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Biomedical subjects

Stephen L Barrett

Publications and source records attributed to Stephen L Barrett.

8 recordsLinked to original sources
PubMed2006

Endoscopic nerve decompression.

Endoscopic decompression for forefoot nerve entrapments is discussed in this article from not only the perspective of preoperative indications, intraoperative technique, and postoperative management, but with reference to the changing paradigm for management of this condition. Surgical results are discussed and compared with other published reports. Complications of the surgical technique are also discussed, which will give the operating surgeon a frame of reference when comparing decompression procedures to those techniques involving nerve resection. There is also a valuable discussion of current methods of diagnosis that may help the practitioner improve patient outcomes.

Decompression, Surgical↗
PubMedDate not supplied

Superficial peroneal nerve (superficial fibularis nerve): the clinical implications of anatomic variability.

The purpose of this study is to refine further the knowledge about the anatomic variability of the superficial peroneal nerve in the middle third of the leg. Approaching the superficial peroneal nerve in this location is required: 1) when either the deep or the superficial peroneal nerve must be resected for the treatment of dorsal foot pain; 2) when a neurolysis of the superficial peroneal nerve is required; 3) when a fasciotomy must be performed either for trauma or for exertional compartment syndrome surgery; and 4) during elevation of a fasciocutaneous or fibular flaps. Because of the variability encountered during these procedures, a prospective study was carried out via lower extremity cadaver dissection with fresh, frozen specimens. A total of 35 nonpaired lower extremities and 40 paired lower extremities were dissected with 3.5 loupe magnification. The superficial peroneal nerve was identified in the lateral compartment immediately adjacent to the fascial septum in 72% of the specimens (54 of 75), with a branch in both the anterior and the lateral compartment in 5% of the specimens (4 of 75), and located in the anterior compartment in only 23% of the specimens (17 of 75). The clinical implications of these anatomic findings are that the surgeon operating in the anterior and lateral compartments of the leg should be aware that the superficial peroneal nerve may be located in the lateral compartment and may also exhibit branches in both the anterior and lateral compartments.

Adult↗
PubMedDate not supplied

Sinus tarsi denervation: clinical results.

Traumatic neuroma of the branches of the deep peroneal nerve that innervate the sinus tarsi can be the source of recalcitrant lateral ankle pain. That these nerves can be the source of the pain can be demonstrated by nerve blocks, and this pain can be surgically treated by resection of the appropriate branch of the deep peroneal nerve. This article documents the clinical results of this approach in 13 patients with sinus tarsi syndrome. At a minimum of 6 months postoperatively, 10 patients (77%) were completely pain-free, wore normal shoes, and had returned to work. Two patients (15%) had a small degree of residual pain but resumed usual activities and wore normal footwear. One patient had some pain relief but could not resume usual activities. We conclude that denervation of the sinus tarsi can relieve recalcitrant pain emanating from the sinus tarsi. This approach may reduce the need for subtalar fusion or evacuation procedures, including arthroereisis, thus avoiding their potential complications. Moreover, sinus tarsi denervation may allow the continued use of an arthroereisis implant in the presence of satisfactory objective findings, despite the subjective presence of postoperative pain.

Adult↗
PubMedDate not supplied

Accurate nomenclature for forefoot nerve entrapment: a historical perspective.

Current medical nomenclature is often based on the early history of the condition, when the true etiology of the disease or condition was not known. Sadly, this incorrect terminology can become inextricably woven into the lexicon of mainstream medicine. More important, when this is the case, the terminology itself can become integrated into current clinical decision making and ultimately into surgical intervention for the condition. "Morton's neuroma" is perhaps the most striking example of this nomenclature problem in foot and ankle surgery. We aimed to delineate the historical impetus for the terminology still being used today for this condition and to suggest appropriate terminology based on our current understanding of its pathogenesis. We concluded that this symptom complex should be given the diagnosis of nerve compression and be further distinguished by naming the involved nerve, such as compression of the interdigital nerve to the third web space or compression of the third common plantar digital nerve. Although the nomenclature becomes longer, the pathogenesis is correct, and treatment decisions can be made accordingly.

Foot Diseases↗
PubMedDate not supplied

Use of high-resolution ultrasound in evaluation of the forefoot to differentiate forefoot nerve entrapments.

Forefoot pain can have single or multiple etiologies, and frequently pain is attributed solely to a forefoot nerve entrapment. It is well known that forefoot nerve entrapments, such as Morton's, can be falsely assumed to be the cause of forefoot pain when in fact other factors, such as plantar plate disturbances, are the true cause. Frequently, the cause of the patient's forefoot pain starts as a forefoot nerve entrapment, but then, as a result of treatment with a corticosteroid injection, other pathologies manifest, such as plantar plate rupture. The development of high-resolution, high-frequency ultrasound scanners has opened the door to in-depth examination of peripheral nerves as well as small pericapsular and intracapsular joint structures of the foot and ankle. In the hands of an experienced clinician, ultrasound can play an important role in differentiating nerve lesions and entrapment syndromes from nonneurogenic pain generators, such as tendons, ligaments, fasciae, and joint capsules. The focus of this article is the forefoot, where differentiation of neuroma, neuritis, and capsulitis can be difficult.

Diagnosis, Differential↗
PubMedDate not supplied

Equinus deformity as a factor in forefoot nerve entrapment: treatment with endoscopic gastrocnemius recession.

Forefoot nerve entrapments are common, and they are usually mistakenly categorized under the misnomer of "Morton's neuroma." Although the complete etiology of these forefoot entrapments is still not known, exogenous mechanical factors must be considered when patients present with clinical signs of forefoot nerve entrapment. It has been well established that equinus deformity can increase plantar forefoot pressures. This article provides a brief overview of equinus deformity as it relates to forefoot pathology, specifically, its mechanical contribution to forefoot nerve entrapment, and the use of endoscopic gastrocnemius recession for the treatment of forefoot nerve entrapment.

Endoscopy↗
PubMedDate not supplied

Endoscopic decompression of intermetatarsal nerve entrapment: a retrospective study.

Sixty-nine patients who had 96 interspaces decompressed were retrospectively reviewed to assess the efficacy of the endoscopic decompression of the intermetatarsal nerve procedure. Cases were evaluated between October 1, 1993, and December 31, 1999. Of the 69 patients, 14 were men and 55 were women, and their average age was 50.6 years. Of the 96 interspaces released, 39 were second interspaces and 57 were third interspaces. Nine interspaces were lost to follow-up. There were 75 interspaces with excellent or good results (86%) and 12 with poor results (14%). Of the interspaces with poor results, five required further surgery. Those five interspaces, in five patients, were treated with traditional neurectomy. The other patients, accounting for seven interspaces, who classified their result as poor declined any further surgery. Evaluation of these cases was by means of medical chart review only, where the patient's success or failure was based on the patient's subjective assessment. None of the patients who underwent decompression developed a true amputation neuroma.

Decompression, Surgical↗