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far more common clinical problem, and once again does not provide anatomic localization to the tarsal tunnel In summary, con dent electrodiagnostic support for the tarsal tunnel syndrome is a rare electrodiagnostic event Prognostication for recovery in mononeuropathies is imprecise In general, mild de cits, younger age, fewer comorbidities, and less of a distance between the site of injury and the structure being innervated, increase the likelihood of a satisfactory outcome Electrodiagnostically, the demonstration of a predominantly demyelinating lesion in the absence of persistent nerve insult usually predicts a complete or near-complete recovery occurring over a period of 3 months or less In one study of femoral mononeuropathy, axon loss of >50% comparing the area of the femoral CMAP on the affected vs unaffected side predicted an incomplete recovery of quadriceps function137 The availability of MR imaging has greatly enhanced the value of imaging in the assessment of mononeuropathies MRI with the addition of gadolinium is the test of choice to identify a suspected nerve sheath tumor (Fig 22 11) MRI may also be used to identify an abnormal structure that is compressing and injuring a peripheral nerve such as an osteochondroma of the bular head or a Baker s cyst within the popliteal fossa Ultrasound can be useful in speci c circumstances Although usually addressed more readily by EDX, MRI can detect signal changes restricted to muscles that serve to de ne a pattern of denervation As previously mentioned, MRI can demonstrate enlargement and signal changes within the muscles of a given anatomic compartment that help to de ne a compartment syndrome Although immunemediated, in ammatory neuropathies are typically

To give your windows and buttons the Windows Classic look without changing personalized settings such as your wallpaper, you can select the Appearance tab instead of Themes; click the Windows and buttons drop-down list and select Windows Classic style

Figure 22 11 Enhancing, fusiform lesion of the distal sciatic nerve (schwannoma)

Figure 7-3

multifocal in nature and are rarely confused with the phenotypes of any of the disorders described in this chapter, these may initially present as a mononeuropathy As the involved segment of nerve may enhance with gadolinium, imaging has the potential to aid in this diagnosis as well

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Step 2 Changing the theme of your Windows XP interface doesn t change the way the Start menu works, which is signi cantly different from earlier versions of Windows The Start menu has the same functionality as in previous Windows versions, but it was restyled for XP As it does for the overall screen look, Windows XP enables you to change the Start menu to Classic mode, if you prefer it that way Before you can explore the XP style of Start menu, though, you need to know which style you re working with The following steps will ensure that your system is using the Windows XP Start menu style: a) Right-click the Start button and select Properties to display the Taskbar and Start Menu Properties dialog box b) Select the Start Menu tab c) Select the Start Menu radio button d) Click OK Click Start to open the Start menu Notice that the left side of the Start menu shows your recently used applications You can adjust the number of applications that Windows displays there The top two applications are the default Web browser and e-mail client, which you can also modify Follow these steps: a) Right-click the Start button, and select Properties b) Select the Start Menu tab c) Be sure the Start Menu radio button is selected, and click Customize d) Under the General tab (Figure 13-2), change any of the following settings if you like:

The management of mononeuropathy is dependent on the etiology, location, severity, and duration of nerve injury With rare exception, monophasic compressive nerve injuries are treated conservatively If it can be determined that a nerve injury is progressive and due to a de nable cause of external compression, the source of compression should be surgically altered or removed Surgical intervention in diabetics with mononeuropathies should be undertaken cautiously, as the already potentially compromised microvasculature may be further injured with nerve manipulation or transposition In case of trauma from clean penetrating injuries such as knife or glass wounds in which complete loss of function implicates potential nerve transaction, immediate exploration with attempted primary reanastomosis is considered If potential nerve transaction occurs from trauma associated with considerably surrounding tissue damage such as a gun shot wound, exploration is typically delayed for a month of more, assuming that there is no suggestion of recovery from either a clinical or an EDX perspective If the nerve is transected, nerve grafting will be required if anastomosis is attempted, as the retraction of the severed ends will prevent primary reanastomosis on a delayed basis If the nature of the injury makes nerve transaction unlikely, even in the setting of complete or near-complete nerve injury, surgical exploration is usually not attempted for at least 6 months If there is partial but convincing improvement measured either clinically or electrically, it is unlikely that surgical intervention will improve outcome If there is no evidence of improvement, exploration may be considered The goals in this case would be to perform nerve grafting if the nerve is transected, to identify and remove any external source of nerve compression (external neurolysis), and potentially to perform internal neurolysis The latter is considered if the epineurium is intact, but intraoperative nerve conductions indicate that there is no impulse transmission through the injured segment The intent is to dissect out individual fasicles and to potentially free them from any scarring that has taken place within the con nes of the epineurial sheath Alternatively if upon dissection, all fasicles are anatomically discontinuous despite preservation of epineurial continuity, a predictably rare event, nerve grafting may be attempted as part of the previous165 The outcome of surgical intervention for peripheral nerve injury is often disappointing The age of the patient, comorbid illnesses, and the distance between in-.

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