Lower Extremity Nerve Decompression to Treat Complex Regional Pain Syndrome: A Case Report in Pediatric Age Group

Abstract

While much has been written about the persistence and symptoms of Complex Regional Pain syndrome, the role of peripheral nerve surgery as a treatment remains overlooked, especially in the lower extremity of the pediatric population. The purpose of this report is to describe the application of lower extremity peripheral nerve decompression to address specific injuries and entrapments, to provide meaningful relief and functional recovery in a pediatric patient with CRPS. A 14-year-old male presented with severe CRPS after several traumatic events involving the left lower extremity. After seeing 11 different physicians, failing physical therapy, and dropping out of high school, the patient was referred to a Peripheral Nerve Surgeon. On physical examination, multiple peripheral nerve entrapments were identified. The surgical approach included neurolysis of the tibial nerve at the soleal sling, a release of the four medial ankle tunnels, a neurolysis of the common peroneal nerve and lateral sural nerve at the fibular head, and a decompression of the saphenous nerve at the medial knee with the goal of treating multiple previously unrecognized peripheral nerve entrapments that had developed from the time of his injuries to his first consultation. At 1 year post-op, the patient reported full use of the extremity, a decrease in pain from 8 to 1. He had returned to physical activities and work, graduated from high school, and returned to the sport of fencing. He was off opiates. This report gives insight into how pain relief and functional restoration of lower extremity CRPS of a pediatric patient may be achieved by the same peripheral nerve approach to CRPS as in an adult patient.