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Scratch Collapse Test and Patient-Reported Outcomes After Lower Extremity Nerve Decompression Surgery
Syeda Hoorulain Ahmed1, Ramin Shekouhi1, Syed Ali Haider1
1Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
Introduction:
Entrapment neuropathies of the lower extremity are uncommon, frequently misdiagnosed or diagnosed late, and have no well-established diagnostic protocol. The scratch collapse test (SCT) has been described for carpal and cubital tunnel syndrome and, in the lower extremity, has been evaluated only for common peroneal nerve compression; whether it can localize uncommon or multiple sites of lower extremity nerve compression, and how it compares with Tinel's sign at those sites, is unknown. This study evaluates the feasibility of the SCT for localizing the site of nerve compression and describes functional and patient-reported outcomes (PROMs) in a cohort undergoing lower extremity nerve decompression (LEND).
Methods:
Forty-five consecutive patients who underwent LEND surgery were reviewed. Patients were assessed using standardized PROMs, including Visual Analog Scale (VAS), Patient Satisfaction Scale (PSS), Norfolk QOL-DN questionnaire, Lower Extremity Functional Scale (LEFS), and Michigan Neuropathy Screening Instrument (MNSI). Data were analyzed using t-tests and linear regression models.
Results:
Ten compression sites were identified across 45 patients, most commonly the common peroneal (19, 42.2%), superficial peroneal (17, 37.8%), and tibial (13, 28.9%) nerves. The SCT was positive in all 45 patients and Tinel's sign in 38 (84.4%). Postoperatively, sensory deficits improved in 73.3% of patients and muscle weakness in 35.6%. Among the 10 patients with paired clinical pain scores, pain improved from 8.9 ± 1.8 to 4.3 ± 3.5 (p = 0.003). Postoperative PROMs, available for 18 patients (40.0%), showed a mean VAS of 4.8 ± 2.8, PSS 3.6 ± 1.6, Norfolk QOL-DN 38.1 ± 29.5, LEFS 47.5 ± 24.5, and MNSI 5.2 ± 3.2.
Conclusions:
The SCT is a feasible bedside adjunct for localizing common and uncommon sites of lower extremity nerve compression. In the absence of a control group or independent reference standard, these findings reflect feasibility and clinical utility rather than diagnostic accuracy.
