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J Reconstr Microsurg 2012; 28(04): 235-240
DOI: 10.1055/s-0032-1306371
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Positive Tinel Sign as Predictor of Pain Relief or Sensory Recovery after Decompression of Chronic Tibial Nerve Compression in Patients with Diabetic Neuropathy

A. Lee Dellon
1   Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland
2   Dellon Institute for Peripheral Nerve Surgery, Peripheral Nerve Towson, Baltimore, Maryland
,
Vicki L. Muse
2   Dellon Institute for Peripheral Nerve Surgery, Peripheral Nerve Towson, Baltimore, Maryland
,
Nickerson D. Scott
3   Northeast Wyoming Wound Care Center, Sheridan, Wyoming
,
et al › Author Affiliations
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Publication History

13 August 2011

16 October 2011

Publication Date:
12 March 2012 (online)

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Abstract

Predictive ability of a positive Tinel sign over the tibial nerve in the tarsal was evaluated as a prognostic sign in determining sensory outcomes after distal tibial neurolysis in diabetics with chronic nerve compression at this location. Outcomes were evaluated with a visual analog score (VAS) for pain and measurements of the cutaneous pressure threshold/two-point discrimination. A multicenter prospective study enrolled 628 patients who had a positive Tinel sign. Of these patients, 465 (74%) had VAS >5. Each patient had a release of the tarsal tunnel and a neurolysis of the medial and lateral plantar and calcaneal tunnels. Subsequent, contralateral, identical surgery was done in 211 of the patients (152 of which had a VAS >5). Mean VAS score decreased from 8.5 to 2.0 (p <0.001) at 6 months, and remained at this level for 3.5 years. Sensibility improved from a loss of protective sensation to recovery of some two-point discrimination during this same time period. It is concluded that a positive Tinel sign over the tibial nerve at the tarsal tunnel in a diabetic patient with chronic nerve compression at this location predicts significant relief of pain and improvement in plantar sensibility.

Keywords

Tinel sign - diabetic neuropathy - neurolysis
 

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