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sign at the exor retinaculum is uncertain As mentioned below, the prevalence of tarsal tunnel syndrome is controversial, its objective documentation frustrating, and its optimal management uncertain Sural mononeuropathies are uncommon other than as a consequence of nerve biopsy Sural neuropathies present with some combination of numbness, pain, or paresthesias on the lateral foot in the cutaneous distribution of the nerve Sural neuropathies are most commonly traumatic in etiology associated with ankle injury, surgery, or vein stripping procedures Schwannomas, ganglionic cysts, Baker cysts or their surgery, fracture of the base of the fth metatarsal, arthroscopic knee surgery, muscle biopsy of the calf, compression from the hard upper edges of ski boots, vasculitis, and idiopathic are other recognized causes163,164 Electrodiagnostic con rmation is readily obtained Pudendal neuropathy may result from pelvic and hip fractures, injection injuries, hemorrhage into piriformis, neoplastic invasion, surgical procedures, childbirth, or prolonged or inordinate pressure on perineum from ill- tting bicycle seats or pressure devices that may be used to reduce hip dislocations Recognition of pudendal neuropathy follows from sensory symptoms of the penis, scrotum, labia majora, and perineum, impotence, and fecal and urinary incontinence if bilateral

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EDX is the primary adjunctive diagnostic modality in the evaluation of the patient with a suspected lower extremity mononeuropathy The goals are to identify the existence of nerve injury if possible, localize the injury both to and within the course of an individual nerve, de ne the pathophysiology if possible, and, by doing so, estimate prognosis and aid in management decisions There are no reliable, routinely performed nerve conduction study techniques that assess the function of ilioinguinal, iliohypogastric, genitofemoral, pudendal, or posterior cutaneous nerve of the thigh In the appropriate clinical context, needle electromyographic evidence of denervation con ned to abdominal muscles supports but does not prove the existence of an ilioinguinal or iliohypogastric mononeuropathy Although it is theoretically possible to do an electromyographic evaluation of the cremaster muscle to support the diagnosis of a genitofemoral mononeuropathy, this is rarely if ever performed Needle electromyography of the external anal sphincter can be done but may be dif cult to interpret It res tonically, thereby making electrical silence dif cult to achieve and brillation potentials dif cult to detect The small motor unit action potentials that populate this muscle may also confound the detection of brillation potentials Sensory nerve conduction studies of the lateral cutaneous nerve of the thigh have been described and are

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