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At least 19 recordsLinked to original sources
PubMed2005

Missile-induced complete lesions of the tibial nerve and tibial division of the sciatic nerve: results of 119 repairs.

OBJECT: Very few extensive studies regarding the repair of missile-induced tibial nerve or tibial division complete lesions have been published to date. In this prospective study, the outcomes of such repairs as well as factors influencing them are presented. METHODS: Between 1991 and 1994, 119 patients with missile-induced complete lesions of the tibial nerve or tibial division were treated in the neurosurgical department of the Military Medical Academy, Belgrade. After at least 4 years of follow up, the final outcome was defined as poor, insufficient, good, or excellent, based on sensorimotor recovery, electromyoneurography-demonstrated recovery, and patient judgment. Good and excellent outcomes were considered to be successful. The influence of the repair level, length of the defect, and preoperative interval on final outcome was also tested. A successful outcome was obtained in 30.3% of high-level, 50% of intermediate-level, and 85.7% of low-level repairs (p < 0.001). On average, the nerve defect and preoperative interval were significantly shorter in patients with a successful outcome. Significant worsening of the outcome was related to a nerve defect longer than 5 cm and a preoperative interval longer than 4 months. Repair level, preoperative interval, and length of the defect were independent predictors of a successful outcome. CONCLUSIONS: A successful outcome is most probable following the low-level repairs, within the first 4 months after injury, and using grafts shorter than 5 cm. Other repairs can also be beneficial in preventing dangerous anesthesia of the sole of the foot and enabling almost normal walking.

Adolescent↗
PubMed1991

Median nerve and posterior tibial nerve somatosensory evoked potentials in the non-affected hemisphere: a prospective one-year follow-up study in patients with supratentorial cerebral infarction.

Somatosensory potentials in the non-affected hemisphere evoked by simulation of both the median nerve (median nerve SEPs) and the posterior tibial nerve (tibial nerve SEPs) were studied in 40 patients with supratentorial nonhaemorrhagic cerebral infarction three times during a one-year follow-up period. The EP-N20 interpeak latencies (IPLs) of the median nerve SEPs were on average longer in the patient group than in the control group (especially in patients with evidence of mass displacements in the cerebral computed tomography), whereas no significant differences were observed in the amplitudes of the median nerve SEPs. The P57-N75 amplitudes of the tibial nerve SEPs were on average lower in the patient group than in the control group. During the follow-up period the peak latencies and the P40-N75 IPLs of the tibial nerve SEPs increased and the amplitudes of the tibial nerve SEPs diminished.

Cerebral Infarction↗
PubMed1989

Maturation of peripheral nerves in preterm infants: proprioceptive and motor nerve conductions of tibial nerve.

Premature birth induces a profound change in the environmental factors affecting nerve maturation. The proprioceptive sensory and motor nerve conduction velocities (NCV) of the posterior tibial nerve, which reflect peripheral nerve maturation, have been measured in 3 groups of newborns. Two groups of premature (PT) babies, studied when they reached the expected date of birth (group I, gestational age (GA) at birth, 28-31 weeks, n = 8; group II, GA at birth, 32-35 weeks, n = 6) were compared to 9 normal full-term (FT) newborns. As previously shown, the motor NCV of PT babies at a post-conceptional age close to term is similar to that of FT newborns: group I, 22.70 +/- 2.95 m/s (mean +/- SD); group II, 25.90 +/- 4.61 m/s; FT, 25.48 +/- 4.09 m/s. The proprioceptive sensory NCV was significantly lower in group I (21.59 +/- 4.39 m/s) than in group II (31.89 +/- 4.15 m/s) and FT newborns (32.22 +/- 6.56 m/s) (p less than 0.01). Such a delay in maturation could be responsible for the subtle clinical dysfunctions often observed in PT babies.

Gestational Age↗
PubMedDate not supplied

The influence of interfering input from the peroneal nerve on tibial-nerve somatosensory evoked potential.

Using a conditioning-test paradigm, we studied the recovery function of tibial nerve somatosensory evoked potentials (SEPs) conditioned by preceding peroneal nerve stimulation. The inter-stimulus intervals (ISIs) ranged from 0 to 400 msec, where 0 msec indicated simultaneous arrival of tibial and peroneal nerve volleys at the L1 spine. The recovery curve was W-shaped, showing two peaks of SEP suppression, maximum at 6 msec ISI (1st phase) and 50-75 ISI msec (2nd phase). In the 1st phase suppression, we found distinct differences in wave forms between 0-2 msec ISI and 4-6 msec ISI. At 0-2 msec ISI, P40-N50-P60 amplitude decreased and latencies shortened, while P31 and N35 were unchanged. At 4-6 msec ISI, all peaks, possibly excluding P31, were markedly depressed. We attribute the former change to an "occlusive effect" and the latter to an "inhibitory effect," each mediated via a central synaptic network between the two nerves. The attenuation of the 2nd but not the 1st phase suppression by peroneal nerve block distal to the stimulating electrodes provided evidence that the 2nd phase suppression resulted primarily from interfering afferent signals generated by peroneal nerve peripheral receptors, activated by foot movement.

Adult↗
PubMed1993

[The effects of two and five percent aqueous phenol on the cat tibial nerve in situ--II: Effect on the circulation of the tibial nerve].

The previous report of ours showed that the biphasic depression of the compound action potentials in cat tibial nerve was observed after administration of 2% aqueous phenol, and the delayed depression was considered to be the result of the ischemia of the nerve fibers caused by the vascular damage with phenol. This second report includes two studies; one is the change in total blood flow of the cat tibial nerve, and the other is the observation of the microcirculatory damage of the nerve surface and its contribution to the block of nerve transmission. The sacral and tibial nerves were exposed under microscopic vision and platinum electrodes were placed on both nerves; one for nerve stimulation and the other for recording its action potential. First, total blood flow of the tibial nerve tissue was measured using laser doppler flow meter ALF-2100 with A-type probe (Advance), and secondly, using videomicroscope VMS-1300 with object lens LL-006W (Nihon Kohden), magnifying objects 500 times, the change of the microcirculation of the nerve was observed. With the doppler flow meter, no statistical changes in total blood flow was recognized with both 2% and 5% aqueous phenol. The examination of microcirculation was followed. In cases of physiologic saline injection, the blood flow stagnated within one minute after injection. After recovery, no more change was recognized in microcirculatory blood flow. In cases of 2% aqueous phenol, prior to the delayed depression of the compound action potentials, the progressive damage in microcirculation, such as slugging, oscillation, plasma skimming and inverted flow, were observed after transient cessation of the microcirculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗
PubMed1995

Tibial nerve function during tibial lengthening. Measurement of nerve conduction and blood flow in rabbits.

We evaluated in 20 Japanese white rabbits the effects of tibial lengthening on tibial nerve conduction and intraneural blood flow at the end of lengthening. Both tibiae were distracted 1 mm per day. The distraction frequency was in 2 steps (0.5 mm/12 h) on the right side and in 120 steps (0.0083 mm/12 min) on the left. The rabbits were separated into 4 subgroups based on the percentage of lengthening: 0 (control), 10, 20, and 30 percent. In the 2-step group, nerve conduction was delayed at 20 and 30 percent lengthening, compared to the control group, while in the 120-step group, it was delayed only at 30 percent lengthening. Intraneural blood flow in the 2-step group was decreased at 10, 20, and 30 percent lengthenings, while in the 120-step group it was reduced at 30 percent lengthening. Our findings indicate that an increase in the frequency of distraction reduces the impairment of nerve function during bone lengthening.

Animals↗
PubMedDate not supplied

Current source density mapping of somatosensory evoked responses following median and tibial nerve stimulation.

Potential recording of brain activities always encounters the problem resulting from the activation of reference electrodes. Current source density (CSD) computation does not take reference sites into account and consequently may better localize the generator sources. In the past, several attempts have been made to record CSDs of the somatosensory evoked responses (SERs) following median nerve stimulation. In order to compare the generating mechanisms of SERs following median nerve and tibial nerve stimulation, the scalp CSD distributions of the median nerve SER and the tibial nerve SER were compared in 5 normal subjects. In the median nerve SER, far-field potentials such as P14 and N16 were abolished in the CSD records. N20, P25 and N35 showed almost identical CSD distributions, albeit P25 had a reversed polarity. By contrast, the tibial nerve SER showed similar distributions for P40 and P60 CSDs, but N50 had a different distribution from the others. In the potential records, P40 and P60 were distributed predominantly ipsilateral to the stimulus (paradoxical lateralization), whereas the P40 and P60 CSDs formed a dipole localized over the contralateral foot somatosensory area. N50 disclosed the same tendency, although it had a slightly different CSD pattern from that of P40 and P60. These findings suggest that the median nerve and tibial nerve SER components are not necessarily comparable and that under certain circumstances CSDs are better indicators of local electrical events than the corresponding potentials.

Adult↗
PubMed2006

Nerve sheath ganglion of the tibial nerve presenting as a Baker's cyst: a case report.

Nerve sheath ganglion is a relatively rare clinical entity commonly found in the peroneal nerve in the lower limb or the ulnar nerve in the upper extremity. It is rarely found in the tibial nerve. The occurrence of a nerve sheath ganglion in a patient's tibial nerve has been identified. The initial presentation of the tumor mass has been very similar to that of a Baker's cyst, namely a soft undulating popliteal mass. Yet, the case also presented symptoms and signs of tibial nerve compressive neuropathy. We present here a rare case of nerve sheath ganglion of the tibial nerve. Clinical courses of the patient were reviewed, and relevant issues were discussed with a thorough literature review.

Adrenal Cortex Hormones↗
PubMed1996

Nerve allotransplantation following severe tibial nerve injury. Case report.

The successful recovery of sensibility across a long peripheral nerve allograft in a 12-year-old boy who sustained a severe posterior tibial nerve injury is reported. The historical clinical experience with nerve allotransplantation is also reviewed. It is concluded that in the carefully selected patient with severe nerve injury, consideration for nerve allotransplantation can be given.

Child↗
PubMed1996

[Ultrastructural changes in the encapsulated nerve endings of the tibial nerve under the action of diethyl ether in 2 strains of rats selected for their threshold of nervous system excitability].

Ultrastructure of tibial nerve receptor endings was studied in two rat lines different in the threshold of the nerve excitation after decapitation and euthanasia with diethyl ether use. Interlinear diversities of shape and parameters of receptor endings and their mitochondria were established. The results obtained indicate different reactivity of rats varying in genetically determined nervous system excitation threshold to tissue respiration decrease and oxygen insufficiency on ultramicroscopic levels.

Anesthetics, Inhalation↗
PubMed2005

End-to-side nerve grafting of the tibial nerve to bridge a neuroma-in-continuity.

Standard treatment for a neuroma-in-continuity with partial retained function is neurolysis with or without grafting. The present study tests the outcome of a novel partial nerve lesion bypassed with an end-to-side bridge graft, intended to increase the number of axons crossing the defect while not disturbing intact axons. An 8-mm portion of tibial nerve was resected in 20 rats. Three weeks later, half had the defect repaired with an end-to-side bridge allograft and perineurial windows; controls had only neurolysis. Recovery was evaluated using walking-track analysis, allodynia testing, muscle weight ratios, and histology at 8 weeks. No significant differences in motor or sensory functional recovery were noted between the two groups. Histology showed good axonal regeneration through the defect in all specimens. The experimental group also had regenerated axons in the bridge graft, but their maturity was less advanced, presumably due to delays in regeneration.

Animals↗
PubMed1976

Intraneural tissue reactions induced by internal neurolysis. An experimental study on the blood-nerve barrier, connective tissues and nerve fibres of rabbit tibial nerve.

Surgical treatment of peripheral nerve lesions associated with intraneural fibrosis is sometimes extended to include internal neurolysis. This procedure is performed in order to release the individual nerve fascicles from interfascicular scar tissue which is believed to constrict nerve fibres and thereby interfere with their function and regenerative capacity. However, an internal neurolysis per se implies a significant trauma to the nerve and may induce microvascular damage and formation of new intraneural scar tissue. Considering this, such a procedure appears justified only when the preoperative intraneural fibrosis is more severe than the scarring which might be induced by the surgical procedure as such. In order to evaluate the tissue reactions following internal neurolysis an experimental investigation was carried out: internal neurolysis was performed on normal rabbit tibial nerve. After varying postoperative periods up to 6 months specimens of nerves were analysed. Reactive changes of connective tissue and myelin sheath lesions, indicating nerve fibre damage, were investigated in histological sections studied by light microscopy. Barrier function of perineurial membrane and endoneurial vessels was investigated by fluorescent microscopic tracing of locally applied or intravenously injected albumin labelled with Evans' blue. The results indicate that an experimental internal neurolysis per se may induce fibrosis in all layers of the nerve and may cause some nerve fibre damage. However, the barrier function of the perineurium and the endoneurial vessels seems to be generally well preserved. The findings are discussed in relation to indications for internal neurolysis.

Animals↗
PubMed2004

Restoration of motor function of the deep fibular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: an anatomical study.

Traction injuries of the common fibular (peroneal) nerve frequently result in significant morbidity due to tibialis anterior muscle paralysis and the associated loss of ankle dorsiflexion. Because current treatment options are often unsuccessful or unsatisfactory, other treatment approaches need to be explored. In this investigation, the anatomical feasibility of an alternative option, consisting of nerve transfer of motor branches from the tibial nerve to the deep fibular nerve, was studied. In ten cadaveric limbs, the branching pattern, length, and diameter of motor branches of the tibial nerve in the proximal leg were characterized; nerve transfer of each of these motor branches was then simulated to the proximal deep fibular nerve. A consistent, reproducible pattern of tibial nerve innervation was seen with minor variability. Branches to the flexor hallucis longus and flexor digitorum longus muscles were determined to be adequate, based on their branch point, branch pattern, and length, for direct nerve transfer in all specimens. Other branches, including those to the tibialis posterior, popliteus, gastrocnemius, and soleus muscles were not consistently adequate for direct nerve transfer for injuries extending to the bifurcation of the common fibular nerve or distal to it. For neuromas of the common fibular nerve that do not extend as far distally, branches to the soleus and lateral head of the gastrocnemius may be adequate for direct transfer if the intramuscular portions of these nerves are dissected. This study confirms the anatomical feasibility of direct nerve transfer using nerves to toe-flexor muscles as a treatment option to restore ankle dorsiflexion in cases of common fibular nerve injury.

Adult↗
PubMed1985

Classical conditioning of a flexor nerve response in spinal cats: effects of tibial nerve CS and a differential conditioning paradigm.

Previous studies have shown flexor nerve response increases produced by classical conditioning procedures in spinal cats when the conditioned stimulus (CS) was delivered to the superficial peroneal nerve and the unconditioned stimulus (US) was delivered to the ankle skin. In this study, these effects were produced when the CS was delivered to the whole tibial nerve or to the medial plantar branch. The finding that response increases followed by extinction effects could be obtained when either the superficial peroneal or the tibial nerve was utilized allowed the assessment of the effects of a differential conditioning paradigm. The responses to CS-US presentations on the superficial peroneal nerve increased, whereas responses to CS presentations on the tibial nerve remained unchanged. However, lack of extinction effects in the superficial peroneal data suggested that stimulation of the tibial nerve potentiated superficial peroneal evoked responses. Furthermore, responses evoked by stimulation of either nerve increased when paired trials were given on the tibial nerve. These data demonstrate that stimulation of the tibial nerve potentiates responses to superficial peroneal nerve stimulation but that superficial peroneal nerve stimulation has no effect on responses to CS presentations to the tibial nerve.

Animals↗
PubMed2000

Post reinnervation maturation of myelinated nerve fibers in the cat tibial nerve: chronic electrophysiological and morphometric studies.

The extent to which the long-term recovery of nerve fibers differs according to the cause of Wallerian degeneration is not clear, although outgrowth of axons is better after lesions with continuity of basal lamina of the Schwann cell tubes (nerve crush) compared with lesions with interruption of basal lamina (nerve section). Post-reinnervation maturation of myelinated nerve fibers of the cat tibial nerve was followed in chronic electrophysiologic studies after crushing, sectioning, and section+freeze lesions, and compared with morphometric analysis of the same nerves. The amplitudes of the compound nerve action potentials (CNAPs) recovered to a much lesser extent after sectioning than after crushing the nerve. This difference could be related to a smaller number of large fibers, a greater degree of sprouting after sectioning than after crushing, or less synchronization of conduction in regenerated fibers. In comparison, the compound muscle action potentials (CMAPs) recovered to a greater extent than the CNAP after sectioning and section+freeze, though not to the same degree or as fast as after crushing. The difference between the recovery of the CNAP and the CMAP could be due to better regeneration of motor fibers, to differences in the size of motor units or to a better summation of motor unit action potentials. The maximal conduction velocities (CV) in mixed nerve and in motor fibers increased faster after crushing than after sectioning and section+freeze to 60%-70% of control values. The diameters of the largest myelinated fibers increased in all lesions to about 80% of controls. The relation between fiber diameter and CV was influenced by remodeling of myelin during maturation. Hence, long-term functional recovery is influenced by the nature of the nerve lesion, and a smaller proportion of fibers recovered functionally after nerve section than after crush.

Action Potentials↗