Ultrasono graphic Evaluation of Tarsal Tunnel Syndrome in Patients with Rheumatoid Arthritis

Abstract

Background:Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause that primarily affects the peripheral joints in a symmetrical pattern. Rheumatoidneuropathy could result from entrapment as by adjacent tenosynovitis, nerve ischemia due to vasculitis or drugs used to treat these conditions. Tarsal tunnel syndrome is a condition that is caused by compression of the tibial nerve or its associated branchesas the nerve passes underneath the flexor retinaculum at the level of the ankle ordistally.Musculoskeletalultrasoundhaslong been established asa valuable tool inthe diagnosis of synovitis and tenosynovitis in addition to effusions in RA patientsand also proofed valuable for diagnosis of TTS. Objective: The aim of the current study was to diagnose and evaluate tarsal tunnelsyndromein patients withrheumatoid arthritis by meansof ultrasonography and nerve conduction studies. Patients and methods: This study included fifty patients with age ranged from (20 to 68) years.All patients were classified as having RA according to ACR/EULAR 2010criteria for RA classification, and suspected clinically to have TTS by complaining of burning pain or paresthesia onthe plantar aspect of their feet and toes.
Results:Of 50 patients (50 feet), 47 patients (94.0%) had abnormal Electrophysiologicalfindings; 28 patients (59.6%) had prolonged distal latency in the motor Lateral planternerve (any variable). 12 patients (25.5%) had prolonged distal latency in the motor medial planter nerve (any variable). 35 patients (74.5%) had prolonged distal latency in the sensory Lateral planter nerve (any variable). Musculoskeletal Ultrasonographyshowed 86.0 % of patients had abnormal findings including ankle effusion (34.8%), Doppler (synovitis) (32.6%),tenosynovitis (tendon girth) (28.3%) and plantar faciatis (4.3%) Conclusion:Musculoskeletal ultrasound and nerve conduction study should be used concomitantly to confirm the
diagnosis of tarsal tunnel syndrome in patients with rheumatoid arthritis.