RESUMO
BACKGROUND: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve or its branches within its fibro-osseous tunnel beneath the flexor retinaculum on the medial side of the ankle. It is a rare but important condition which is regularly under diagnosed leading to a range of symptoms affecting the plantar aspect of the foot. Management of this entrapment neuropathy remains a challenge and we have therefore reviewed the published literature in an attempt to clarify aspects of initial presentation, investigation and definitive treatment including surgical decompression. We also assessed the continuing controversial role of electrodiagnostic techniques in its diagnosis. CONCLUSION: Recommendations from literature: Excellent results with decompression in selected patients. To prevent nerve fibrosis, decompression should be performed early. Remain aware of false negative NCS (under-diagnosing of those with symptoms but 'normal' NCS. Role of NCS remains controversial with inability to predict which cases respond to decompression. Poor outcome may be due to nerve fibrosis.
Assuntos
Síndrome do Túnel do Tarso/diagnóstico , Síndrome do Túnel do Tarso/terapia , Humanos , Síndrome do Túnel do Tarso/etiologiaRESUMO
We describe a patient who sustained a widely displaced, high-energy, mid-shaft clavicular fracture in association with brachial plexus damage. The distal fragment was subsequently found to have penetrated the thoracic cavity. We describe the treatment of this rare injury with a successful outcome.
Assuntos
Clavícula/lesões , Fraturas Ósseas/complicações , Cavidade Torácica/lesões , Adolescente , Plexo Braquial/lesões , Clavícula/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Twenty-three patients with acute displaced three- and four-part fractures of the proximal humerus, including seven patients with associated shaft involvement, were treated with the Polarus intramedullary interlocking nail using a closed technique. At the 1-year follow up, the median Neer scores were 89 and 60 for the three- and four-part fractures, respectively. Three patients (13%), all of whom were in the four-part group, continued to have significant pain at final review. We found the implant to be extremely satisfactory and particularly useful in the treatment of combined neck and shaft fractures of the humerus.
