Great case. Did the patient have an EMG and nerve conduction study as well before hydrodisection? What's the sensitivity of MSK US for diagnosing medical calcaneal nerve impingement in patients with a higher body fat?
Thank you for watching the presentation. We deferred EMG in this patient as there is a relatively high false negative rate for large nerve entrapments, I've seen in literature up to 50%, and EMG identification for smaller sensory nerves like this are even less accurate. The diagnosis problem with ultrasound is very difficult due to the anatomic variation in the area and the sensitivity is not high, and why I believe the nerve block/hydrodissection was important. The key I believe in cases like this is the reproducibility of the symptoms with sonopalpation directly over the course of the nerve and at site of visualized potential entrapment, and identifiable tissue variation comparing contralateral side which I tried to highlight here.
This is amazing that you are picking up the slack for countless lazy and uninspired foot doctors. So typical to just diagnose PF and give cookie cutter treatments that will make nerve pain worse. My foot doctor, who is an excellent surgeon that I hold dear for fixing some major tears, is denying that I have calcaneal nerve entrapment when I am 100% sure thats what it is. I've begged him to just do a scope, put a camera inside and do a patch job surgery to give me SOME relief. But no, I have to go through the MONTHS of red tape. He wants me to go do that outdated EMG that I know will give a false negative. He wants me to get a neurologist's opinion. They're even more useless. Gapabentin and PT is their be all, end all. All this running around on two painful feet. My symptoms are not only not consistent with plantar fascitis, they are the inverse. There at rest. Worse with activity. Moved around and not localized at all. Textbook nerve pain. There's so many things that could be causing it, PF, heel spur, fat pad hypertrophy, impingement between two muscles, bursitis. They just don't want to do the work. I'll be having the hydrodissection January 3 2024. If I could be 85-90% improved at 3 months or later I'll be overjoyed.
Great case. Did the patient have an EMG and nerve conduction study as well before hydrodisection? What's the sensitivity of MSK US for diagnosing medical calcaneal nerve impingement in patients with a higher body fat?
Thank you for watching the presentation. We deferred EMG in this patient as there is a relatively high false negative rate for large nerve entrapments, I've seen in literature up to 50%, and EMG identification for smaller sensory nerves like this are even less accurate. The diagnosis problem with ultrasound is very difficult due to the anatomic variation in the area and the sensitivity is not high, and why I believe the nerve block/hydrodissection was important. The key I believe in cases like this is the reproducibility of the symptoms with sonopalpation directly over the course of the nerve and at site of visualized potential entrapment, and identifiable tissue variation comparing contralateral side which I tried to highlight here.
Thank you for expanding on that and for the very nice presentation. Great learning tool.
This is amazing that you are picking up the slack for countless lazy and uninspired foot doctors. So typical to just diagnose PF and give cookie cutter treatments that will make nerve pain worse. My foot doctor, who is an excellent surgeon that I hold dear for fixing some major tears, is denying that I have calcaneal nerve entrapment when I am 100% sure thats what it is. I've begged him to just do a scope, put a camera inside and do a patch job surgery to give me SOME relief. But no, I have to go through the MONTHS of red tape. He wants me to go do that outdated EMG that I know will give a false negative. He wants me to get a neurologist's opinion. They're even more useless. Gapabentin and PT is their be all, end all. All this running around on two painful feet.
My symptoms are not only not consistent with plantar fascitis, they are the inverse. There at rest. Worse with activity. Moved around and not localized at all. Textbook nerve pain. There's so many things that could be causing it, PF, heel spur, fat pad hypertrophy, impingement between two muscles, bursitis. They just don't want to do the work. I'll be having the hydrodissection January 3 2024. If I could be 85-90% improved at 3 months or later I'll be overjoyed.