine the anatomical structure of the nerve and its connections to adjacent structures.

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Treatment

When treating tibia and fibula neuritis, it is important to determine the extent of nerve damage and the cause of the damage.

Electrophoresis with anti-inflammatory, pain-relieving and dissolving drugs (enzymes) as well as phonophoresis with hydrocortisone are carried out on the affected area. Electrotherapy (UHF, pulsed currents), massage and acupuncture are also recommended.

Pharmacological treatment includes analgesics, non-steroidal anti-inflammatory drugs and drugs that increase the activity of nerve cells (B vitamins).

complications

Foot dysfunction, atrophy and paresis may occur.

prevention

Prevention of inflammation of the tibia and fibula nerves includes a number of measures. It is important to treat the conditions that cause nerve inflammation, avoid trauma to the foot, and maintain a healthy weight. It is very important to avoid walking in high heels for long periods of time and keeping your feet in an awkward position for long periods of time. Excessive physical activity should be limited.

What questions should I ask my doctor?

What tests should be done to make the diagnosis?

What is the most effective treatment?

Advice for the patient

It is important to dress appropriately for the weather: feet should be dry, warm and protected from hypothermia. For this purpose, the shoes should not be too tight. Another requirement for footwear is that the heel must not be too high.

Stress reduction and good nutrition are important in preventing all neurological diseases.

In the event of illness, it is important to consult a doctor in a timely manner and start treatment in a timely manner.

Inflammation of the femoral nerve

Inflammation of the femoral nerve, also known as femoral neuropathy, is quite common. However, it is often confused with a spinal disease, even by doctors. According to doctors, up to 9 % of 'radiculopathies' are actually various neuropathies, of which at least 10 % are due to inflammation of the femoral nerve.

The cause of neuritis of the femoral nerve is often cramping and overloading in the area of the large lumbar muscle, e.g. B. as a result of sports injuries or a visit to a chiropractor who also carried out manipulations in the lumbar area. Less common causes of neuropathy include tumors or hematomas in the retroperitoneal space, aneurysms of the iliac and femoral arteries, abscesses or inflammation of the muscles between which the femoral nerve lies, inguinal lymphadenopathy, and femoral fractures. Finally, the causes of nerve inflammation can also be iatrogenic, meaning that the nerve can be damaged as a result of treatment for another disease.

Inflammation of the tibia and fibular nerves

Inflammation of the tibial nerve is also known as ankle nerve neuropathy. It is one of the most common pathologies of the lower limbs. The most common cause is trauma (fractures, bruises, dislocations, etc.). However, tibial neuritis usually develops for the same reasons. Another common cause of temporary damage to these nerves is prolonged standing in a certain position (anesthesia, sitting at a desk in an uncomfortable chair, intoxication), as well as professional changes in the surrounding tissues (couriers, athletes, etc.).

The femoral and tibial neuropathies are manifested by numbness in the legs, pain in the toes, pain below the knee and in the lower leg area (on the back), muscle weakness in the form of 'shooting' in the toes and lower leg.

Diagnostic criteria.

The diagnosis is made by a neurologist who collects all relevant information through an initial examination and tests.

First of all, the doctor must examine the reflexes and carry out diagnostic tests that can provide information about the location of the lesion and the extent of its development.

Sensitivity tests reveal the extent of fiber damage, and ultrasound scans provide clues to possible treatments for the condition.

The sooner a patient seeks specialist care, the sooner a treatment option can be found.

Neuropathy – symptoms and treatment

Phalangeal neuropathy is an inflammatory process characterized by numbness and reduced sensitivity in the fingers and hands. Advanced phalangeal neuropathy can lead to muscle wasting, which can result in complete numbness in the fingertips.

Symptoms that may indicate phalangeal neuropathy include:

• Decreased sensitivity of the limbs, resulting in a lack of sensation of pain;
• Impairment of the function of the fingers and hands;
• Numbness of the limb, affecting mobility.

As a rule, damage to the tibial nerve is quite common in professional athletes and can be caused by excessive muscle tension that leads to pinching of the nerve. An echo of this problem may be instability of the knee joint.

Treatment of neuropathy includes a combination of the following methods:

• First, the patient is admitted to the hospital;
• then anti-inflammatory painkillers are prescribed;
• a physiotherapeutic complex is applied;
• Detoxification therapy and taking vitamins to support the body are also considered effective treatments for neuropathy.

General information.

Neuropathy of the external femoral cutaneous nerve was described in 1895 by the Russian neurologist VK Roth and the German doctor M. Berngardt. The former gave it the name meralgia (from the Greek meros - thigh), the latter the name neuralgia. For this reason, in modern neurological literature there are several names for the disease - Bernhardt-Roth disease, paraesthetic geralgia, Roth syndrome. It occurs mainly in men over 50 years of age (75 % of cases are men aged 50-60 years). It occurs in pregnant women, more commonly in the third trimester, due to a change in the position of the pelvis.

Most clinical cases of cutaneous neuropathy of the external femoral nerve are unilateral. Bilateral lesions account for approximately 20 %. There are known familial cases of neuropathy, which are probably due to genetically determined features of the nerve structure and surrounding anatomical structures.

Anatomical Features

The external femoral cutaneous nerve or lateral cutaneous nerve arises from the anterior branches of the L2-L3 spinal roots. It runs anteriorly along the surface of the iliac muscle and reaches the upper anterior iliac spine, from where it passes medially under the inguinal ligament and to the anterolateral surface of the thigh, where it divides into 2-3 terminal branches. Reaching the thigh, the lateral cutaneous nerve forms a fairly sharp posterior curve. In 17 % of observations, a fusiform thickening of the nerve trunk was noted at the flexion site.

A distinctive feature of the nerve is the appearance of age-related degenerative changes in the parenchymatous fibers, which explains the manifestation of paraesthetic gerigia mainly in older people. The changes occurring in the nerve are described as a reduction in the diameter and number of myofibers with secondary development of sclerotic processes. No compensatory hypertrophy of the nerve sheaths is observed, only thickening.

The lateral femoral cutaneous nerve and its branches extending to the knee joint innervate the outer and partially the anterior surface of the thigh. The part of the nerve most susceptible to injury is where it enters the thigh. Kinking of the nerve trunk beneath the inguinal ligament and near the bone can result in rapid compression of the nerve as the anatomical area changes.

trigger

Among the triggers of Bernhardt-Roth disease, compression of the inguinal nerve is the most common. These include wearing a corset, a tight belt or too tight underwear, obesity, pregnancy, spinal curvature (scoliosis, lordosis), hip injuries and pelvic bone fractures, musculotonic and neuroreflexive changes in diseases and injuries of the spine (lumbar radiculitis, osteochondrosis, myelopathy, lumbar spine fractures). The above causes lead to changes in the anatomical structures of the inguinal ligament, so that the nerve rubs against the ligament or the pelvic spine during forward bends and thigh movements.

Compression of the lateral cutaneous nerve can occur at the level of the iliopsoas muscle. It can be caused by retroperitoneal hematomas, abdominal inflammation, pelvic varices, tumors or surgery. Like other mononeuropathies (e.g., sciatic neuropathy, femoral neuropathy, fibular and tibial nerve neuropathy), Bernhardt-Roth disease can occur in alcoholism, diabetes, heavy metal poisoning, systemic vasculitis, rheumatism, and infectious diseases.

Treatment of tibial nephropathy.

Treatment of tibial nephritis begins with eliminating the possible cause of the disease. If the compression is caused by a hematoma or tumor, surgery is required to remove it. If a concomitant musculoskeletal disorder is identified, treatment should be initiated at the same time.

Conservative treatment of tibial neuropathy consists of restoring the functionality of the tibial nerve. The most common manual therapies used to treat tibial neuropathy are a combination of reflexology (acupuncture) and osteopathy. If necessary, the therapist will develop an additional therapeutic exercise program and combine it with massage therapy.

Treatment of a traumatic tibial nerve injury should include anti-swelling and bruising measures, physiotherapy, massage and osteopathy to improve tissue trophics.

Treatment of inflammation of the tibial nerve requires an individual approach. Depending on the type of lesion detected, the general condition of the patient and the presence of concomitant diseases, the doctor determines the treatment of shin neuritis.

If you need treatment for your tibial nerve, you can schedule a free appointment with a neurologist at our chiropractic clinic. The initial consultation is free for all patients. It will help you determine whether chiropractic techniques can be used in your individual case.

Doctor of medicine, chief physician of the clinic

Causes of peripheral nerve injuries

When it comes to injuries to the peripheral nerve, a distinction is made between closed and open injuries.

• Closed injuries: Compression of the soft tissues of the arm or leg, e.g. B. due to improper application of a pressure bandage in the event of bleeding, due to severe bruises or impacts, prolonged forced positioning of the limb with external pressure, as a result of bone fractures. As a rule, in these cases there is no complete rupture of the nerve, so the outcome is usually favorable. In some cases, e.g. B. in the case of dislocations of the hand, foot or large joints as well as in closed fractures of limb bones with displacement of the fragments, the entire nerve trunk or even several nerves can be severed.
• Open injuries are caused by broken glass, knives, metal sheets, mechanical tools, etc. In these cases, the integrity of the nerve structure is always damaged.

Unfortunately, nerve damage is often the result of surgical procedures.

Depending on the extent of nerve damage, the type of injury, or the duration of exposure to the damaging substance, the appearance of lesions manifests as a dysfunctional syndrome.

Clinical manifestations

In a closed trauma With a brain bruise or concussion, there are no changes in the internal structure of the nerve trunk; The impairments of the sensory organs and limb functions are temporary, fleeting and usually completely reversible. With a bruise, functional impairment is deeper and more permanent, but complete recovery is noted after 1-2 months. However, the sequelae of such injuries should not be underestimated and self-diagnosis and treatment is unacceptable as the effects of 'self-medication' may be irreversible. A trauma surgeon, neurologist or traumatologist should be consulted immediately. If necessary, the doctor may recommend additional tests to clarify the extent of nerve damage - electromyography, ultrasound examination of the nerve pathways and sometimes even CT or MRI scans. Only a qualified doctor can recommend appropriate treatment.

Open peripheral nerve injuries. The fibers of all peripheral nerves are of mixed type – motor fibers, sensory fibers and autonomic fibers; The ratio between these types of fibers varies from nerve to nerve, so that in some cases the motor disorders are more pronounced, in others there is a reduction or complete absence of sensation, and in still others there are autonomic disorders.

Motor disorders are characterized by paralysis of muscle groups or individual muscles, accompanied by atrophy of reflexes and atrophy of the paralyzed muscles over time (1-2 weeks after injury).

Sensitivity disorders such as reduced or absent sensitivity to pain, temperature and touch are present. Pain that worsens with a delay.

Autonomic symptoms - the skin is hot and red in the first period after the injury, turns blue and cold a few weeks later (vasculopathy), swelling, sweating, trophic skin disorders - dryness, peeling, sometimes even ulceration, nail deformation.

symptoms

The nerve damage at the beginning of the sciatic nerve branch impairs the flexion function of the fingers and toes. The patient cannot walk on his toes and must walk on his heels. The muscles in the back of the lower leg atrophy and skin sensitivity is impaired in this area and on the soles of the feet. The Achilles reflex gradually disappears.

Inflammation of the tibial nerve is accompanied by severe pain (neuralgia) in the posterior tibia and calf muscle, as well as autonomic and trophic disorders.

In tarsal tunnel syndrome, the pain in the sole of the foot is stabbing and extends into the calf muscle. At the same time, the feeling for the edges of the foot is impaired, the foot flattens and the toes assume a claw position.

Treatment

At First Medical Clinic, treatment of tibial nerve neuralgia is successfully carried out using non-surgical methods.

First, the pain syndrome is treated. Are particularly effective in this context Treatment blocks – Injection of anesthetic into the affected area within the nerve.

The following measures are used to relieve inflammation, tissue swelling and reflexive muscle spasms Local injection therapy – Antibacterial, anti-inflammatory, analgesic, muscle relaxant, vitamin-containing and other preparations are injected into the center of the pathology.

To suppress pathological processes and activate tissue self-repair, the following is used Autoplasmotherapy applied. In this method, plasma is obtained from the patient's venous blood using a special technique. This plasma contains large amounts of platelets – a source of growth factors, anti-inflammatory cytokines and other bioactive substances. As a result of treatment with Autoplasm, inflammation, swelling and pain subside and the patient can resume normal activity.

Depending on the underlying cause of shin neuritis (neuralgia), treatment may include the following methods

• Percutaneous electromyneurostimulation – Weak current pulses to stimulate muscle activity;
• Manual therapy and osteopathy
• therapeutic massage;
• shockwave therapy;
• Foot reflexology etc.

The necessary scope of therapeutic care can only be determined by a specialist following a diagnostic procedure. If you experience symptoms of inflammation of the tibial nerve (neuralgia), we recommend that you contact the general medicine clinic.

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• Tibialis posterior muscle.
• Innervation of the lower leg muscles.
• Tendon of the tibialis anterior muscle.
• Anterior shin muscle (tibialis anterior).
• Long fibula muscle.
• Medial tibial strain syndrome.
• peroneus muscle.
• median soleus nerve.