echemi logo
Product
  • Product
  • Supplier
  • Inquiry
    Home > Active Ingredient News > Study of Nervous System > Baxter nerve impingement MR diagnosis which is easy to be misdiagnosed (with classic schematic diagram at a glance)

    Baxter nerve impingement MR diagnosis which is easy to be misdiagnosed (with classic schematic diagram at a glance)

    • Last Update: 2021-12-01
    • Source: Internet
    • Author: User
    Search more information of high quality chemicals, good prices and reliable suppliers, visit www.echemi.com

    Heel pain is a common clinical symptom.
    The differential
    diagnosis includes plantar fasciitis, fat pad atrophy, calcaneal stress fracture or osteoporosis , inflammatory arthritis, tumor, and infection
    .
    One of the more elusive diagnostic factors in heel pain is the compression of the first branch of the lateral plantar nerve (Baxter's nerve impingement)

    .
    Baxter's nerve is a mixed nerve of sensory and motor, which provides motor transmission for Abductor digiti minimi (AbDM)

    .
    Baxter's nerve entrapment can produce clinical symptoms that are indistinguishable from plantar fasciitis.
    Although it is seen in 20% of patients with heel pain, other causes of heel pain are often overlooked

    .
    The abductor digitorum (AbDM) may have lesions, but it is difficult to detect clinically

    .
    MR can be used to detect muscle changes related to innervation in the abductor digitorum (AbDM), thereby confirming the diagnosis of Baxter's nerve entrapment

    .

    Heel pain is a common clinical symptom.
    The differential
    diagnosis includes plantar fasciitis, fat pad atrophy, calcaneal stress fracture or osteoporosis , inflammatory arthritis, tumor, and infection
    .
    One of the more elusive diagnostic factors in heel pain is the compression of the first branch of the lateral plantar nerve (Baxter's nerve impingement)

    .
    Baxter's nerve is a mixed sensory and motor nerve, which provides motor transmission for the abductor digiti minimi (Abductor digiti minimi, AbDM)

    .
    Baxter's nerve entrapment can produce clinical symptoms that are indistinguishable from plantar fasciitis.
    Although it is seen in 20% of patients with heel pain, other causes of heel pain are often overlooked

    .
    The abductor digitorum (AbDM) may have lesions, but it is difficult to detect clinically

    .
    MR can be used to detect muscle changes related to innervation in the abductor digitorum (AbDM), thereby confirming the diagnosis of Baxter's nerve entrapment

    .
    Diagnose osteoporosis infection

    Anatomy:

    Anatomy: Anatomy:

    The two terminal branches of the tibial nerve are the medial plantar nerve and the lateral plantar nerve.
    The skin branches of the medial plantar nerve are distributed in the skin of the inner plantar, and the skin of the lateral plantar nerve innervates the skin on the outer plantar.
    This nerve is the sensory branch of the little toe and the outer fourth toe, which innervates the movement of the abductor digitorum and quadratus plantar muscle

    .

    The two terminal branches of the tibial nerve are the medial plantar nerve and the lateral plantar nerve.
    The skin branches of the medial plantar nerve are distributed in the skin of the inner plantar, and the skin of the lateral plantar nerve innervates the skin on the outer plantar.
    This nerve is the sensory branch of the little toe and the outer fourth toe, which innervates the movement of the abductor digitorum and quadratus plantar muscle

    .

    Baxter's nerve (Baxter nerve) is the first branch of the lateral plantar nerve, also known as the inferior calcaneus nerve, which innervates the abductor digitorum muscle (AbDM)
    .

    Baxter's nerve (Baxter nerve) is the first branch of the lateral plantar nerve, also known as the inferior calcaneus nerve, which innervates the abductor digitorum muscle (AbDM)
    .

    Lateral plantar nerve: Lateral plantar nerve (LPN)

    Lateral plantar nerve: Lateral plantar nerve (LPN)
    Lateral plantar nerve (LPN)

    Medial plantar nerve: Medial plantar nerve (MPN)

    Medial plantar nerve: Medial plantar nerve (MPN) Medial plantar nerve (MPN)

    Abductor digiti minimi: Abductor digiti minimi (AbDM)

    Abductor minor digiti: Abductor digiti minimi (AbDM) Abductor minor digiti: Abductor digiti minimi (AbDM)

     

    pathology:

    Pathology: Pathology:

    Baxter nerve entrapment is common in two places (see picture below)
    .

    Baxter nerve entrapment is common in two places (see picture below)
    .

    Baxter nerve entraps two potential sites (in the oval circle):

    Two potential parts of Baxter nerve compression (in the oval circle): Two potential parts of Baxter nerve compression (in the oval circle):

    1.
    When the nerve passes through the deep fascia of the abductor muscle ( AH ) and the medial plantar edge of the quadratus plantar muscle ( QP )
    .

    1.
    When the nerve passes through the deep fascia of the abductor muscle ( AH ) and the medial plantar edge of the quadratus plantar muscle ( QP )
    .
    1.
    When the nerve passes between the deep fascia of the abductor muscle ( AH ) and the medial plantar edge of the quadratus plantar muscle ( QP )
    .

    2.
    When the more distal nerve passes along the anterior part of the medial tuberosity of the calcaneus, the plantar calcaneal attachment point and plantar fasciitis may cause compression
    .

    2.
    When the more distal nerve passes along the anterior part of the medial tuberosity of the calcaneus, the plantar calcaneal attachment point and plantar fasciitis may cause compression
    .
    2.
    When the more distal nerve passes along the anterior part of the medial tuberosity of the calcaneus, the plantar calcaneal attachment point and plantar fasciitis may cause compression
    .

     

     


    According to reports in the literature, risk factors for Baxter nerve involvement include
    advanced age, calcaneal bone hyperplasia, plantar fasciitis, plantar masses, thickened blood vessels , muscle enlargement (such as athletes), obesity, and foot varus
    .


    According to reports in the literature, risk factors for Baxter nerve involvement include
    advanced age, calcaneal bone hyperplasia, plantar fasciitis, plantar masses, thickened blood vessels , muscle enlargement (such as athletes), obesity, and foot varus
    .
    Senior citizens, calcaneus osteoarthritis, plantar fasciitis, plantar tumor, blood vessel thickening, muscle enlargement (such as athletes), obesity and foot within the vessel turned

     

     

    Imaging performance:

    Imaging performance: Imaging performance:


    MRI has proven to be very valuable to show denervated muscle-related changes; compared with ultrasound or CT, MRI is more sensitive to changes in the tissues in the muscle; and has advantages compared with electromyography, because MRI examinations Non-invasive, superior anatomical details, can show the pathological changes of the muscles with dual innervation, and can rule out other diagnoses (fractures, tumors, fasciitis)

    .
    The normal abductor digitorum muscle shows isointensity on T1WI and fluid sensitivity sequence (red arrow in the figure below)

    .


    MRI has proven to be very valuable to show denervated muscle-related changes; compared with ultrasound or CT, MRI is more sensitive to changes in the tissues in the muscle; and has advantages compared with electromyography, because MRI examinations Non-invasive, superior anatomical details, can show the pathological changes of the muscles with dual innervation, and can rule out other diagnoses (fractures, tumors, fasciitis)

    .
    The normal abductor digitorum muscle shows isointensity on T1WI and fluid sensitivity sequence (red arrow in the figure below)

    .


    Acute and subacute muscle denervation are best assessed by fluid-sensitive sequences, such as T2WI images with fat suppression (T2 FS) or short tau reversal recovery (STIR) images.
    Compared with normal muscles, the muscle abdominal The increased signal is related to neurogenic muscle edema.
    The enhanced scan occurs in the acute to subacute stage of denervation; in the case of Baxter nerve compression, according to the patient’s innervation anatomy, muscle edema will be selectively in the abductor digitorum (AbDM) occurs internally, and may also occur in the flexor digitorum brevis and quadratus plantar muscle; obvious muscle atrophy and fatification can be seen in the chronic phase

    .


    Acute and subacute muscle denervation are best assessed by fluid-sensitive sequences, such as T2WI images with fat suppression (T2 FS) or short tau reversal recovery (STIR) images.
    Compared with normal muscles, the muscle abdominal The increased signal is related to neurogenic muscle edema.
    The enhanced scan occurs in the acute to subacute stage of denervation; in the case of Baxter nerve compression, according to the patient’s innervation anatomy, muscle edema will be selectively in the abductor digitorum (AbDM) occurs internally, and may also occur in the flexor digitorum brevis and quadratus plantar muscle; obvious muscle atrophy and fatification can be seen in the chronic phase

    .

    T1 image muscle showed isosignal (asterisk) and no atrophy; suppressed T2 image showed muscle edema of the abductor digitorum (arrow) and flexor digitorum brevis (arrow)
    .

    T1 image muscle showed isosignal (asterisk) and no atrophy; suppressed T2 image showed muscle edema of the abductor digitorum (arrow) and flexor digitorum brevis (arrow)
    .
    T1 image muscle showed isosignal (asterisk) and no atrophy; suppressed T2 image showed muscle edema of the abductor digitorum (arrow) and flexor digitorum brevis (arrow)
    .

     


     Coronal abductor of the little toe of a patient suffering from severe atrophy and fatty infiltration of T1WI and suppression PDWI image, due to chronic Baxter nerve involvement selectively involving the abductor of the little toe; signal strength of the abductor of the little toe (arrow) with similar There is no obvious muscle edema in adjacent subcutaneous fat
    .


     Coronal abductor of the little toe of a patient suffering from severe atrophy and fatty infiltration of T1WI and suppression PDWI image, due to chronic Baxter nerve involvement selectively involving the abductor of the little toe; signal strength of the abductor of the little toe (arrow) with similar There is no obvious muscle edema in adjacent subcutaneous fat
    .
    Coronal abductor of the little toe of a patient suffering from severe atrophy and fatty infiltration of T1WI and suppression PDWI image, due to chronic Baxter nerve involvement selectively involving the abductor of the little toe; signal strength of the abductor of the little toe (arrow) with similar There is no obvious muscle edema in adjacent subcutaneous fat .

     


    The transverse T1WI and coronary fat suppression PDWI images of another patient with chronic Baxter nerve compression showed severe diffuse atrophy and fatty infiltration of the abductor digitorum (arrow) .



    The transverse T1WI and coronary fat suppression PDWI images of another patient with chronic Baxter nerve compression showed severe diffuse atrophy and fatty infiltration of the abductor digitorum (arrow) .


    The transverse T1WI and coronary fat suppression PDWI images of another patient with chronic Baxter nerve compression showed severe diffuse atrophy and fatty infiltration of the abductor digitorum (arrow) .


     


    The initial treatment of Baxter nerve compression is usually conservative treatment, including a combination of rest, non-steroidal anti-inflammatory drugs, corticosteroid injections, and orthotics

    .
    If persistent pain persists after conservative treatment, surgery can be performed

    .


    The initial treatment of Baxter nerve compression is usually conservative treatment, including a combination of rest, non-steroidal anti-inflammatory drugs, corticosteroid injections, and orthotics

    .
    If persistent pain persists after conservative treatment, surgery can be performed

    .

    in conclusion:

    Conclusion: Conclusion:


    Baxter nerve compression is a clinically difficult diagnosis and is often overlooked in the manifestations of heel pain

    .
    MRI can evaluate the denervation effect of nerve compression by identifying abnormalities in the abdomen of the abductor digitorum (AbDM) muscle

    .
    In addition, potential causes of impact (eg calcaneal spurs, soft tissue masses, vasodilatation) and related pathologies (eg plantar fasciitis, tendinopathy) can be found, and other differential diagnoses (eg stress fractures) can be ruled out

    .


    Baxter nerve compression is a clinically difficult diagnosis and is often overlooked in the manifestations of heel pain

    .
    MRI can evaluate the denervation effect of nerve compression by identifying abnormalities in the abdomen of the abductor digitorum (AbDM) muscle

    .
    In addition, potential causes of impact (eg calcaneal spurs, soft tissue masses, vasodilatation) and related pathologies (eg plantar fasciitis, tendinopathy) can be found, and other differential diagnoses (eg stress fractures) can be ruled out

    .


    Leave a message here
    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

    Contact Us

    The source of this page with content of products and services is from Internet, which doesn't represent ECHEMI's opinion. If you have any queries, please write to service@echemi.com. It will be replied within 5 days.

    Moreover, if you find any instances of plagiarism from the page, please send email to service@echemi.com with relevant evidence.