Prevalence of accessory deep peroneal nerve in referred patients to an electrodiagnostic medicine clinic

Abstract

BackgroundAccessory Deep Peroneal Nerve (ADPN) is an anatomic variation that can potentially cause disturbance in electrodiagnostic studies. This anomaly could be detected by nerve conduction studies. There are no recent updates about prevalence of this anatomic variation. Electrodiagnostic medicine clinic is the best environment for detecting presence and prevalence of this nerve, so present study enrolled.Materials & MethodsIn this cross sectional descriptive study that take place from March 2009 to July 2010, 230 cases comprising 460 legs referred for electrodiagnostic studies of upper limbs problems participated in the study. Compound muscle action potential (CMAP) and Nerve conduction Velocity (NCV) of Deep Peroneal Nerve (DPN) were measured by using EMG machine by stimulating DPN at knee, ankle and lateral malleolous areas accordingly, with recording from extensor digitorum brevis muscle. Results were analyzed and conclusion made.ResultsThe study population included 120 females (52%) and 110 (47%) males with mean age of 42.1 ± 13.5 years. ADPN was detected in 28 patients (12%). Among them,10(17.9%) had bilateral ADPN and in remained 18 cases (82.1%) APN was unilateral. In 8 patients there was no recorded CMAP from EDB by proximal and distal stimulation implying EDB agenesis. Gender distribution was similar which means half of the cases (14 patients) belonged to each gender.ConclusionThe prevalence of ADPN in this study was 12.2%, (17.9% bilateral and 82.1% unilateral).

Neurophysiological and clinical aspects of nerve communications of the upper and lower extremities

“…It was reported that ADPN was present in 12-35% of the popula- 58 . It was found that there is a wide variation of prevalence of ADPN among different studies [58][59][60][61][62][63] . One a meta-analysis study assessed the overall pooled ADPN prevalence of 18.8%, the electrophysiological pooled ADPN prevalence of 13.6%, and the anatomical pooled prevalence of 39.3% 63 .…”

“…Studying the ADPN can complicate the clinical picture and disturb the interpretation of the electrophysiological studies of common peroneal, deep peroneal, and superficial peroneal nerves lesions and injuries, as well as, ADPN neuropathy 54,57 . Namely, superficial peroneal nerve and its branches (including ADPN) are risk for iatrogenic damage while performing arthroscopy, local anesthetic block, surgical approach to the fibula, open reduction and internal fixation of lateral malleolar fractures, application of external fixators, elevation of a fasciocutaneous or fibular flaps for grafting, surgical decompression of neurovascular structures, or miscellaneous surgery on leg, foot and ankle 57,59 .…”

Innervation Anomalies and Interneural Anastomoses: Is There Clinical Relevance or Not?

“…The most prevalent anastomosis of lower limbs is additional deep fibular nerve (ADFN), which is formed from superficial peroneal nerve or its branch, which together with deep motor branch of common fibular nerve innervate flexor pedis and provides sensory innervation to the lateral part of the foot (Fig. 3) (34).…”

Overview of the Application of EMG Recording in the Diagnosis and Approach of Neurological Disorders

“…Abnormalities of its components are useful in the diagnostic evaluation of neurological disorders ( fig 5). Special recording techniques are required when significantly different CMAP amplitude is recorded between two nerve segments in order to rule out the presence of anatomical variants [41][42][43][44].…”