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The American Journal of Sports Medicine 1989In a practice involving large groups of athletes, seven runners and one soccer player with peroneal nerve compression neuropathy secondary to exercise have been found....
In a practice involving large groups of athletes, seven runners and one soccer player with peroneal nerve compression neuropathy secondary to exercise have been found. Running incited pain, numbness and tingling to varying degrees in all patients, and examination after running revealed muscle weakness and a positive percussion test as the nerve winds around the fibular neck. Nerve conduction velocity studies confirmed the diagnosis in the five patients on whom the test was performed; other studies served primarily to exclude other causes of pain. All patients were treated surgically by neurolysis of the peroneal nerve as it travels under the sharp fibrous edge of the peroneus longus origin. Seven of eight had excellent results and returned to their previous level of physical exertion without further symptoms. We think entrapment of the peroneal nerve at the fibular neck is a more common entity than previously recognized, and it should be considered in the differential diagnosis of exertional lateral leg pain.
Topics: Adult; Athletic Injuries; Diagnosis, Differential; Female; Humans; Male; Peroneal Nerve; Running
PubMed: 2757134
DOI: 10.1177/036354658901700224 -
Journal of Reconstructive Microsurgery Aug 2008Traumatic damage to the common peroneal nerve due to sharp injury, gunshot wound, sciatic nerve tumor, radiculopathy, or hip replacement surgery may result in foot drop....
Traumatic damage to the common peroneal nerve due to sharp injury, gunshot wound, sciatic nerve tumor, radiculopathy, or hip replacement surgery may result in foot drop. We present an alternative strategy for reanimation of foot drop following deep peroneal nerve palsy, successfully restoring voluntary movement. Fourteen consecutive patients with deep peroneal nerve injuries resulting in foot drop underwent nerve transfer of functional fascicles of either the superficial peroneal nerve or of the tibial nerve as donor for deep peroneal-innervated muscle groups. Eleven cases had successful restoration of British motor grade 3+ to 4+/5 ankle dorsiflexion, one case had restoration of grade 3 ankle dorsiflexion, and two cases had no restoration of dorsiflexion. Nerve transfer to the deep peroneal nerve is a feasible and effective method of treating deep peroneal nerve injuries of less than 1-year duration.
Topics: Adolescent; Adult; Aged; Female; Gait Disorders, Neurologic; Humans; Male; Middle Aged; Nerve Transfer; Peroneal Nerve; Peroneal Neuropathies
PubMed: 18680090
DOI: 10.1055/s-0028-1082894 -
Foot & Ankle International Sep 2021Anatomic and clinical studies show many variants of the superficial peroneal nerve (SPN) course and branching within the compartments and at the suprafascial layer. The...
BACKGROUND
Anatomic and clinical studies show many variants of the superficial peroneal nerve (SPN) course and branching within the compartments and at the suprafascial layer. The anatomy of the transition zone from the compartment to the subcutaneous layer has been occasionally described in the literature, mainly in studies reporting the intraseptal SPN variant in 6.6% to 13.6% of patients affected by the SPN entrapment syndrome. Despite the little evidence available, the knowledge of the transition zone is relevant to avoid iatrogenic lesions to the SPN during fasciotomy, open approaches to the leg and ankle, and SPN decompression. Our anatomic study aimed to describe the SPN transition site and to evaluate the occurrence of a peroneal tunnel and of an intraseptal SPN variant.
METHODS
According to the institutional ethics committee requirements, 15 fresh-frozen lower limbs were dissected to study the SPN course and its branching, focusing on the transition site to the suprafascial layer.
RESULTS
The SPN was located in the anterior compartment in 2 cases and in the lateral in 13. An intraseptal tunnel was present in 10 legs (66%), at a mean distance of 10.67 cm from the lateral malleolus. Its mean length was 2.63 cm. The tunnel allowed the passage of the main SPN in 8 cases and of its branches in two. In the remaining 5 legs (33%), the SPN pierced a crural fascia window.
CONCLUSION
In our sample a higher rate than expected of intraseptal SPN variants was found.
CLINICAL RELEVANCE
The knowledge of the anatomy of the SPN course and intraseptal variant is relevant to avoid iatrogenic lesions during operative dissection. Further studies are needed to evaluate the effective prevalence of an intraseptal tunnel, independently from the SPN entrapment syndrome, and how to avoid associated iatrogenic complications.
Topics: Ankle; Cadaver; Fasciotomy; Humans; Leg; Peroneal Nerve
PubMed: 34151593
DOI: 10.1177/10711007211002508 -
Clinical Orthopaedics and Related... Sep 2005Entrapment of the superficial peroneal nerve is an uncommon entrapment that occurs in sports trauma or fracture and dislocation as the nerve comes under pressure between...
UNLABELLED
Entrapment of the superficial peroneal nerve is an uncommon entrapment that occurs in sports trauma or fracture and dislocation as the nerve comes under pressure between the underlying muscles and the overlying fascia. Although the superficial peroneal nerve traditionally is depicted as being in the lateral compartment, we have found it in the anterior compartment in some patients. We hypothesized that patients with entrapment of the superficial peroneal nerve were more likely to have this anatomic variant than the normal population and that surgical decompression of both compartments would improve clinical outcome versus the historic surgical approach of decompressing just the lateral compartment. We retrospectively reviewed the location of the superficial peroneal nerve in a consecutive series of 35 limbs in 31 patients with entrapment of the superficial peroneal nerve. The results showed that the location of the superficial peroneal nerve was not different from the reported normal variation. However, the location of the superficial peroneal nerve in the anterior compartment in 47% of the patients in this series suggests that surgeons must explore the anterior and the lateral compartments in each patient with entrapment or neuroma of the superficial peroneal nerve.
LEVEL OF EVIDENCE
Therapeutic study, Level IV (case series-no, or historical, control group). See the Guidelines for Authors for a complete description of levels of evidence.
Topics: Evidence-Based Medicine; Fasciotomy; Genetic Variation; Humans; Nerve Compression Syndromes; Peroneal Nerve; Peroneal Neuropathies; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies
PubMed: 16131898
DOI: 10.1097/01.blo.0000169041.43495.58 -
The Journal of Arthroplasty Dec 2016The common peroneal nerve (CPN) is an important structure of the lower limb and is at risk of injury during total knee arthroplasty. The aim of this study was to use a...
BACKGROUND
The common peroneal nerve (CPN) is an important structure of the lower limb and is at risk of injury during total knee arthroplasty. The aim of this study was to use a tibial reference system to determine the position of the CPN relative to the knee center and popliteus.
METHODS
Two hundred consecutive knee magnetic resonance images at the level of a standard tibial arthroplasty cut were evaluated for (1) distance of the CPN from the posterolateral capsule; (2) angle of the CPN from the center of the tibial anteroposterior axis; and (3) location of CPN with respect to the popliteus.
RESULTS
The mean distance between the CPN and the posterolateral joint capsule was 11.9 mm (range, 4.7-22.13 mm), which correlated positively with the medial-lateral axis of the tibia (Pearson correlation, 0.157; P = .026) and negatively with the angle of the nerve from the midline (Pearson correlation, -0.237, P = .001). The mean angle of the nerve from the midline was 42.2° (range, 25.0°-64.0°). In 116 knees (58%), the CPN was in line with the popliteus from the center of the knee, in 69 knees (34.5%) the CPN was lateral to the popliteus, and in 15 knees (7.5%), the CPN was medial to the popliteus. A danger zone was identified as between 29.95° and 54.57° from the anteroposterior axis.
CONCLUSION
The CPN is at risk during total knee arthroplasty. This study describes a method to help predict the location of the CPN intraoperatively and therefore avoid direct injury.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anatomic Landmarks; Arthroplasty, Replacement, Knee; Female; Humans; Joint Capsule; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal; Peroneal Nerve; Reference Values; Tibia; Young Adult
PubMed: 27267229
DOI: 10.1016/j.arth.2016.05.005 -
The Knee Dec 2020The recurrent peroneal nerve (RPN) branches from the common peroneal nerve or the deep peroneal nerve and it innervates to the lower patellar region. It has recently...
BACKGROUND
The recurrent peroneal nerve (RPN) branches from the common peroneal nerve or the deep peroneal nerve and it innervates to the lower patellar region. It has recently been reported that damage to the RPN causes pain in the lower patellar region; therefore, this study examined the recurrent position and the innervation pattern of the RPN.
METHODS
Cases of knee deformity or atrophy were excluded, and 50 legs (25 males and 25 females) of 34 cadavers (15 males and 19 females) were examined to assess the recurrent position and the innervation pattern of the RPN.
RESULTS
The recurrent position of the RPN was 27.9 ± 3.6 mm from the tip of the fibula. The RPN innervated to the patellar tendon in five of the 50 legs (10%), to the infrapatellar fat pad in 13 legs (26%), and to both the patellar tendon and the infrapatellar fat pad in 20 legs (40%), and to neither the patellar tendon nor the infrapatellar fat pad in 12 legs (24%). No significant sex differences were observed in the recurrent position and the innervation pattern of the RPN.
CONCLUSIONS
In all cases, the recurrent position of the RPN was almost fixed from the tip of the fibula. The RPN frequently innervated to the patellar tendon or the infrapatellar fat pad (76%) in both males and females. These findings would be useful in knee surgery to preserve the RPN or for the diagnosis of pain in the lower patellar region.
Topics: Aged; Aged, 80 and over; Cadaver; Female; Humans; Knee Joint; Male; Middle Aged; Peroneal Nerve
PubMed: 33197816
DOI: 10.1016/j.knee.2020.09.012 -
Journal of Neuropathology and... Aug 2009Indications for nerve biopsy have decreased during the last 20 years. For the most part, this is a result of progress in the application of molecular biologic diagnostic... (Review)
Review
Indications for nerve biopsy have decreased during the last 20 years. For the most part, this is a result of progress in the application of molecular biologic diagnostic testing for genetic peripheral neuropathies (PNs) and the increasing use of skin biopsy. The latter is primarily used to evaluate small-fiber PN, although it rarely discloses the specific etiology of a PN. Nerve biopsies are usually performed on either the sural or the superficial peroneal nerve, the latter in combination with removal of portions of the peroneus brevis muscle. The definite diagnosis of vasculitic lesions can be readily established on small paraffin-embedded nerve biopsy samples, although in some cases, the characteristic lesions are only apparent in muscle specimens. Other nerve specimens are routinely fixed in buffered glutaraldehyde and prepared for semithin sections and electron microscopy; frozen specimens are used for immunofluorescence studies. Electron microscopy is of great value in some cases of chronic inflammatory demyelinating polyneuropathies, monoclonal gammopathy, and storage diseases. Because more than 30 genes may be involved in genetic PNs, analysis of nerve lesions can direct the search for mutations in specific genes. Electron microscopy immunocytochemistry is mandatory in some cases of monoclonal dysglobulinemia. Thus, nerve biopsy is still of value in specific circumstances when it is performed by trained physicians and examined in a laboratory with expertise in nerve pathology.
Topics: Biopsy; History, 20th Century; History, 21st Century; Humans; Microscopy, Electron; Muscles; Nervous System Diseases; Peroneal Nerve
PubMed: 19606069
DOI: 10.1097/NEN.0b013e3181af2b9c -
Clinical Anatomy (New York, N.Y.) Jan 2017The superficial fibular (peroneal) nerve (SFN) is one of the successive branches of the common fibular (peroneal) nerve and goes on to bifurcate into the medial dorsal... (Meta-Analysis)
Meta-Analysis Review
The superficial fibular (peroneal) nerve (SFN) is one of the successive branches of the common fibular (peroneal) nerve and goes on to bifurcate into the medial dorsal cutaneous (MDN) and intermediate dorsal cutaneous (IDN) nerves. The SFN is a main contributor to sensory innervation of the foot and lower leg. It varies widely in its penetrance of the deep (crural) fascia, and differences in its subsequent course can result in iatrogenic injuries. Articles on the prevalence of this anatomical variation were identified by a comprehensive database search. The data collected were extracted and pooled into a meta-analysis. A total of 14 articles (n = 665 lower limbs) were included on the meta-analysis of SFN variations in fascial piercing. The normal Type 1 variation, where the SFN pierces the deep fascia as a single entity and later bifurcates into the MDN and IDN, had a pooled prevalence of 82.7% (95%CI: 74.0-89.4). The Type 2 variant, where the SFN bifurcates early and then pierces the fascial layer separately as the MDN and IDN, had a pooled prevalence of 15.6% (95%CI: 8.9-23.6). Type 3, when the SFN penetrates the deep fascia and courses similar to the MDN with absent IDN was noted in 1.8% (95%CI: 0.0-4.9) of cases. A substantial portion of the population has a pattern of SFN piercing that deviates from the normal Type 1 anatomy. It is recommended that possible SFN variants in patients should be addressed thoroughly to help prevent iatrogenic injuries and postoperative complications. Clin. Anat. 30:120-125, 2017. © 2016 Wiley Periodicals, Inc.
Topics: Anatomic Variation; Fascia; Humans; Peroneal Nerve
PubMed: 27271092
DOI: 10.1002/ca.22741 -
Turkish Neurosurgery 2021This article presents the case of a 32-year-old female patient with schwannoma. The patient had swelling on the anterior aspect of her right foot for 1 year with...
This article presents the case of a 32-year-old female patient with schwannoma. The patient had swelling on the anterior aspect of her right foot for 1 year with increasing pain over the past 2 months. Moreover, a positive Tinel sign was present over the swelling. Magnetic resonance imaging revealed a large schwannoma mass in the deep peroneal nerve. Consequently, the patient?s large schwannoma was completely excised along with its capsule. Schwannomas are benign tumors of the peripheral nerves that rarely exhibit malignant transformation. Treatment is considered to be curative if complete resection is achieved.
Topics: Adult; Female; Humans; Magnetic Resonance Imaging; Neurilemmoma; Pain; Peripheral Nerves; Peroneal Nerve
PubMed: 34664701
DOI: 10.5137/1019-5149.JTN.34238-21.1 -
JBJS Case Connector Jan 2023An 18-year-old man sustained a peroneal nerve (PN) injury during an all-inside repair of the posterior horn of the lateral meniscus from the medial portal. Although he...
CASE
An 18-year-old man sustained a peroneal nerve (PN) injury during an all-inside repair of the posterior horn of the lateral meniscus from the medial portal. Although he could dorsiflex his ankle actively after emergence from general anesthesia, he had a foot drop on the day after surgery. Exploration of the PN at 5 months postoperatively revealed that the nerve was entrapped by the suture. Fifteen months after a nerve repair using a sural nerve graft, he recovered from the foot drop.
CONCLUSION
This case report highlights the risk of PN injury during an all-inside repair of the posterior horn of the lateral meniscus.
Topics: Male; Humans; Adolescent; Menisci, Tibial; Arthroscopy; Peroneal Neuropathies; Peroneal Nerve; Tibial Meniscus Injuries; Peripheral Nerve Injuries
PubMed: 36735799
DOI: 10.2106/JBJS.CC.22.00460