title: Ultrasound guided block of the saphenous neuroma following use of an AFO in a patient with paraplegia. A case report.
abstract: The saphenous nerve is the terminal branch of the femoral nerve and a pure sensory nerve that provide sensation to medial leg. Injury to saphanous nerve following trauma or surgery of the knee can result in formation of a painful neuroma along its distribution. We present a case of saphenous neuroma following use of an ankle-foot orthosis (AFO) in a patient with paraplegia. A 36-year-old patient with paraplegia who was capable of walking independently with his AFO presented to our department with a 3-month history of pain in his left calf. Examination revealed tenderness, paresthesias and positive Tinel sign over the anteromedial aspect of the calf. Ultrasonographic examination of the painful area showed a mass with heterogenous echogenity which was consistent with a saphenous neuroma at the site where fastener band of AFO compressed to skin. We performed a nerve block with steroid and local anesthetic injection under ultrasound guidance to the neuroma. The patient reported pain relief following injection. The use of the AFO may cause a painful saphenous neuroma which is an unusual cause of extremity pain in patients with paraplegia. Ultrasound may be a beneficial diagnostic tool and a guidance for the therapeutic interventions in this condition.
authors.affiliation: Department of Physical Medicine and Rehabilitation Gülhane Military Medical Academy Turkish Armed Forces Rehabilitation Center, Ankara, Turkey - serdarkb@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Kesikburun
authors.forename: Ö
authors.initials: Ö
authors.lastname: Köroğlu Omaç
authors.forename: E
authors.initials: E
authors.lastname: Yaşar
authors.forename: B
authors.initials: B
authors.lastname: Yilmaz
authors.forename: A
authors.initials: A
authors.lastname: Kenan Tan
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D009463:Neuroma / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D009989:Orthotic Devices / Q000009:adverse effects*; D010264:Paraplegia / Q000534:rehabilitation*; D012501:Saphenous Vein; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014463:Ultrasonography; D019043:Vascular Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*