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Role of electromyography and ultrasonography in the diagnosis of double crush lumbar radiculopathy and common fibular injury: illustrative cases
BACKGROUND: Double crush syndrome consists of two compression sites along a peripheral nerve and is rare in the lower extremities. Electrodiagnostic and ultrasound (US) studies may be helpful in evaluating foot drop involving overlapping pathologies. OBSERVATIONS: Case 1 involved a man who presented...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Association of Neurological Surgeons
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379723/ https://www.ncbi.nlm.nih.gov/pubmed/36303488 http://dx.doi.org/10.3171/CASE21566 |
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author | Shields, Lisa B. E. Iyer, Vasudeva G. Harpring, John E. Rao, Abigail J. Zhang, Yi Ping Shields, Christopher B. |
author_facet | Shields, Lisa B. E. Iyer, Vasudeva G. Harpring, John E. Rao, Abigail J. Zhang, Yi Ping Shields, Christopher B. |
author_sort | Shields, Lisa B. E. |
collection | PubMed |
description | BACKGROUND: Double crush syndrome consists of two compression sites along a peripheral nerve and is rare in the lower extremities. Electrodiagnostic and ultrasound (US) studies may be helpful in evaluating foot drop involving overlapping pathologies. OBSERVATIONS: Case 1 involved a man who presented with left dorsiflexor weakness and left foot numbness. Electromyography (EMG) revealed a left common fibular nerve entrapment neuropathy and left L5 radiculopathy. US and magnetic resonance imaging (MRI) revealed a large cystic lesion of the left common fibular nerve treated by cyst removal. The left foot drop persisted postoperatively. Lumbar computed tomography myelography revealed severe left foraminal stenosis at L5–S1. Multilevel lumbar laminectomies and facetectomies with an L5–S1 fusion were performed. Within 1 month postoperatively, the left foot drop had improved. Case 2 involved a man who developed a right foot drop caused by right lumbar foraminal stenosis at L4–5 and L5–S1. EMG and US of the right common fibular neuropathy showed large fascicles involving the right common fibular nerve. MRI revealed a hyperintense signal of the right common fibular nerve. Spontaneous improvement occurred within 6 months without surgery. LESSONS: Spine surgeons should recognize double crush in the lower extremities. EMG and US are valuable in detecting peripheral nerve abnormalities, especially in cases with overlapping lumbar pathology. |
format | Online Article Text |
id | pubmed-9379723 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Association of Neurological Surgeons |
record_format | MEDLINE/PubMed |
spelling | pubmed-93797232022-10-04 Role of electromyography and ultrasonography in the diagnosis of double crush lumbar radiculopathy and common fibular injury: illustrative cases Shields, Lisa B. E. Iyer, Vasudeva G. Harpring, John E. Rao, Abigail J. Zhang, Yi Ping Shields, Christopher B. J Neurosurg Case Lessons Case Lesson BACKGROUND: Double crush syndrome consists of two compression sites along a peripheral nerve and is rare in the lower extremities. Electrodiagnostic and ultrasound (US) studies may be helpful in evaluating foot drop involving overlapping pathologies. OBSERVATIONS: Case 1 involved a man who presented with left dorsiflexor weakness and left foot numbness. Electromyography (EMG) revealed a left common fibular nerve entrapment neuropathy and left L5 radiculopathy. US and magnetic resonance imaging (MRI) revealed a large cystic lesion of the left common fibular nerve treated by cyst removal. The left foot drop persisted postoperatively. Lumbar computed tomography myelography revealed severe left foraminal stenosis at L5–S1. Multilevel lumbar laminectomies and facetectomies with an L5–S1 fusion were performed. Within 1 month postoperatively, the left foot drop had improved. Case 2 involved a man who developed a right foot drop caused by right lumbar foraminal stenosis at L4–5 and L5–S1. EMG and US of the right common fibular neuropathy showed large fascicles involving the right common fibular nerve. MRI revealed a hyperintense signal of the right common fibular nerve. Spontaneous improvement occurred within 6 months without surgery. LESSONS: Spine surgeons should recognize double crush in the lower extremities. EMG and US are valuable in detecting peripheral nerve abnormalities, especially in cases with overlapping lumbar pathology. American Association of Neurological Surgeons 2022-04-18 /pmc/articles/PMC9379723/ /pubmed/36303488 http://dx.doi.org/10.3171/CASE21566 Text en © 2022 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ). |
spellingShingle | Case Lesson Shields, Lisa B. E. Iyer, Vasudeva G. Harpring, John E. Rao, Abigail J. Zhang, Yi Ping Shields, Christopher B. Role of electromyography and ultrasonography in the diagnosis of double crush lumbar radiculopathy and common fibular injury: illustrative cases |
title | Role of electromyography and ultrasonography in the diagnosis of double crush lumbar radiculopathy and common fibular injury: illustrative cases |
title_full | Role of electromyography and ultrasonography in the diagnosis of double crush lumbar radiculopathy and common fibular injury: illustrative cases |
title_fullStr | Role of electromyography and ultrasonography in the diagnosis of double crush lumbar radiculopathy and common fibular injury: illustrative cases |
title_full_unstemmed | Role of electromyography and ultrasonography in the diagnosis of double crush lumbar radiculopathy and common fibular injury: illustrative cases |
title_short | Role of electromyography and ultrasonography in the diagnosis of double crush lumbar radiculopathy and common fibular injury: illustrative cases |
title_sort | role of electromyography and ultrasonography in the diagnosis of double crush lumbar radiculopathy and common fibular injury: illustrative cases |
topic | Case Lesson |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379723/ https://www.ncbi.nlm.nih.gov/pubmed/36303488 http://dx.doi.org/10.3171/CASE21566 |
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