Best Practice Case Studies-Case 126 Asset 2 Lower Extremity Peripheral Entrapment Neuropathies

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Video Summary

This lecture, hosted by the AMSSM, focused on peripheral neuropathies of the lower extremity in sports medicine, presented by Dr. Gary Ho. He began with core concepts useful for board preparation, including the Seddon classification of nerve injury: neuropraxia, axonotmesis, and neurotmesis. He emphasized that neuropathic symptoms are not always classic numbness or tingling, and can also present as aching, stiffness, fatigue, or pain that mimics tendon or joint disease.<br /><br />Dr. Ho highlighted several diagnostic pearls: symptoms may radiate proximally as well as distally, double crush syndrome can cause multiple entrapments along one nerve, and metabolic issues such as diabetes or hypothyroidism can worsen nerve injury and recovery. He stressed careful exam techniques, including inspecting the spine and entire limb, using provocative maneuvers, and examining athletes after exercise if symptoms are activity-related. He also reviewed ultrasound, MRI, MR neurography, and EMG/NCS, noting that EMGs can be falsely negative if done too early.<br /><br />Treatment options were framed as “R’s”: rest/relieve, rehabilitate, release via hydrodissection, and regenerate with orthobiologics. He explained nerve glides, ultrasound-guided hydrodissection, and when surgery is indicated.<br /><br />The second half covered specific lower-extremity nerves: ilioinguinal, obturator, saphenous, lateral femoral cutaneous, pudendal, peroneal, and tarsal tunnel syndromes. For each, he reviewed anatomy, typical symptoms, common sports-related mechanisms, exam findings, imaging, and treatment options. He concluded with case-based questions and a Q&A on ultrasound timing, hydrodissection technique, repeat injections, small fiber neuropathy testing, and post-knee-replacement nerve entrapment.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 126

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Keywords

4th Edition

4th Edition, Case 126

Foot

peripheral neuropathy

lower extremity

sports medicine

nerve entrapment

Seddon classification

neuropraxia

double crush syndrome

ultrasound-guided hydrodissection

EMG NCS

tarsal tunnel syndrome

saphenous nerve