Sural nerve entrapment after injury to the gastrocnemius: a case report

A 43-year-old man developed progressive calf pain and paresthesias after a strain of the right gastrocnemius muscle. Physical examination revealed sensory loss in the distribution of the sural nerve with a positive Tinel's sign in the posterior calf in the region of his previous injury. Electrodiagnostic studies revealed prolongation of the sural distal latency with reduction of the sensory nerve action potential amplitude. Magnetic resonance imaging of the lower right leg demonstrated abnormal signal in the right medial gastrocnemius consistent with a subacute hematoma. Surgical exploration revealed entrapment of the sural nerve in scar tissue beneath the deep fascia of the gastrocnemius. Surgical release of the nerve resulted in complete resolution of symptoms and full return of sensation by the 3-month follow-up point. A brief review of the literature is presented.