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Download Introduction Surface electrodes Near nerve needle electrodes
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Introduction Most nerves are studied with surface electrodes Some nerves are not accessible Sensory neurography with monopolar needle electrodes Björn Falck, M.D., Ph.D. Department of clinical neurophysiology University hospital Uppsala, Sweden Nerve is located deep Nerve is small Difficult to separate from neighboring nerve N.cut.fem.lat. - surface electrodes N.cut.fem.lat. - near needle electrodes N.alveolaris inferior N.calcaneus medialis Digital nerves Surface electrodes Near nerve needle electrodes Needle electrodes - Alpine Biomed Stimulating electrode and reference electrode 9013R0271 (2 mm2 /0.35 mm) Electrodes Active electrode 9013R0222 (5 mm2 /0.70 mm) 9013R0232 (5 mm2/0.70 mm) 20 mm Cables Black=Active Red=Reference Methodological principles N.digitalis plantaris Sobotta: Atlas of human Anatomy, UrbanSchwarzenberg Electrode placement Recording electrodes Stimulation threshold < 1mA Stimulating electrodes Intensity < 5 mA Frequency 7 Hz Acceptable is still 1-2 mA Plantar digital nerves n.digitalis plantaris lateralis n.digitalis plantaris medialis Normal responses are polyphasic Reference values Morton 2/3, (female, 58 years) n.digitalis plantaris medialis Referece model:CV(m/s)=45.6-0.22*age(years) sd=3.3 diff <8 m/s Morton 2/3, (female, 58 years) Plantar digital nerves lesions n.digitalis plantaris lateralis Morton’s metatarsalgia Temporary compression due to long periods of flexion of the toes Sandals may cause compression of the plantar digital nerve to the lateral side of the great toe Surgery for hallux valgus may damage the digital nerve to the lateral side of the great toe Trauma N.cutaneus femoris lateralis Meralgia paresthetica N.cutaneus femoris lateralis Anatomical variation Recording of n.cut.fem lat Spina ilica anterior superior Meralgia paresthetica dx N.plantaris lateralis N.plantaris medialis sin Plantar nerves Lateral and medial plantar nerve lesions Tarsal tunnel syndrome Isolated lesions are rare Traumatic lesions Tarsal tunnel syndrome Described by several authors Usually no neurophysiology done Diagnosis is based on clinical findings “Neuromythology”: does idiopathic tarsal tunnel syndrome exist at all???? Lesions of these nerves may be caused by Complicated malleolar fractures Severe deformity Tendinitis of the flexor tendons Inferior patellar nerve N.saphenus r.infrapateraellaris 37/60 Kartüs et al. The localization of the infrapatelar nerve in the anterior knee region..Arthroscopy 1999;15:577- 37/60 Inferior patellar nerve Inferior patellar nerve 6/60 15/60 2/60 1/60 4/60 Inferior patellar nerve lesion after endoscopy Saphenous nerve Inferior patellar nerve inferior branch Inferior patellar nerve superior branch Inferior alveolar nerve Inferior alveolar nerve Medial calcaneal nerve Dorsal branch of ulnar nerve Sensory nerves rarely studied Patient Findings left right Left right Loss of sensation Recording setup Findings n.radialis r.dorsalis n.ulnaris Anomalous anatomy Findings in patients children Daughter Son Palmar digital nerves Palmar digital nerves – surface electrodes Isolation of individual digitsal nerves difficult False negative findings Not possible to diagnose reinnervation early following surgery Palmar digital nerve - surface Palmar digital nerve - control Palmar digital nerve - surface Tennis players neuropathy Tennis player´s neuropathy Palmar digital nerves Palmar digital nerves Palmar digital nerves medial side lateral side Utility Digital nerve lesions Traumatic nerve lesions Tennis player´s neuropathy The end
