| 제목 |
Popliteal Entrapment Syndrome after Isolated Popliteus Muscle Overuse Injury : Case Report |
| 소속 |
Kyung Hee University Medical Center, Department of Rehabilitation Medicine1 |
| 저자 |
Miryeong Yang1*, Jong Ha Lee1†, Hee Sang Kim1, Dong Hwan Yun1, Jinmann Chon1, Yunsoo Soh1, Yong Kim1, Myung Chul Yoo1 |
Entrapment of the proximal tibial nerve in popliteal fossa is rare in clinical practice, compared to distal tibial neuropathy in the tarsal tunnel syndrome. We present a case of isolated popliteal muscle injury causing proximal tibial neuropathy.
A 75-year-old man visited our hospital for his left foot pain and weakness started about four months ago. Before the pain started, he played “Jegi-chagi”, a Korean traditional game, for one week with his left leg. After kicking “Jegi” for one week, he had a left popliteal painful swelling. He took medication for popliteal painful swelling, and then the symptom subsided. However, pain at left plantar foot started around one month later. He had no other history of trauma to the knee and foot. At the time of his visit to our hospital, the left calf was generally soft and had no tenderness. Left plantar foot pain scored 7 in visual analog scale. The sensation was diminished to light touch on the plantar area of his left foot. He had 4 of 5 strength of big toe dorsiflexion and 2 of 5 strength of 2nd to 5th toes flexion and abduction. Knee stability testing showed negative results. Magnetic resonance imaging of left knee showed edema and enlargement of the left popliteus muscle with diffuse high signal intensity at T2-weighted fat suppression image. Nerve conduction study showed decreased compound muscle action potential (CMAP) amplitude and delayed CMAP latency in the left tibial nerve. The amplitude of sensory nerve action potential was unobtainable in the left medial plantar nerve and lateral plantar nerve. The needle electromyography study showed abnormal spontaneous activities and discrete recruitment patterns at left abductor digiti quinti, abductor hallucis and tibialis posterior. Under the basis of these results, we confirmed his diagnosis with proximal tibial neuropathy caused by isolated popliteus muscle injury.
Isolated popliteus injury is uncommon. It typically occurs after a traumatic event, such as external rotation of slightly flexed knee or a twisting injury. Playing “Jegi-chagi” consists of repetitive motion of internal rotation of the tibia on the femur. It might cause overuse of popliteus muscle. Our case is rare and unique in that proximal tibial neuropathy was caused by compression related to mass effect from the enlarged popliteus muscle. |
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