Peroneal nerve entrapment at the fibular head: Outcomes of neurolysis

Mhiri, Riadh; Youssef, Mohamed; Lassoued, Nabil Ben; Sebai, Mohamed-Hedi; Essadam, H.

doi:10.1016/j.otsr.2013.05.004

Cited by 61 publications

(71 citation statements)

References 6 publications

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“…In 0-67% of operated PTEN patients no identifiable cause of their PN neuropathy could be found. [1][2][3][4] Similarly, the cause of PNEN in our patient was unknown although it produced severe intermittent claudication. Based on our observations, we suggest that in the absence of an obvious inciting event eliciting PN dysfunction, PNEN should be considered in patients with intermittent claudication.…”

Section: B Amentioning

confidence: 66%

“…3) Maalla et al 2) reported that in their PN decompression surgery series, half of their patients suffered only isolated sensory dysfunction while others manifested both sensory and motor dysfunction. The Tinel sign over the fibular head suggests PN compression and may warrant PN decompression surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Others reported that electrophysiological findings were useful for the diagnosis of PNEN and the identification of the neck of the fibula as the site of nerve compression 2,3,7) although Maalla et al 2) acknowledged that electrophysiological studies did not always detect PNEN anomalies; sensory potential amplitudes were decreased in 12-and motor conduction velocities in 7 of their 15 PNEN patients. Our patient suffered intermittent claudication and was unable to walk more than 100 m due to pain in the area of the PN.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical decompression of the common PN around the fibular head produces symptom abatement. [1][2][3][4] As the diagnosis of PNEN can be difficult, it tends to be misdiagnosed as lumbar spine disorder. We encountered a patient with intermittent claudication due to PNEN whose symptoms were improved by PN neurolysis.…”

Section: Introductionmentioning

confidence: 99%

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Repetitive Plantar Flexion (Provocation) Test for the Diagnosis of Intermittent Claudication due to Peroneal Nerve Entrapment Neuropathy: Case Report

Kim

Isu

Kokubo

et al. 2015

NMC Case Report Journal

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A 64-year-old male with diabetes mellitus had a history of abdominal surgeries due to gallstones and appendicitis. There was no identifiable cause of his PN palsy such as orthopedic procedures or leg trauma. Seven years earlier he suffered left leg-and low back pain for which he underwent two lumbar posterior decompression procedures at a local hospital. His lower limb pain decreased, however, numbness in the left L5 area persisted. Two years before admission to our hospital his left leg pain gradually reappeared. He was conservatively but unsuccessfully treated elsewhere with medications including nonsteroidal anti-inflammatory drugs, and later he came to our hospital.On admission, he reported numbness from the left lower thigh to the dorsum of the foot at rest. Walking exacerbated the symptoms and elicited pain in that area. He was unable to walk more than 100 m and experienced intermittent claudication. There was slight motor weakness of the ankle dorsiflexor at rest; it was gradually increased by walking and he stumbled easily. The Tinel sign test over the PN was not informative and lumbar magnetic resonance imaging (MRI) study showed adequate decompression of the left L5 root (Fig. 1). The clinical symptoms led us to suspect PNEN despite the absence of an identifiable cause at onset or of an obvious inciting event.We performed electrophysiological testing to measure the motor nerve conduction velocity (MNCV) of the PN. Stimulation applied proximal (head of the fibula) and distal (ankle) to the entrapment point elicited responses at the extensor digitorum brevis muscle. The MNCV proximal and distal to the entrapment point was 51.2 m/s, indicating that there was no conduction block on the PN in the at-rest position. He did not undergo electromyogram (EMG) or sensory nerve conduction (SNC) studies.His symptoms failed to improve under observation therapy and their severity affected his activities of daily living. To identify the origin of the intermittent symptoms we observed his ankle plantar flexion during walking. As a PNEN provocation test we also performed loading of the repetitive ankle plantar flexion in the at-rest position to avoid the lumbar factor (Fig. 2). His symptoms appeared reproducibly within 10 s of loading.Using a microscope and no proximal tourniquet, we performed left PN neurolysis under local anesthesia.5) We made a 3-cm oblique skin incision behind the fibular head and proceeded antero-inferiorly along the PN. This revealed the The diagnosis of peroneal nerve (PN) entrapment neuropathy (PNEN) is based on clinical symptoms and nerve conduction studies. However, these studies do not always detect PNEN. Our 64-year-old patient suffered persistent left L5 numbness after two lumbar surgeries. Two years before admission to our institute his left leg pain gradually reappeared. When walking, his numbness in the left lower thigh to the dorsum of the foot increased. Electrophysiological testing revealed no conduction block on the PN. To identify the origin of his intermittent symptoms we performed ...

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Section: B Amentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Repetitive Plantar Flexion (Provocation) Test for the Diagnosis of Intermittent Claudication due to Peroneal Nerve Entrapment Neuropathy: Case Report

Kim

Isu

Kokubo

et al. 2015

NMC Case Report Journal

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“…In general, the prognosis for a demyelinating lesion is much more favorable than for an axonal loss lesion [13]. The outcome is usually favorable if surgery is done within four months after first presentation of neurological deficits, and less favorable in patients who have neurological symptoms for longer than one year [1,14]. For irreparable CPN palsy, a tendon transfer procedure utilizing the tibialis posterior, first described in 1933 by Ober [15], with or without a combined transfer of the flexor digitorum longus is the method of choice for functional recovery of patients (Figure 2A-C) [16,17].…”

Section: Wwwijcasereportsandimagescommentioning

confidence: 99%