Ultrasound of Entrapment Neuropathies of the Lower Extremity
Ultrasound (US) can give direct demonstration of a wide range of neuropathies of the lower extremity. In the hip, the entrapment of the sciatic, femoral and lateral femorocutaneous nerves can be depicted with US. Main signs of nerve compression include echotextural abnormalities, displacement of the affected nerve from its normal course by space-occupying masses and selective changes in the innervated muscles related to denervation edema and fatty infiltration. At the lateral knee, the entrapment of the common peroneal nerve typically occurs between the bone and the fascia as the nerve winds around the fibular neck. In most cases, nerve traumas result from external pressure at the fibular neck. Ganglion cysts are one of the leading causes of peroneal nerve compression at this site: these cysts may be divided in extraneural ganglia, which develop outside the nerve and compress it later and intraneural ganglia, developing within the nerve. At the lateral calf, the superficial peroneal neuropathy can be encountered in patients who have a history of ankle sprains or trauma to the leg leading to sensory disturbances on the dorsal ankle and foot. US can demonstrate the nerve injury as a fusiform hypoechoic thickening of the superficial peroneal nerve at the point where the nerve pierces the fascia. The tarsal tunnel syndrome refers to the entrapment of the tibial nerve and/or of its divisional branches at the medial ankle. US can provide exact information on the nature and extent of constricting findings. Repetitive minor contusion traumas can cause impingement of the deep peroneal nerve that occurs on the dorsal aspect of the midfoot leading to local burning pain. Similarly, the interdigital nerves can be impinged against the distal edge of the intermetatarsal ligament forming a Morton neuroma.Ultrasound (US) can give direct demonstration of a wide range of neuropathies of the lower extremity. In the hip, the entrapment of the sciatic, femoral and lateral femorocutaneous nerves can be depicted with US. Main signs of nerve compression include echotextural abnormalities, displacement of the affected nerve from its normal course by space-occupying masses and selective changes in the innervated muscles related to denervation edema and fatty infiltration. At the lateral knee, the entrapment of the common peroneal nerve typically occurs between the bone and the fascia as the nerve winds around the fibular neck. In most cases, nerve traumas result from external pressure at the fibular neck. Ganglion cysts are one of the leading causes of peroneal nerve compression at this site: these cysts may be divided in extraneural ganglia, which develop outside the nerve and compress it later and intraneural ganglia, developing within the nerve. At the lateral calf, the superficial peroneal neuropathy can be encountered in patients who have a history of ankle sprains or trauma to the leg leading to sensory disturbances on the dorsal ankle and foot. US can demonstrate the nerve injury as a fusiform hypoechoic thickening of the superficial peroneal nerve at the point where the nerve pierces the fascia. The tarsal tunnel syndrome refers to the entrapment of the tibial nerve and/or of its divisional branches at the medial ankle. US can provide exact information on the nature and extent of constricting findings. Repetitive minor contusion traumas can cause impingement of the deep peroneal nerve that occurs on the dorsal aspect of the midfoot leading to local burning pain. Similarly, the interdigital nerves can be impinged against the distal edge of the intermetatarsal ligament forming a Morton neuroma.