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To understand various morphologic types and locations of the sural nerve (SN) that are important for nerve conduction studies or nerve grafting procedures. The aim of this study was to describe the course and variations of the SN based on ultrasonographic findings for an adequate nerve conduction study.
A total of 112 SNs in 56 volunteers with no history of trauma or surgery were examined by ultrasonography. The location and formation of the SNs in relation to the medial and lateral sural cutaneous nerve were investigated. We measured the horizontal distance between the SNs and the midline of the calf at the level of 14 cm from the lateral malleolus, and the distance between the SNs and the most prominent part of the lateral malleolus.
SN variants was classified into four types according to the medial and lateral sural cutaneous nerve; type 1 (73.2%), type 2 (17.9%), type 3 (8.0%), and type 4 (0.9%). The mean distance between the SN and the midline of the calf was 1.02±0.63 cm, the SN and the most prominent part of the lateral malleolus was 2.14±0.15 cm.
Variations in the location and formation of the SN was examined by ultrasonography, and the results of this study would increase the accuracy of the SN conduction study.
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Method: Fourteen lower limbs of 7 adult cadavers were anatomically dissected. The location and formation of the sural nerve (SN) in relation to the medial sural cutaneous nerve (MSCN) and the lateral sural cutaneous nerve (LSCN) were investigated. The length and diameter of the SN and contributing nerves were measured and the differences of the results were analyzed.
Results: Twelve SNs were formed by the union of the MSCNs and LSCNs, and 2 SNs were direct extensions of the MSCNs. The point of formation of the SN by union of the MSCN and LSCN was found in the middle third of the legs in 66.7% of SNs examined. The union sites of the SNs were located at 40.58⁑13.97% of the length of lower leg from the tip of lateral malleolus and 55.84⁑6.48% of the calf width from the medial border of the calf. There were significant statistical differences of diameter among nerves (p＜0.05) and no significant difference of length between MSCN and LSCN.
Conclusion: The results of this cadaveric study would increase the accuracy of the sural nerve conduction study and provide the locational information for precise surgical approach.
Objective: Sural nerve conduction study is known to be one of the sensitive tests for detecting neuropathies. In peripheral neuropathy, the distal sural nerve, lateral dorsal cutaneous branch of sural nerve (LDCBSN), may be more easily affected than proximal portion of the sural nerve. To evaluate the clinical application of LDCBSN conduction study and amplitude comparison between sural nerve and LDCBSN in peripheral neuropathy.
Method: Antidromic conduction studies were performed for sural nerve and LDCBSN and amplitude between two nerve responses were obtained in 30 controls (mean age, 46) and 30 patients with diabetic neuropathy (mean age, 54), but obtainable sural sensory response. The active recording electrodes were placed were placed over the dorsolateral surface at the midpoint of the fifth metatarsal for LDCBSN and posterior aspect of lateral malleolus for sural nerve. The stimulating electrodes were placed 12 cm proximal to the active electrodes in both nerves.
Results: LDCBSN response was obtainable in all controls and not obtainable in 7 diabetic patients in whom the amplitude of sural response was less than 5 uV. The amplitude of LDCBSN to sural nerve was approximately 35% in controls and 22% in diabetic patients, which was statistically significant (p=0.00).
Conclusion: LDCBSN conduction study is sensitive test to detect peripheral neuropathies and amplitude ratio of LDCBSN to sural nerve can be used in the evaluation of peripheral neuropathies.
Objective: The sural nerve is a sensory nerve in the lower extremity which is formed by the union of the medial sural cutaneous nerve of tibial nerve and the communicating branch of the common peroneal nerve. The objective of this study is to standardize the electrodiagnostic technique of proximal conduction of sural nerve and to investigate the usefulness of the technique in evaluation for the patients with peripheral neuropathy.
Method: Fifty eight extremities in 29 normal adults without the clinical signs and symptoms of peripheral neuropathy were evaluated with sural nerve conduction study. The active recording electrode was placed over 14 cm proximal to the lateral malleolus, and the reference electrode was placed over 4cm distal to the active electrode. The antidromic evoked responses were recorded with stimulation at points 7, 14, 21 cm proximal to the recording electrode and directly over the sural nerve.
Results: The mean values of proximal conduction study of sural nerve in normal adults were 2.40⁑1.03 msec for peak latency, 11.55⁑7.31μV in amplitude with stimulation at 7 cm proximal to the recording electrode; 3.43⁑0.78 msec for peak latency, 10.87⁑5.86μV in amplitude with stimulation at 14 cm; 4.51⁑0.83 msec for peak latency, 8.78⁑4.10μV in amplitude with stimulation at 21 cm.
Conclusion: A method of proximal conduction study of sural nerve was introduced which could be used as a valuable technique for the evaluation of peripheral neuropathy.
Objective: The purposes of this study were to obtain the reference values of latency and amplitude of the medial plantar sensory nerve action potential(SNAP) in normal controls and to evaluate the diagnostic sensitivity of medial plantar sensory nerve conduction study(NCS) in diabetic neuropathy.
Method: Thirty healthy controls(mean age, 48.7 years; range, 38∼59 years) and 33 diabetic patients(mean age, 50.8 years; range, 37∼64 years) were included in this study. The inclusion criteria for diabetic patients were subjects with the normal peroneal and tibial compound muscle action potentials, obtainable sural SNAPs and intact pressure-perception to Semmes-Weinstein monofilamentⰒ 5.07.
Results: The medial plantar sensory nerve action potentials were obtainable in all control subjects and the reference values of onset latency and peak to peak amplitude were 4.29⁑0.49 msec and 3.1⁑1.34 ㄍV, respectively.
All 33 diabetic patients showed the normal latency and 3 of them showed the low amplitude in sural SNAPs. The medial plantar SNAPs were obtainable in 24 diabetic patients. Among 9 patients with unobtainable medial plantar SNAPs, 6 showed the normal sural SNAPs and 3 showed the low sural SNAPs. The sensitivities of medial plantar SNAPs to sural nerve and sural SNAPs to medial plantar sensory nerve were 100%(3/3) and 27.3%(3/11) respectively.
Conclusion: We concluded that medial plantar sensory NCS was more valuable in the early diagnosis of diabetic neuropathy than the sural NCS and Semmes-Weinstein monofilamentⰒ(North Coast Medical Inc, USA).
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