John D Stewart

Bio: John D Stewart is an academic researcher. The author has contributed to research in topics: Nerve root & Popliteal fossa. The author has an hindex of 2, co-authored 2 publications receiving 192 citations.

Foot drop: where, why and what to do?

Abstract: Foot drop is a common and distressing problem that can lead to falls and injury. Although the most frequent cause is a (common) peroneal neuropathy at the neck of the fibula, other causes include anterior horn cell disease, lumbar plexopathies, L5 radiculopathy and partial sciatic neuropathy. And even when the nerve lesion is clearly at the fibular neck there are a variety of causes that may not be immediately obvious; habitual leg crossing may well be the most frequent cause and most patients improve when they stop this habit. A meticulous neurological evaluation goes a long way to ascertain the site of the lesion. Nerve conduction and electromyographic studies are useful adjuncts in localising the site of injury, establishing the degree of damage and predicting the degree of recovery. Imaging is important in establishing the cause of foot drop be it at the level of the spine, along the course of the sciatic nerve or in the popliteal fossa; ultrasonography, CT and MR imaging are all useful. For patients with a severe foot drop of any cause, an ankle foot orthosis is a helpful device that enables them to walk better and more safely.

Ulnar neuropathies: where, why, and what to do?

Abstract: Ulnar neuropathy alert by Auguste Rodin Diagnosing and treating ulnar neuropathy is not nearly as straightforward as carpal tunnel syndrome Here I will attempt to guide the busy practical neurologist to make the diagnosis with confidence and to manage patients effectively There are four critical questions to be considered in a patient with a possible ulnar neuropathy: Understanding a few basic points about the anatomy of this nerve is key to making the diagnosis of ulnar neuropathy, or one of its mimics The ulnar nerve is derived from the spinal nerve roots C8 and T1 These fibres pass through the lower trunk and medial cord of the brachial plexus The ulnar nerve itself arises from the plexus in the proximal axilla, then lies on the medial aspect of the upper arm (fig 1) The anatomy of the nerve at the elbow is particularly important Here the nerve lies in the bony ulnar (condylar or retroepicondylar) groove behind the medial epicondyle of the distal humerus (fig 2) As it emerges from this groove, it passes under the aponeurotic arch of the flexor carpi ulnaris muscle (also called the humeroulnar arcade) This is formed from the attachment of the muscle to the medial epicondyle and the olecranon (fig 2) Its edge usually lies about 1 cm distal to a line joining those two points Figure 1 Anterior aspect of the right arm, showing the course and important branches of the ulnar nerve At the wrist the ulnar nerve passes through a fibro-osseous space called Guyon’s canal The nerve divides …

Nerves and Nerve Injuries.

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Effect of a Foot-Drop Stimulator and Ankle–Foot Orthosis on Walking Performance After Stroke: A Multicenter Randomized Controlled Trial

Abstract: Background. Studies have demonstrated the efficacy of functional electrical stimulation in the management of foot drop after stroke. Objective. To compare changes in walking performance with the Wa...

Peroneal Nerve Palsy: Evaluation and Management.

Abstract: Peroneal nerve palsy is the most common entrapment neuropathy of the lower extremity. Numerous etiologies have been identified; however, compression remains the most common cause. Although injury to the nerve may occur anywhere along its course from the sciatic origin to the terminal branches in the foot and ankle, the most common site of compressive pathology is at the level of the fibular head. The most common presentation is acute complete or partial foot drop. Associated numbness in the foot or leg may be present, as well. Neurodiagnostic studies may be helpful for identifying the site of a lesion and determining the appropriate treatment and prognosis. Management varies based on the etiology or site of compression. Many patients benefit from nonsurgical measures, including activity modification, bracing, physical therapy, and medication. Surgical decompression should be considered for refractory cases and those with compressive masses, acute lacerations, or severe conduction changes. Results of surgical decompression are typically favorable. Tendon and nerve transfers can be used in the setting of failed decompression or for patients with a poor prognosis for nerve recovery.

Diagnostic value of high-resolution sonography in common fibular neuropathy at the fibular head

Abstract: Introduction In 30% of patients with common fibular (CF) neuropathy at the fibular head, reliable localization of the site of the lesion by means of electrodiagnostic testing is challenging. Methods We prospectively assessed proximal CF nerve cross-sectional area (CSA) measurements and at the fibular head in 87 patients with CF neuropathy and 16 with a different condition. Reference values were obtained in 64 healthy volunteers. Results Patients with CF neuropathy had a significantly larger CF nerve CSA than controls and patient controls (P 8 mm2 with a sensitivity of 90% (CI 81–95%) and a specificity of 69% (CI 58–78%). Conclusion High-resolution sonography in addition to electrodiagnostic testing improves diagnostic reliability in CF neuropathy. Muscle Nerve, 48: 171–178, 2013

Entrapment neuropathies of the lower extremity.

Abstract: Neuropathies that affect the lower limbs are often encountered after trauma or iatrogenic injury or by entrapment at areas of anatomic restriction. Symptoms may initially be masked by concomitant trauma or recovery from surgical procedures. The nerves that serve the lower extremities arise from the lumbosacral plexus, formed by the L2-S2 nerve roots. The major nerves that supply the lower extremities are the femoral, obturator, lateral femoral cutaneous, and the peroneal (fibular) and tibial, which arise from the sciatic nerve, and the superior and inferior gluteal nerves. An understanding of the motor and sensory functions of these nerves is critical in recognizing and localizing nerve injury. Electrodiagnostic studies are an important diagnostic tool. A well-designed electromyography study can help confirm and localize a nerve lesion, assess severity, and evaluate for other peripheral nerve lesions, such as plexopathy or radiculopathy.