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Interesting case from last week.

30 year old female with a history of receiving a cortisone injection approximately 3 -4 years ago for lateral ankle pain.

She stated that when she received the injection it was "intensely painful" however the doctor continued to inject.

She had a small ecchymotic area for several weeks where the injection was given, pain, and felt that even years later she could see a small purple discoloration.

Symptoms have changed over the years finalizing in a constant burning, at times radiating pain along the outside of the left ankle / foot. Her original problem (ankle pain) had subsided. She feels her pain is directly related to the injection.

We have treated her for the past 14 months with local Marcaine injections, lidoderm patches and pain medication with some success.

An MRI showed a thickening of the Sural Nerve at the level of the distal fibular head.

It was decided to surgically explore the area with a neurectomy as a possible procedure in order to alleviate her chronic nerve pain..

Here are the photos. It appeared a perineurofibrosis had encompassed the Sural N.
This was tediously debrided. We have not seen her postoperatively as yet.

 

Hello drsarbes,
Lovely clear photos but not being a surgeon I'm assuming they are before and after pictures. I would love to have read a description of the process and some interim photos, no wonder it was so time consuming. I hope your patient recovers well and appreciates the skill needed for such a delicate procedure, thank you for posting it.

 

Hi Dazzalyn
I appreciate your kind words, don't lay it on too thick, I already have a large ego.

I did see the patient one week post op and so far so good. None of her pre-op pain and only surgical discomfort.

I am somewhat optimistic.

Steve

 

Hi Steve

If you are still active in forum I am curious for hearing about outcome and further thought s in this case.

I have a similar and difficult case currently and would be interested to discuss if there's anyone out there with some experiences to share.

TIA Martin