The Relative Contributions of the Medial Sural and Peroneal Communicating Nerves to the Sural Nerve

Abstract

The medial sural cutaneous nerve (MSCN) and peroneal communicating nerve (PCN) conjoin in the calf area to form the sural nerve (SN). In previous anatomic studies, there was unresolved debate as to the main contributor to the sural nerve, and the relative contributions of MSCN and PCN had not been studied. The purpose of this study is to determine their relative neurophysiologic contributions to the SN by nerve conduction study (NCS). A total of 47 healthy subjects (25 males and 22 females, mean age 29.6 ± 10.4 yrs, range 20-59 yrs) participated in the study. This study employed the orthodromic nerve conduction technique: stimulation at the ankle and recording at the mid calf (SN); specifically, we preformed stimulation at the mid calf (MSCN, PCN) and recording at 14 cm proximal to the middle of the popliteal fossa (MSCN) and fibular head (PCN). The onset and peak latencies (ms) were SN 2.3 ± 0.2 and 3.0 ± 0.2; MSCN 2.1 ± 0.2 and 2.8 ± 0.2; and PCN 2.1 ± 0.2 and 2.8 ± 0.2. The peak-to-peak amplitudes (µV) and areas (nVsec) of the SN, MSCN, and PCN were 9.7 ± 3.9, 7.0 ± 4.7, and 5.0 ± 3.2; and 7.2 ± 2.9, 5.7 ± 3.4, and 4.0 ± 2.4, respectively. The side-to-side difference was not statistically significant. The main contributor to the SN was found to be the MSCN. The relative contribution ratio of the MSCN to the PCN was 1.37:1 by amplitude and 1.42:1 by area. However, in 32.9% of the subjects, the contribution of the PCN was greater than that of the MSCN.

Anatomical variations of the sural nerve in the leg: A fetal study

“…[17] This has led to the suggestion to utilize the MSCN or PCB as a substitute for the SN in the above procedures to reduce complications. [18] However, if Type B, C, or D SN is present, as the majority of the SN in the present study, this would not be advantageous. Also, the great variability in the origin of the SN needs to be considered when the sural sensory nerve action potential is of low amplitude and disproportionate to the neurologic evaluation.…”

“…[4,6,15,[18][19][20] Some of these studies have shown a greater contribution from the MSCN [4,[18][19][20] while others authors have reported a more substantial contribution from the PCB. [6,15] In the present study, the relative dominance of the PCB contribution as compared to the MSCN was observed slightly more frequently.…”

Study of Sural Nerve Complex in Human Cadavers

“…He also suggested that the medial sural cutaneous nerve fibres are essential for the skin and deep structures of the ankle and heel rather than the skin of the lateral side of the fifth toe and he designated medial sural cutaneous nerve fibres as T fibres [ 20 ]. Kim et al studied the relative contribution of medial sural cutaneous nerve and peroneal communicating nerve to sural nerve by conduction study and showed that the main contributor to sural nerve was found to be the medial sural cutaneous nerve [ 9 ]. Many authors stated that medial sural cutaneous nerve takes a transmuscular course or is deeply embedded on the dorsal surface of gastrocnemius muscle.…”

Anatomical Variations in Formation of Sural Nerve in Adult Indian Cadavers

“…In the present study MSCN communicated with the PCN to form the sural nerve in 36 out of 50 cases. The relative contributions of the MSCN and the PCN to the sural nerve was reported by Kim CH et al, as MSCN was the main contributor to the SN and in 32.9% of subjects PCN was the main contributor [14].…”