title: A positive Tinel sign as predictor of pain relief or sensory recovery after decompression of chronic tibial nerve compression in patients with diabetic neuropathy.
abstract: Predictive ability of a positive Tinel sign over the tibial nerve in the tarsal was evaluated as a prognostic sign in determining sensory outcomes after distal tibial neurolysis in diabetics with chronic nerve compression at this location. Outcomes were evaluated with a visual analog score (VAS) for pain and measurements of the cutaneous pressure threshold/two-point discrimination. A multicenter prospective study enrolled 628 patients who had a positive Tinel sign. Of these patients, 465 (74%) had VAS >5. Each patient had a release of the tarsal tunnel and a neurolysis of the medial and lateral plantar and calcaneal tunnels. Subsequent, contralateral, identical surgery was done in 211 of the patients (152 of which had a VAS >5). Mean VAS score decreased from 8.5 to 2.0 (p <0.001) at 6 months, and remained at this level for 3.5 years. Sensibility improved from a loss of protective sensation to recovery of some two-point discrimination during this same time period. It is concluded that a positive Tinel sign over the tibial nerve at the tarsal tunnel in a diabetic patient with chronic nerve compression at this location predicts significant relief of pain and improvement in plantar sensibility.
authors.affiliation: Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland, USA. ALDellon@Dellon.com
authors.forename: A Lee
authors.initials: AL
authors.lastname: Dellon
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Muse
authors.forename: Nickerson D
authors.initials: ND
authors.lastname: Scott
authors.forename: Thomas
authors.initials: T
authors.lastname: Akre
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Anderson
authors.forename: Steve L
authors.initials: SL
authors.lastname: Barret
authors.forename: Kent R
authors.initials: KR
authors.lastname: Biddinger
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Bregman
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Bullard
authors.forename: Damien M
authors.initials: DM
authors.lastname: Dauphinee
authors.forename: James M
authors.initials: JM
authors.lastname: DeJesus
authors.forename: Ramon A
authors.initials: RA
authors.lastname: DeJesus
authors.forename: Ivica
authors.initials: I
authors.lastname: Ducic
authors.forename: Jeffery
authors.initials: J
authors.lastname: Dunkerly
authors.forename: Michael R
authors.initials: MR
authors.lastname: Galina
authors.forename: Virginia
authors.initials: V
authors.lastname: Hung
authors.forename: Dolf R
authors.initials: DR
authors.lastname: Ichtertz
authors.forename: Michael F
authors.initials: MF
authors.lastname: Kutka
authors.forename: Richard P
authors.initials: RP
authors.lastname: Jacoby
authors.forename: J Barry
authors.initials: JB
authors.lastname: Johnson
authors.forename: David W
authors.initials: DW
authors.lastname: Mader
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Maloney
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mancuso
authors.forename: R Craig
authors.initials: RC
authors.lastname: Martin
authors.forename: Rick F
authors.initials: RF
authors.lastname: Martin
authors.forename: Brian A
authors.initials: BA
authors.lastname: McDowel
authors.forename: Vito J
authors.initials: VJ
authors.lastname: Rizzo
authors.forename: Michael
authors.initials: M
authors.lastname: Rose
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Shafiroff
authors.forename: Jerome K
authors.initials: JK
authors.lastname: Steck
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Stolarski
authors.forename: Patrick
authors.initials: P
authors.lastname: Swier
authors.forename: Tatiana A
authors.initials: TA
authors.lastname: Wellens-Bruschayt
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Wilke
authors.forename: Eric H
authors.initials: EH
authors.lastname: Williams
authors.forename: Michael A
authors.initials: MA
authors.lastname: Wood
authors.forename: William A
authors.initials: WA
authors.lastname: Wood
authors.forename: Michael P
authors.initials: MP
authors.lastname: Younes
authors.forename: Fuat
authors.initials: F
authors.lastname: Yuksel
mesh_terms: D000842:Ankle / Q000294:innervation; D002908:Chronic Disease; D019299:Decompression, Surgical; D003929:Diabetic Neuropathies / Q000601:surgery*; D003943:Diagnostic Techniques, Neurological; D006801:Humans; D009408:Nerve Compression Syndromes / Q000601:surgery*; D010147:Pain Measurement; D011379:Prognosis; D012677:Sensation; D013979:Tibial Nerve / Q000503:physiopathology / Q000601:surgery*