I recently had a case of MRI confirmed inter-metatarsal neuroma 2/3 inter-metatarsal space which I missed with Diagnostic ultrasound exam.
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Studies show good sensitivity for neuroma with US and this suggests my skills need improvement.
The patient had no mulder sign and symptoms were not usual for neuroma.
I find this US exam difficult, the echodensity of the inter-metatarsal space is murky, I have seen a couple of cases which I regarded as well defined US suspicious for neuroma but I still lack confidence.
I am curious about the idea of careful infiltration of 1% lidocaine around the nerve with the intention of creating fluid engorged fatty tissue around the neurovascular bundle and creating better definition of any fibrous tissue which may be present.
I have been unable to find anything in the literature about this.
My questions are
Anyone tried doing this, if so how did it work?
Anyone have any thoughts about if this is likely to work. Would it be reasonable to expect infiltration of lidocaine to create a “halo” around the NV bundle or would it more likely diffuse evenly acroos the entire volume?
Cheers
Martin
The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
Phone [204] 837 FOOT (3668)
Fax [204] 774 9918
www.winnipegfootclinic.com
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