Characterization of mononeuropathy of the lateral cutaneous nerve of the calf.
Characterization of mononeuropathy of the lateral cutaneous nerve of the calf.
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腓总神经的小腿外侧皮神经（LCNC）分支的孤立性损伤可引起不明显的慢性膝关节后外侧和小腿上部疼痛和感觉症状。常规检查和电诊断测试不能检测到它们，因为LCNC没有运动分布，并且不能通过典型的腓神经传导研究进行询问。只有大约10个先前的病例，因此缺乏医生的意识，所以大多数LCNC损伤仍然被误诊或未诊断，阻碍了护理。我们从7名原因不明的膝/小腿后外侧疼痛患者中提取相关记录，其中6名被标记为复杂区域疼痛综合征，以调查单神经病变。患者被要求勾勒出他们的皮肤区域异常反应引脚独立自我检查。三个进行了LCNC特异性电诊断研究，两个皮肤活检表皮神经支配测量。膝后神经的尸体解剖有助于确定潜在的卡压部位。初始事件包括膝关节手术（3例）、支具（1例）、广泛跪姿（1例）和其他膝关节创伤。所有引脚轮廓均包括已发表的LCNC神经刀。两个LCNC特异性电诊断研究之一显示单侧电位缺失。纵向，控制皮肤活检记录深刻的LCNC神经刀去神经支配，然后重新神经支配的同时症状恢复。尸体解剖发现LCNC穿过近侧腓肠肌止点的致密筋膜。孤立性LCNC单神经病可引起原因不明的后外侧膝/小腿疼痛综合征。该系列描述了演示文稿的特点，并支持患者引脚映射作为一种灵敏的、全球可用的、低成本的诊断辅助工具。改善识别可能有助于更快速，更准确的诊断，从而优化管理和改善结果。
Isolated injuries to the lateral cutaneous nerve of the calf (LCNC) branch of the common peroneal nerve can cause obscure chronic posterolateral knee and upper calf pain and sensory symptoms. Routine examination and electrodiagnostic testing do not detect them because the LCNC has no motor distribution and it is not interrogated by the typical peroneal nerve conduction study. There are only about 10 prior cases, thus scant physician awareness, so most LCNC injuries remain misdiagnosed or undiagnosed, hindering care. We extracted pertinent records from seven patients with unexplained posterolateral knee/calf pain, six labeled as complex regional pain syndrome, to investigate for mononeuropathies. Patients were asked to outline their skin area with abnormal responses to pin self-examination independently. Three underwent an LCNC-specific electrodiagnostic study, and two had skin-biopsy epidermal innervation measured. Cadaver dissection of the posterior knee nerves helped identify potential entrapment sites. Initiating events included knee surgery (three), bracing (one), extensive kneeling (one), and other knee trauma. All pin-outlines included the published LCNC neurotome. One oftwo LCNC-specific electrodiagnostic studies revealed unilaterally absent potentials. Longitudinal, controlled skin biopsies documented profound LCNC-neurotome denervation then re-innervation contemporaneous with symptom recovery. Cadaver dissection identified the LCNC traversing through the dense fascia of the proximolateral gastrocnemius muscle insertion. Isolated LCNC mononeuropathy can cause unexplained posterolateral knee/calf pain syndromes. This series characterizes presentations and supports patient pin-mappings as a sensitive, globally available, low-cost diagnostic aid. Improved recognition may facilitate more rapid, accurate diagnosis and, thus, optimize management and improve outcomes.