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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 6,
814-816.
doi: 10.1302/0301-620X.89B6.19077 Copyright © 2007 by British Editorial Society of Bone and Joint Surgery Schwannoma of the posterior tibial nerveTHE PROBLEM OF DELAY IN DIAGNOSISD. H. Nawabi, MA, MRCS (Eng), Specialist Registrar in Orthopaedic Surgery, Percival Pott Rotation (London)1; and M. Sinisi, MD, Consultant Peripheral Nerve Surgeon11 Peripheral Nerve Injury Unit, The Royal National, Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK. Correspondence should be sent to Mr M. Sinisi; e-mail: danyalnawabi{at}gmail.com
Schwannomas are the most common tumours of the sheath of peripheral nerves. The clinical diagnosis is usually straightforward, but may be delayed for many years in a schwannoma of the posterior tibial nerve. The symptoms are often attributed to entrapment neuropathy or to lumbosacral radiculopathy. We describe 25 patients with a schwannoma of the posterior tibial nerve. Only three were diagnosed within a year of presentation. The mean time to diagnosis was 86.5 months with a median of 48 months (2 to 360). All the patients complained of pain, which was felt specifically in the sole of the foot in 18. A Tinel sign was detected in all 25 patients. MRI confirmed the diagnosis in all the cases in which it had been undertaken. Surgical resection of the lesion abolished the neuropathic pain. In patients with a long history of neuropathic pain in the lower limb in whom lumbar and pelvic lesions have been excluded, a benign tumour of the sheath of a peripheral nerve may explain the symptoms. Surgical resection of the tumour is safe and effective. This article has been cited by other articles:
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