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Just had a patient (71 year old female) present with a "tingly, but not really" sensation radiating distally from the left styloid process. It is brought on by gentle palpation or percussion of the bony prominence.
The sensation does not impede any activity, is not exaggerated by activity, and has been present for 6/12

I couldn't find any place proximal along the Sup. Peronela Nn. or Common Peroneal Nn. that palpation or percussion reproduced it.

Her nothing obvious presented biomechanically, and her vascular and nerological status is without defecit.

She has been diagnosed with Sjogren's, and injured her mid-back while moving house several years ago.

I'm thinking sural neuralgia based on the location, but i can't think of a possible aetiology.

Any thoughts?

 

Injury or adhesions to the sural nerve, particularly around the styloid process are relatively common. There may be an underlying bursal issue related to her inflammatory arthritis that could be contributory.

This can be confirmed easily by doing a diagnostic local anaesthesia block of the nerve proximal to the area of maximum radiating pain with percussion.

Treatment is usually surgical release or a series of steroid infiltrations.

LL