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Kang PB, McMillan HJ, Kuntz NL, Lehky TJ, Alter KE, Fitzpatrick KF, El Kosseifi C, Quijano-Roy S. Utility and practice of electrodiagnostic testing in the pediatric population: An AANEM consensus statement. Muscle Nerve 2020; 61:143-155. [PMID: 31724199 DOI: 10.1002/mus.26752] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022]
Abstract
Nerve conduction studies and needle electromyography, collectively known as electrodiagnostic (EDX) studies, have been available for pediatric patients for decades, but the accessibility of this diagnostic modality and the approach to testing vary significantly depending on the physician and institution. The maturation of molecular diagnostic approaches and other diagnostic technologies such as neuromuscular ultrasound indicate that an analysis of current needs and practices for EDX studies in the pediatric population is warranted. The American Association of Neuromuscular & Electrodiagnostic Medicine convened a consensus panel to perform literature searches, share collective experiences, and develop a consensus statement. The panel found that electrodiagnostic studies continue to have high utility for the diagnosis of numerous childhood neuromuscular disorders, and that standardized approaches along with the use of high-quality reference values are important to maximize the diagnostic yield of these tests in infants, children, and adolescents.
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Affiliation(s)
- Peter B Kang
- Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.,Department of Neurology, University of Florida College of Medicine, Gainesville, Florida
| | - Hugh J McMillan
- Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nancy L Kuntz
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Lurie Children's Hospital, Chicago, Illinois
| | - Tanya J Lehky
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Katharine E Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Kevin F Fitzpatrick
- Inova Neuroscience and Spine Institute, Inova Fairfax Hospital, Falls Church, Virginia
| | - Charbel El Kosseifi
- Centre de Référence Maladies Neuromusculaires, Service de Neurologie, Réanimation et Réeducation Pédiatriques, Hôpital Raymond Poincaré, Garches, France
| | - Susana Quijano-Roy
- Centre de Référence Maladies Neuromusculaires, Service de Neurologie, Réanimation et Réeducation Pédiatriques, Hôpital Raymond Poincaré, Garches, France
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Costales JR, Socolovsky M, Sánchez Lázaro JA, Costales DR. Peripheral nerve injuries in the pediatric population: a review of the literature. Part II: entrapment neuropathies. Childs Nerv Syst 2019; 35:37-45. [PMID: 30209596 DOI: 10.1007/s00381-018-3975-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Entrapment neuropathies are infrequent in children, and therefore remain unrecognized. The incidence of radial, median, and cubital mononeuropathies are all similar. Despite the rarity of such cases, extensive, albeit scattered, literature has accumulated concerning entrapment neuropathies in children. OBJECTIVE To the literature concerning entrapment neuropathies in children. METHODS A systematic review of the existing literature has been made. RESULTS The management of chronic pediatric pain is very important in such patients to prevent youths from experiencing prolonged absences from school, sports, or other productive activities, and limit the psychological burden of chronic disease. Nonsurgical treatment of both cubital and carpal tunnel syndromes has been disappointing in pediatric patients, with only limited success; and, to date, there is no clear explanation for the outcome differences generated by nonsurgical management between adults and youths. Simple decompression of the ulnar nerve at the elbow also has much higher rates of failure in children than in adults. CONCLUSIONS The presence of an entrapment neuropathy (specially carpal tunnel syndrome) in a pediatric-age patient should alert medical care providers to the potential of some underlying genetic condition or syndrome.
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Affiliation(s)
| | - Mariano Socolovsky
- Peripheral Nerve & Brachial Plexus Surgery Program, Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
| | | | - David Robla Costales
- Department of Plastic Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
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Peripheral nerve injuries in the pediatric population: a review of the literature. Part I: traumatic nerve injuries. Childs Nerv Syst 2019; 35:29-35. [PMID: 30215119 DOI: 10.1007/s00381-018-3974-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This article reviews the clinical results that can be obtained after repair of a traumatic peripheral nerve injury in the pediatric population. METHODS A systematic review of the published literature has been made. RESULTS Functional outcome after major nerve injuries is sometimes disappointing in adults. However, children have been reported to experience much better functional results after nerve repair than adults. Moreover, recovery generally is faster in children. The superior capacity of children's central nervous system to adapt to external or internal environmental changes (neural plasticity) and the shorter recovery distance from the axon repair site to the target muscle are claimed to be crucial determinants of their favorable outcomes. Moreover, even in the pediatric population, it has been demonstrated that functional results are better the younger the patient is, including better clinical results in those injured in early childhood (< 6 years old) than in those injured in adolescence. Other favorable prognostic factors include the type of nerve injury (with complete transections doing less well than crush injuries) and the timing of surgery (with better outcomes after early repairs). CONCLUSIONS All efforts should be done to repair in a timely and adequate fashion traumatic peripheral nerve injuries in children, as the results are good.
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Payne R, Sieg E, Fox E, Harbaugh K, Rizk E. Management of nerve compression in multiple hereditary exostoses: a report of two cases and review of the literature. Childs Nerv Syst 2016; 32:2453-2458. [PMID: 27444292 DOI: 10.1007/s00381-016-3166-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/04/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Multiple hereditary exostoses (MHE) is a rare autosomal dominant condition that results in the growth of cartilage-capped prominences that often cause nerve compression and injury. Many patients suffer from continued and debilitating chronic pain which leads some to advocate avoiding surgical intervention in patients with multiple hereditary exostoses. We present a review of the literature as well as a case series at our institution in order to evaluate the role of surgery in multiple hereditary exostoses. METHODS We searched the literature for reports of patients with multiple hereditary exostoses undergoing surgery for nerve compression. We then reviewed the recent experience at our institution which revealed two patients with multiple hereditary exostoses. RESULTS Our literature search revealed that there have been several case series and retrospective analyses in the literature that assess the benefit of surgery in the case of nerve compression caused by exostoses. The majority of these reports are of solitary exostoses. Few reports expand on the role of surgery in patients with multiple hereditary exostoses suffering from nerve compressions secondary to bony overgrowth. A recent review of the experience at our institution revealed two patients with multiple hereditary exostoses who together underwent a total of four surgeries for treatment of peripheral nerve compression resulting in pain or weakness. Postoperative evaluation revealed improvement in pain and/or motor strength following each operation. CONCLUSION Based on our experience and literature review, we advocate that nerve compression in selected individuals with multiple hereditary exostoses that results in neurological injury should be considered for nerve decompression and resection of the offending exostosis.
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Affiliation(s)
- Russell Payne
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, Building B, Suite 1200, Hershey, PA, 17033, USA.
| | - Emily Sieg
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, Building B, Suite 1200, Hershey, PA, 17033, USA
| | - Edward Fox
- Department of Orthopedics, Pennsylvania State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kimberly Harbaugh
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, Building B, Suite 1200, Hershey, PA, 17033, USA
| | - Elias Rizk
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, Building B, Suite 1200, Hershey, PA, 17033, USA
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Göçmen S, Topuz AK, Atabey C, Şimşek H, Keklikçi K, Rodop O. Peripheral nerve injuries due to osteochondromas: analysis of 20 cases and review of the literature. J Neurosurg 2014; 120:1105-12. [DOI: 10.3171/2013.11.jns13310] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Nerve compressions due to osteochondromas are extremely rare. The aim of this retrospective study was to investigate the mechanisms, diagnostic evaluations, and treatment of nerve lesions due to osteochondromas, and to review the literature.
Methods
The authors retrospectively reviewed their clinic data archive from 1998 through 2008, and 20 patients who were operated on due to peripheral nerve injuries caused by osseous growth were enrolled in the study. Patients' age, duration of symptoms, localizations, intraoperative findings, and modified British Medical Research Council (MRC) and electromyography data obtained from hospital records were evaluated. The literature on this topic available in PubMed was also reviewed. All 20 patients underwent surgery, which consisted of tumor excision performed by orthopedic surgeons and nerve decompression performed by neurosurgeons.
Results
There were 17 men and 3 women included in the study, with a mean age of 21 years (range 18–25 years). Three patients had multiple hereditary exostoses, and 17 had a solitary exostosis. All of the patients underwent en bloc resection. The most common lesion site was the distal femur (45%). The peroneal and posterior tibial nerves were the structures that were affected the most frequently. The mean follow-up was 3.9 years (range 2–7 years). After the surgery, all patients (100%) experienced good sensory recovery (modified MRC Grade S4 or S5).
Conclusions
To the authors' knowledge, no large series have reported peripheral nerve compression due to exostoses. The authors have several recommendations as a result of their findings. First, all patients with peripheral nerve compression due to an osteochondroma should undergo surgery. Second, preoperative electromyographic examinations and radiographic evaluation, consisting of MRI and CT to provide optimal information about the lesion, are crucially important. Third, immediate treatment is mandatory to regain the best possible recovery. And fourth, performing nerve decompression first and en bloc resection of osteochondroma consecutively in a multidisciplinary fashion is strongly recommended to avoid peripheral nerve injury.
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Affiliation(s)
| | | | | | | | - Kenan Keklikçi
- 2Orthopedics, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Osman Rodop
- 2Orthopedics, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
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Damarey B, Demondion X, Wavreille G, Pansini V, Balbi V, Cotten A. Imaging of the nerves of the knee region. Eur J Radiol 2013; 82:27-37. [DOI: 10.1016/j.ejrad.2011.04.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/29/2011] [Indexed: 01/11/2023]
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Yoo JH, Min KD, Kim CK, Cha JG. A case of extension loss of great toe due to peroneal nerve compression by an osteochondroma of the proximal fibula. Arch Orthop Trauma Surg 2010; 130:1071-5. [PMID: 19633864 DOI: 10.1007/s00402-009-0944-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Indexed: 11/28/2022]
Abstract
The authors present a case of extension loss of great toe caused by entrapment neuropathy of a peroneal nerve due to an osteochondroma of the proximal fibula. Plain radiographs revealed no bony abnormality around the foot or ankle, but a sessile exophytic bony growth at the proximal fibula. A positive Tinel sign in this area led us to a suspicion of compressive neuropathy of the peroneal nerve, and a subsequent electrophysiologic study confirmed the entrapment neuropathy. The peroneal nerve was decompressed by excisional biopsy. At 3 months postoperatively, normal full extension of the great toe was completely restored. The current case deserves attention in that the only clinical manifestation of peroneal nerve entrapment neuropathy by the osteochondroma at the fibular neck was extension loss of great toe.
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Affiliation(s)
- Jae Ho Yoo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital, 1174 Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do, South Korea.
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Abstract
This article describes a case of a 11-year-old boy with an osteochondroma of the peroneal head causing peroneal nerve palsy. Physical examination disclosed large exostoses palpated at the right fibular head. Neurological examination revealed paresis of the tibialis anterior, lateral peroneal, and extensor digitorum muscles with a muscle strength grade of 2. Electrophysiological studies confirmed denervation of the muscles supplied by the right peroneal nerve. Radiological examination showed an osteochondroma in the head of the right fibula. The patient underwent surgical decompression of the right peroneal nerve after resection of the bone tumor. At 36-month follow-up, there was a complete recovery of the deficits. Peroneal mononeuropathy in children is uncommon. Osteochondroma is a benign tumor consisting of projecting bone capped by cartilage. These tumors may be solitary or multiple and occur in hereditary multiple exostoses syndrome. The conjunction of this lesion with peroneal nerve palsy has been exceptionally reported for children, usually linked to hereditary multiple exostoses syndrome. Most peroneal nerve trauma occurs at the fibular head, where the common nerve has not yet divided into its deep and superficial peroneal nerve and where most peroneal nerve lesions, therefore, involve both branches, although motor deficits are more frequently involved than sensory ones. Surgical treatment should not be delayed because neurological improvement may be achieved if surgery is performed before severe neurological deficits become irreversible.
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Affiliation(s)
- Hichem Mnif
- Department of Orthopedics, Hospital Monastir, Road 1 June, Monastir, Tunisia
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Shahar E, Landau E, Genizi J. Adolescence peroneal neuropathy associated with rapid marked weight reduction: case report and literature review. Eur J Paediatr Neurol 2007; 11:50-4. [PMID: 17166754 DOI: 10.1016/j.ejpn.2006.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Revised: 09/18/2006] [Accepted: 10/30/2006] [Indexed: 02/06/2023]
Abstract
PURPOSE We report herein an uncommon presentation of peroneal nerve palsy and possible myelopathy in an adolescent associated with marked uncontrolled weight loss during a relatively short period. CASE PRESENTATION He presented with left drop foot accompanied with sensory impairment at the foot dorsum. Neurophysiologic studies revealed a severe neuropathy of the left peroneal nerve with evidence of a conduction block at the left fibular head suggestive of entrapment neuropathy. ETIOLOGY As for the underlying etiology of acute peroneal neuropathy (PN) and possible myelopathy associated with marked weight loss, it has been suggested that rapid loss of the subcutaneous tissue may lead to entrapment of the peroneal nerve at the fibular head leading to foot drop. Body fat percentage was found remarkably low for age at 10% (normal value for age for males: 22.3%) indicative of massive rapid weight reduction markedly depleting fat stores. CONCLUSION When an adolescent presents with acute foot drop, PN associated with rapid uncontrolled weight reduction should be taken into account. Prompt resumption of a balanced diet including vital nutritional ingredients may avoid permanent neurological damage and probably assist in recovery from severe flaccid weakness of the lower extremity.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel.
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Flores LP, Koerbel A, Tatagiba M. Peroneal nerve compression resulting from fibular head osteophyte-like lesions. ACTA ACUST UNITED AC 2005; 64:249-52; discussion 252. [PMID: 16099258 DOI: 10.1016/j.surneu.2004.11.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Accepted: 11/30/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND The anatomical relationship of the fibular head with the fibular nerve is a critical point in regard to injuries of peripheral nerves in the lower extremities. In this location, the peroneal nerve may be injured due to several mechanisms, and osteophyte-like lesions can be considered as a differential diagnosis. METHODS The suitable literature concerning this association is reviewed and a case is presented. A 15-year-old adolescent boy presented with right peroneal nerve palsy on admission. The radiological examinations (computed tomography and magnetic resonance imaging) demonstrated an osteophytic lesion in the head of the right fibula. The patient underwent surgical decompression of the nerve and resection of the lesion. Postoperatively, there was a complete recovery of the deficits. CONCLUSIONS The association of osteophyte-like bone changes and peroneal nerve palsy is rare. The differential diagnoses of these lesions include cartilaginous exostoses and osteochondromas, which may be related to hereditary multiple exostoses syndrome. The timing of the treatment plays an important role in the neurological recovery.
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Affiliation(s)
- Leandro P Flores
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
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Rubin DI, Nottmeier E, Blasser KE, Peterson JJ, Kennelly K. Acute onset of deep peroneal neuropathy during a golf game resulting from a ganglion cyst. J Clin Neuromuscul Dis 2004; 6:49-53. [PMID: 19078752 DOI: 10.1097/00131402-200412000-00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a case of sudden onset of deep peroneal neuropathy resulting from a ganglion cyst. Electrophysiology demonstrated a severe deep peroneal neuropathy with axonal loss and probably proximal conduction block. Magnetic resonance imaging demonstrated a mass arising from the proximal tibiofibular joint extending along the peroneal nerve. Surgical resection of the ganglion resulted in gradual improvement of strength. Peroneal nerve ganglia should be considered in the evaluation of patients with sudden painless foot drop.
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Affiliation(s)
- Devon I Rubin
- From the Departments of *Neurology, daggerNeurosurgery, double daggerOrthopedic Surgery, and section signRadiology, Mayo Clinic, Jacksonville, FL
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Abstract
Mononeuropathies are uncommon in childhood but can be a cause of significant disability. A considerable proportion of pediatric peroneal palsies arise as iatrogenic complications of casting, footboards, and intraoperative positioning. This article provides a description of a patient who developed bilateral peroneal palsies after cardiac transplantation. Factors predisposing this patient to neuropathy included hemophilia and prolonged immobilization, with focal involvement of the peroneal nerves being likely related to the use of ankle-foot orthoses. Peroneal nerve palsies are a significant, but potentially avoidable, iatrogenic complication of lower-extremity orthoses.
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Affiliation(s)
- Monique M Ryan
- Department of Neurology, Children's Hospital, Boston, MA 02115, USA
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Yamamoto T, Tanaka K, Nagira K, Marui T, Akisue T, Kurosaka M, Mizuno K. Intermittent radial nerve palsy caused by a humeral osteochondroma: a case report. J Shoulder Elbow Surg 2002; 11:92-4. [PMID: 11845157 DOI: 10.1067/mse.2002.119393] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Kobe University School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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Paik NJ, Han TR, Lim SJ. Multiple peripheral nerve compressions related to malignantly transformed hereditary multiple exostoses. Muscle Nerve 2000; 23:1290-4. [PMID: 10918272 DOI: 10.1002/1097-4598(200008)23:8<1290::aid-mus23>3.0.co;2-m] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Autosomal dominantly transmitted hereditary multiple exostoses is an uncommon disorder consisting of multiple projections of bone capped by cartilage. The lesions are most numerous in the metaphyses of long bones but may appear on flat bones. Sarcomatous transformation occurs in 1-25% of patients. We report a 33-year-old man with sciatica, previously diagnosed as hereditary multiple exostoses, presenting with multiple peripheral nerve compressions. Electrodiagnostic studies showed profound axon-loss multiple neuropathies involving the sciatic, superior gluteal, and inferior gluteal nerves. Magnetic resonance imaging of the left pelvis showed a large mass in the sacral area that was suggestive of a chondrosarcoma. An open intralesional excision biopsy confirmed chondrosarcoma transformed from chondromatosis. Excision of the lesion was effective in eliminating the impingement of nerves and retarding progressive osseous growth. We suggest that malignant transformation be suspected in cases with focal compression neuropathy of patients known to have multiple exostoses. Osteochondroma as a possible cause for compression neuropathy is discussed.
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Affiliation(s)
- N J Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Republic of Korea.
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Abstract
Common peroneal neuropathy is uncommon in children and adolescents. In this population, it is usually caused by direct nerve injury at the fibular head level. Most commonly, the nerve is damaged during sports-related blunt trauma. Other etiologies such as hereditary neuropathies and bone tumors are much less frequent. In some cases, repetitive microtrauma to the peroneal nerve is felt to cause neuropathy. We describe the case of a teenager who developed common peroneal neuropathy in association with prolonged wave-surfing in the presence of weight loss.
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Affiliation(s)
- N Watemberg
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel.
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Chapter 57 Mononeuropathies of infancy and childhood. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s1567-424x(09)70188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Jones HR, Felice KJ, Gross PT. Pediatric peroneal mononeuropathy: a clinical and electromyographic study. Muscle Nerve 1993; 16:1167-73. [PMID: 8413369 DOI: 10.1002/mus.880161105] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Seventeen children with pediatric peroneal mononeuropathies evaluated between 1979 and 1991 are reported. Twelve boys and 5 girls, ranging in age from 1.5 months to 17 years, were referred for footdrop in 16 children (94%) or for lower extremity pain in 1 child (6%). Causes included compression in 10 children (59%), trauma in 3 children (18%), entrapment in 3 children (18%), and indeterminate in 1 child (5%). Based on nerve conduction studies and electromyography, the level of the pediatric peroneal mononeuropathic lesion was the common peroneal nerve in 10 children (59%), the deep peroneal nerve in 2 children (12%), and the superficial peroneal nerve in 1 child (5%). In 4 other children (24%), pediatric peroneal mononeuropathy at the knee was not more precisely identified. Surgical exploration in 3 children with progressive pediatric peroneal mononeuropathy was valuable. Improvement occurred in 13 of 17 children (76%).
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Affiliation(s)
- H R Jones
- Department of Neurology, Children's Hospital, Boston, Massachusetts
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