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Post-op Sciatic Neuropathy?
I have seen 2 cases of sciatic nerve damage following foot/ankle surgery over the past few years. In both cases, the surgery involved popliteal block and tourniquet, with post-op complaints of motor and sensory loss from the knee down. The first case was a few years ago and I don't recall all the Edx details, other than there were abnormalities below the knee c/w tibial/fibular injury. The second case I saw this week 15 y/o with dense sensory loss globally below the knee and global weakness following ankle ligament reconstruction 7 months ago. The patient described some improved sensory in the proximal 1/3 of the leg but no feeling in the distal leg and foot. Motor exam with marked weakness (2/5 DF, toe flex/ext, eversion, PF). NCS with absent superficial fibular, sural and fibular motor. Interestingly, tibial motor WNL and no side to side difference (so tibial weakness seems out of proportion to the motor nerve study). Needle EMG c/w denervation short head bicep, gastroc/soleus, TA and fibularis longus (small amplitude spontaneous activity, long duration polyphasic motor units) and normal EMG quad and proximal hamstring.
Question: Other than the Edx study, does anyone have a take on whether these need to be further worked up? The case I had a few years ago I recall getting MRI of either the femur or leg and then did the other part of the limb when the first study was unremarkable in terms of obvious abnormality around the sciatic (memory not totally clear). However, it was a work comp case and studies were approved, so no issue with $$ for the patient. In the current patient, any thoughts? In the cases that the community has seen, have you figured out etiology?
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