Rare Case of Traction Sural Neuropathy due to Acute Achilles Tendon Rupture

Sural nerve injury (SNI) is a reported complication of acute Achilles tendon rupture (ATR), primarily iatrogenic in operatively managed cases. The sural nerve typically runs along the lateral border of the Achilles tendon. Its branches provide sensory information from the lateral foot and ankle. Given its proximity to the Achilles tendon, sural nerve-related complications in operatively managed cases are a known adverse outcome. However, the incidence of SNI in conservatively managed cases is thought to be much less common. Most patients recover to normal sensation by one year of injury to the sural nerve. CASE DESCRIPTION: A previously healthy 30 y.o. male presented with acute onset right posterior lower leg pain that occurred while running. He was clinically diagnosed with a complete ATR. Additionally, the patient reported numbness and tingling in the right lateral hindfoot since the time of injury. CLINICAL COURSE: The patient opted to pursue conservative management for his ATR with an accelerated functional rehabilitation protocol. However, he continued to endorse minimally improved sensory deficits in the sural nerve distribution nearly one year post-injury. The patient felt these symptoms were negatively impacting his return to full physical function, prompting further testing. Nerve conduction studies were consistent with an isolated right sural sensory neuropathy that was chronic and axonal in nature. Nonsurgical management and conservative treatment were recommended, including a discussion regarding the natural history of nerve healing and the available treatment options for nerve injuries. CONCLUSION: SNI associated with ATR likely results from traction on the nerve at the time of injury. Prior literature has focused on the incidence of sural nerve injury in the setting of operative repair of ATR. This case highlights the rarity of SNI in the absence of surgical repair and the importance of assessing for SNI in all cases of acute ATR

Osteochondral lesions in Wilsons disease: case report and literature review.

BACKGROUND: Wilsons disease (WD) is a rare genetic disorder characterized by copper accumulation in the body, leading to a spectrum of health issues, such as liver disease, neurological disturbances, and psychiatric disorders. In recent years, there has been increasing recognition that WD can also result in osteoarticular defects. Research has shed light on the potential of WD to cause these findings, which in some instances, can progress to osteoarthritis and persistent pain. However, the exact pathophysiological process through which WD leads to osteochondral defects remains unclear. CASE DESCRIPTION: We present a case of a 30-year-old male diagnosed with WD exhibiting musculoskeletal symptoms. The patients medical history revealed chronic intermittent knee pain. Radiographic and magnetic resonance imaging (MRI) studies revealed a substantial osteochondral lesion with high-grade chondral fissuring. This report reviews the proposed pathophysiology of orthopedic pathology in WD, offers an updated literature review, and provides clinical recommendations for management. Treatment options including nonsurgical options and surgery are discussed. CONCLUSIONS: This case underscores the significance of identifying the orthopedic manifestations of WD, even in the absence of classic signs and symptoms. Any WD patient suspected of having osteoarticular defects should be thoroughly evaluated, with a low threshold for initiating imaging studies. Moreover, treatment plans should be tailored to the patients specific presentation, emphasizing the importance of individualized patient care. This case highlights key findings in WD and provides important insights, particularly on the clinical relevance of osteoarticular defects in WD, the potential application of nonsurgical and surgical treatments, and the importance of individualized patient care in the management of WD