ajkim1's version from 2015-06-17 12:31


Question Answer
True neuromaProliferation of axons
Typical neuromaDegeneration of the myelin around the axon causing histopathological changes
Nerves involving the hot spot for neuromas in the 3rd interspaceCommunicating branch of the lateral plantar nerve and the 3rd common digital branch of the medial plantar nerve
Medial halluxJoplin
1st interspaceHeuter
2nd interspaceHauser
3rd interspaceMorton
4th interspaceIselin
Double crush syndromeAKA tarsal tunnel syndrome
Pathology proximally causes the nerve to be more sensitive and is more likely to become pathologic distally
What could case a double crush in a Morton's neuroma?Tarsal tunnel syndrome
Neuromas are usually (inferior/superior) to the DTMLInferior
Failure rate of neuromas15-20%
NeuromyodesisBurying the stump of the cut nerve into an intrinsic muscle
Location where a stump neuroma is buriedIntrinsic muscle
2nd most common neuroma location2nd interspace
Sclerosing agentsKill the nerve
Sclerosing agent used to kill the nerveMarcaine with epi
Freeing of the nerve from the adherent fibrous tissue and DTMLExternal neurolysis
Microsurgical technique tha separates epineurium from perineurium and funiculi from each otherInternal neurolysis
% of neuromas that form a stump neuroma when cut100%
Location of most of the histologic changes seen in interdigital neuromaDistal to DTML
Roots theory of neuroma formation4th MT is most stable, other surrounding MTs form an arch and rotate around it
According to Easley, during the EDINS procedure, which tendon is most likely to be severed?Lumbricals
Double heel raise testFlexibility of STJ for flatfoot
According to Easley, if you are unable to visualize the DTML during the EDINS procedure, what should you do?Open the foot
3 criteria for successful neuromyodesisNo tension, implant into limited motion muscle (intrinsic), and located away from WB surface
What the the most common etiology of tarsal tunnel syndrome?Nerve entrapment
Specific location of Joplin's neuromaPlantar medial proper digital nerve of the hallux
Entrapment neuropathy under DTMLInterdigital neuritis
Changes in neuromasFibrosis of perineurium and epineurium, thickening/hyalinization/collagenation of endoneural and epineural vessels, degeneration of myelinated fibers, collagen
Mulder's signSqueeze FF from medial to lateral and push-up into the effected interspace, may hear a click
Sullivan's signDivergent toes because neuroma is so big
According to Mcglamry's, what is the % of revisional surgery failure?8-80%
Single heel raise testIntegrity of TP tendon
How is a needle used to plan incision for revisional neuroma surgery?Put needle at proximal aspect of dorsal incision, poke it out plantarly, and that is where the revisional plantar incision should be
What is used in a diagnostic injection?Lidocaine plain 2cc
Is MRI standard of care?No
How do stump neuromas occur?Don't cut far enough proximally
What incision must be made if procedure must be redone to excise a stump neuroma?Plantar incision
What is not an incision we discussed for surgical excision of a neuroma?Dorsal transverse
For neuromyodesis, which layer of the nerve do you suture into the muscle?Epineurium
Describe the procedure for a neuromyodesisSuture epineurium using a 6-0 nylon suture to limit muscle movement, and suture away from WB surface