Normative Reference Values of the Tibial Nerve in Healthy Individuals Using Ultrasonography: A Systematic Review and Meta-Analysis

Author:

Senarai Thanyaporn1,Suwannakhan Athikhun23ORCID,Pratipanawatr Thongchai4,Yammine Kaissar56,Yurasakpong Laphatrada23,Sathapornsermsuk Tanapat7,Janta Sirorat8ORCID,Kittiboonya Achiraya9

Affiliation:

1. Microscopy Unit, Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand

2. Department of Anatomy, Faculty of Science, Mahidol University, Bangkok 10400, Thailand

3. In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok 10400, Thailand

4. Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand

5. Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center—Rizk Hospital, Beirut 11-3288, Lebanon

6. The Center for Evidence-Based Anatomy, Sports and Orthopedic Research, Lebanese American University, Byblos 1102-2801, Lebanon

7. Mahidol University International College, Salaya, Nakhon Pathom 73170, Thailand

8. Anatomy Unit, Department of Medical Science, Faculty of Science, Rangsit University, Pathumthani 12000, Thailand

9. Centre for Anatomy and Human Identification (CAHID), School of Science and Engineering, University of Dundee, Dundee DD1 4HN, UK

Abstract

Background: High-resolution ultrasound of the tibial nerve has been used for screening of several neurologic disorders, but normative reference values of tibial nerve cross-sectional areas (CSA) have not been well established. Thus, the present meta-analysis was performed to generate normative estimates of tibial nerve CSA at various sites of the lower limb based on ultrasonography. Methods: Google Scholar, Scopus and PubMed were searched for potential studies. Studies were required to report tibial nerve CSA in healthy individuals to be included. A random-effect meta-analysis was performed to calculate tibial nerve CSA values. Subgroup and statistical analyses were performed to study covariates. Results: Forty-eight eligible articles consisting of 2695 limbs were included. The average tibial nerve CSA was found to be 10.9 mm2 at the ankle (95% CI: 9.9–11.8) and should not exceed 11.8 mm2 in healthy adults. At the popliteal fossa, the overall CSA was 21.7 mm2 (95% CI: 17.5–25.8) in healthy adults. At both sites, the average tibial nerve CSA was significantly larger in adults than in children, and the differences by geographical region were not statistically significant. At the ankle, tibial nerve CSA increased with age and body mass index, while at the popliteal fossa it increased with age and weight. Conclusions: our findings indicate that the tibial nerve varied not only along its course but also among sub-variables. Establishing normal references values of tibial nerve CSA is helpful to differentiate healthy from diseased tibial nerves such as in diabetic peripheral neuropathy or tarsal tunnel syndrome.

Funder

Faculty of Medicine at Khon Kaen University, Thailand

Publisher

MDPI AG

Subject

General Medicine

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