A Case of Double Anatomic Variation: Diagnostic Efficacy of Combination of Ultrasound and Neurophysiology.

Abstract

The purpose of this paper is to underline that the association of physical examination, electrophysiology, and ultrasound was crucial in identifying the correct disease and atypical characteristics of its presentation, in turn, providing proper information for both surgical treatment and a rehabilitation program. Fibular nerve compression is a common finding in the adult population, and it is more frequent at the fibular head. The clinical picture may be characterized by motor and/or sensory deficits. The same symptoms may sometimes be suggestive of root impairment. We report the case of a 39-year-old man who came to our laboratory with a diagnosis of multimetameric lumbosacral radiculopathy. The patient reported a history of ankle numbness and transient foot drop. Neurophysiologic examination showed peripheral axonal damage at tibialis anterior and lateral gastrocnemius muscles. A nerve ultrasound showed the presence of a conflict between a fibular exostosis and the fibular nerve. Furthermore, the fibular nerve presented an anatomic variation supplying the lateral gastrocnemius muscle. Ultrasound was crucial in recognizing the cause of the atypical presentation and avoiding a misdiagnosis. Also, it allowed the identification of the appropriate treatment and rehabilitation, as well as preventing irreversible nerve damage. As a result, critical information was presented to the surgeon for surgical treatment.