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

Pietro Antenucci
Pietro Antenucci
, 
Domenico Carlucci
Domenico Carlucci
, 
Maura Pugliatti
Maura Pugliatti
 and 
Marta Lucchetta
Marta Lucchetta
   | May 11, 2023
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Article Category: Case report
Published Online: May 11, 2023
Page range: e97 - e100
Received: Oct 19, 2022
Accepted: Jan 12, 2023
DOI: https://doi.org/10.15557/jou.2023.0017
Keywords
© 2023 Pietro Antenucci et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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/ Positions Site Latency Peak amplitude 2–3 μV Distance cm Velocity m/s
Sural – Lateral malleolus
Left sura Lateral malleolus 2,55 14,0 11,5 45,1
Right sura Lateral malleolus 2,45 22,6 11 44,9
Superficial peroneal – foot
Left lateral leg Foot 1,75 28,4 10 57,1
Right lateral leg Foot 1,80 27,6 10 55,6

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 nerve Nerve/ Positions Latency ms Peak amplitude 2–4 mV Distance cm Velocity m/s
Medial malleolus 1 Right common peroneal nerve
50 ms 5 mV Ankle (1) 5,15 15,7
Fibular head (2) 10,85 14,7 27 47,4
(3) 13,05 14,0 10 45,5
Left common peroneal nerve
Ankle (1) 5,35 7,4
Medial malleolus (2) 5,25 10,0
Fibular head (3) 11,95 8,9 30 44,8
Fibular head 2 (4) 14,30 8,7 10 42,6
50 ms 5 mV Right tibial nerve
Medial malleolus (1) 5,50 21,1
Fibular head (2) 4,85 21,8

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

Spontaneous Motor unit action potential Recruitment
Insertion activity Fibrillations Positive sharp wave Fasciculations High frequency Amplitude Durations Polyphasic potentials Pattern
Left tibialis anterior Normal None None None None Normal Normal Normal -
Left vastus lateralis Normal None None None None Normal Normal Normal Normal
Left gastrocnemius (MED) + ++ +++ + None 0 0 0 0
Left tibialis posterior + + +++ + None 0 0 0 0
eISSN:
2451-070X
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Basic Medical Science, other
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