Percutaneous Ultrasound-Guided Hydrodissection of a Symptomatic Sural XXXX .

@entity1 @entity1183 @entity2245 @entity4 @entity809 @entity2318 @entity158 @entity2950 @entity1118
Symptomatic @entity2950 of the sural nerve are a rare but significant cause of @entity158 and debilitation in athletes. Presentation is usually in the form of @entity1118 and @entity809 or paresthesias of the lateral foot and ankle. Treatment traditionally ranges from conservative measures, such as removing all external compressive forces, to administration of nonsteroidal anti-inflammatory drugs, @entity2245 , tricyclic antidepressants, antiepileptics, or topical anesthetics. This article reports a case of sural nerve entrapment in a 34-year-old male triathlete with a history of recurrent training-induced right-sided gastrocnemius strains. The @entity1 presented with @entity1183 in the right lateral foot and ankle that had persisted for 3 months, after he was treated unsuccessfully with extensive nonoperative measures, including anti-inflammatory drugs, activity modification, and a dedicated physical therapy program of stretching and strengthening. Orthopedic assessment showed worsening @entity158 with forced passive dorsiflexion and manual pressure applied over the distal aspect of the gastrocnemius. Plain radiographs showed normal findings, but in-office ultrasound imaging showed evidence of sural nerve entrapment with @entity4 and @entity2318 formation in the absence of gastrocnemius or soleus pathology. Percutaneous ultrasound-guided hydrodissection of the sural nerve at the area of symptomatic @entity4 was performed the same day. The @entity1 had complete relief of symptoms and full return to the preinjury level of participation in competitive sports. This case report shows that hydrodissection, when performed by an experienced physician, can be an effective, minimally invasive technique for neurolysis in the setting of sural nerve entrapment, resulting in improvement in clinical symptoms. [Orthopedics. 2015; 38(11):e1046-e1050.].
