Peroneal Mononeuropathy

Peroneal Mononeuropathy

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Mononeuropathies are a form of peripheral neuropathy characterized by sensory disturbances and/or motor deficits in the distribution of the affected nerve. They can occur secondary to direct trauma, compression, stretch injury, ischemia, infection, or inflammatory disease. [1] In the lower extremity, peroneal neuropathy is the most common isolated mononeuropathy and the third most common mononeuropathy overall. Peroneal mononeuropathy may result in the clinical complaint of pain and sensory disturbances in the lateral lower limb and dorsal foot, and weakness of the ankle dorsiflexors and evertors. The peroneal nerve is also known as the superficial peroneal nerve and more recently the superficial fibular nerve. [2]

Compression and entrapment neuropathies are predominantly demyelinating.

Myelin loss results in slowing of the nerve conduction through the area involved.

When acute compression occurs, this may result in a conduction block. When the compression is more chronic, only slowing across the involved segment may be seen.

When compression is severe, ischemic changes occur that cause secondary axonal damage.

Pure demyelinating lesions typically have a better capacity to recover.

The pathophysiology of ischemic injuries and nerve transection is axonal damage. When axonal damage occurs, recovery is slower and longer and may not be complete.

This results in wallerian degeneration distally, and recovery requires the nerve to regenerate and reinnervate.

This process is slower than healing from other types of injuries and may not be complete.

Nerve conduction studies and electromyography (EMG) can aid in defining the lesion location and type.

Knowledge of peroneal nerve anatomy is essential to understanding the mechanism of its injury and to localizing the site of the lesion. [3]

The peroneal nerve is a division of the sciatic nerve, which splits at or slightly above the popliteal fossa to form the tibial and common peroneal nerves.

The common peroneal nerve extends anterolaterally to wind around the neck of the fibula.

At this level, the nerve is superficial, covered only by skin and subcutaneous tissue. Here, it is predisposed to direct compression.

The nerve then dives into the peroneus longus muscle, where tethering can occur, making it susceptible to stretch injury at this level.

The nerve then divides into the superficial and deep peroneal branches.

The superficial branch supplies the foot everters and sensation to the skin of the lateral calf and dorsum of the foot.

The deep peroneal branch supplies the foot and toe dorsiflexors and has a small sensory component, which innervates only the skin of the web space between the first and second toes.

No racial predilection is known.

No gender proclivity is known.

Peroneal mononeuropathy is uncommon in children but has been reported in all age groups.

Dancers are also prone to superficial and deep peroneal nerve entrapments. [4]

Common peroneal nerve decompression is a useful procedure to improve sensation and strength as well as to decrease pain. [5]

A retrospective study evaluated electrodiagnostic prognostic factors after peroneal nerve injury in 39 subjects. Outcome was associated with compound muscle action potential responses from extensor digitorum brevis and tibialis anterior: 81% of subjects with any tibialis anterior response and 94% with any extensor digitorum brevis response had a good outcome (at least 4 of 5 ankle dorsiflexion strength) compared with those with absent responses (46% and 52%, respectively). In addition, all patients with nontraumatic compression had a good outcome. [6]

Hobson-Webb LD, Juel VC. Common Entrapment Neuropathies. Continuum (Minneap Minn). 2017 Apr. 23 (2, Selected Topics in Outpatient Neurology):487-511. [Medline].

Bregman PJ, Schuenke M. Current Diagnosis and Treatment of Superficial Fibular Nerve Injuries and Entrapment. Clin Podiatr Med Surg. 2016 Apr. 33 (2):243-54. [Medline].

Tzika M, Paraskevas G, Natsis K. Entrapment of the superficial peroneal nerve: an anatomical insight. J Am Podiatr Med Assoc. 2015 Mar. 105 (2):150-9. [Medline].

Kennedy JG, Baxter DE. Nerve disorders in dancers. Clin Sports Med. 2008 Apr. 27 (2):329-34. [Medline].

Humphreys DB, Novak CB, Mackinnon SE. Patient outcome after common peroneal nerve decompression. J Neurosurg. 2007 Aug. 107(2):314-8. [Medline].

Kollrack YM, Möllenhoff G. [Exertional compartment syndrome of the lower leg and common peroneal nerve palsy as combined injury after weight lifting]. Sportverletz Sportschaden. 2009 Sep. 23(3):165-8. [Medline].

Kabayel L, Balci K, Turgut N, Kabayel DD. Development of entrapment neuropathies in acute stroke patients. Acta Neurol Scand. 2009 Jul. 120(1):53-8. [Medline].

Chan M, Campbell C, Lim RK. De novo footdrop resulting from an isolated acute repetitive strain injury. Pediatr Emerg Care. 2009 Feb. 25(2):102-4. [Medline].

Mnif H, Koubaa M, Zrig M, Zammel N, Abid A. Peroneal nerve palsy resulting from fibular head osteochondroma. Orthopedics. 2009 Jul. 32(7):528. [Medline].

Terrence Jose Jerome J. Superficial peroneal nerve lipoma. Rom J Morphol Embryol. 2009. 50(1):137-9. [Medline].

Bonnevialle P, Dubrana F, Galau B, Lustig S, Barbier O, Neyret P. Common peroneal nerve palsy complicating knee dislocation and bicruciate ligaments tears. Orthop Traumatol Surg Res. 2010 Feb. 96(1):64-9. [Medline].

O’Neill PJ, Parks BG, Walsh R, Simmons LM, Miller SD. Excursion and strain of the superficial peroneal nerve during inversion ankle sprain. J Bone Joint Surg Am. 2007 May. 89(5):979-86. [Medline].

Seyyed Hosseinzadeh HR, Eajazi A, Kazemi SM, Daftari Besheli L, Hassas Yeganeh M, Aydanloo A. Sudden peroneal nerve palsy in a varus arthritic knee. Orthopedics. 2009 Dec. 32(12):920-3. [Medline].

Weyns FJ, Beckers F, Vanormelingen L, Vandersteen M, Niville E. Foot drop as a complication of weight loss after bariatric surgery: is it preventable?. Obes Surg. 2007 Sep. 17(9):1209-12. [Medline].

Weber P, Rost B. [Anorexia nervosa and nervus peronaeus lesions]. Z Kinder Jugendpsychiatr Psychother. 2009 Sep. 37(5):469-72. [Medline].

Baker JF, Lui DF, Kiely PD, Synnott KA. Foot drop–an unusual presentation of exertional compartment syndrome. Clin J Sport Med. 2009 May. 19(3):236-7. [Medline].

Marcu D, Dunbar WH, Kaplan LD. Footdrop without significant pain as late presentation of acute peroneal compartment syndrome in an intercollegiate football player. Am J Orthop (Belle Mead NJ). 2009 May. 38(5):241-4. [Medline].

Liem NR, Bourque PR, Michaud C. Acute exertional compartment syndrome in the setting of anabolic steroids: an unusual cause of bilateral footdrop. Muscle Nerve. 2005 Jul. 32(1):113-7. [Medline].

Mckenna J, Ibrahim A. Isolated common peroneal nerve palsy in sarcoidosis. Ir Med J. 2008 Nov-Dec. 101(10):313-4. [Medline].

McKay G, Gill I, Chauhan S. Lyme disease: an unusual case of peripheral nerve palsy. J Bone Joint Surg Br. 2010 May. 92(5):713-5. [Medline].

Fukuda H. Bilateral peroneal nerve palsy caused by intermittent pneumatic compression. Intern Med. 2006. 45(2):93-4. [Medline].

Singhal A, Varma M, Goyal N, Vij V, Wadhawan M, Gupta S. Peroneal neuropathy following liver transplantation: possible predisposing factors and outcome. Exp Clin Transplant. 2009 Dec. 7(4):252-5. [Medline].

Kayal R, Katirji B. Atypical deep peroneal neuropathy in the setting of an accessory deep peroneal nerve. Muscle Nerve. 2009 Aug. 40(2):313-5. [Medline].

De Maeseneer M, Madani H, Lenchik L, Kalume Brigido M, Shahabpour M, Marcelis S, et al. Normal Anatomy and Compression Areas of Nerves of the Foot and Ankle: US and MR Imaging with Anatomic Correlation. Radiographics. 2015 Sep-Oct. 35 (5):1469-82. [Medline].

El Demellawy D, Bain J, Algawad H, Provias JP. Inflammatory pseudotumor of the peroneal nerve: case report and literature review. Ann Diagn Pathol. 2008 Feb. 12(1):44-7. [Medline].

Vieira RL, Rosenberg ZS, Kiprovski K. MRI of the distal biceps femoris muscle: normal anatomy, variants, and association with common peroneal entrapment neuropathy. AJR Am J Roentgenol. 2007 Sep. 189(3):549-55. [Medline].

Ersozlu S, Ozulku M, Yildirim E, Tandogan R. Common peroneal nerve palsy from an untreated popliteal pseudoaneurysm after penetrating injury. J Vasc Surg. Feb 2007. 45(2):408-10. [Medline].

Visser LH. High-resolution sonography of the common peroneal nerve: detection of intraneural ganglia. Neurology. 2006 Oct 24. 67(8):1473-5. [Medline].

Nodera H, Sato K, Terasawa Y, Takamatsu N, Kaji R. High-resolution sonography detects inflammatory changes in vasculitic neuropathy. Muscle Nerve. 2006 Sep. 34(3):380-1. [Medline].

Spinner RJ, Amrami KK, Angius D, Wang H, Carmichael SW. Peroneal and tibial intraneural ganglia: correlation between intraepineurial compartments observed on magnetic resonance images and the potential importance of these compartments. Neurosurg Focus. 2007 Jun 15. 22(6):E17. [Medline].

Aprile I, Tonali P, Caliandro P, Pazzaglia C, Foschini M, Di Stasio E, et al. Italian multicentre study of peroneal mononeuropathy: multiperspective follow-up. Neurol Sci. 2009 Feb. 30(1):37-44. [Medline].

Souter J, Swong K, McCoyd M, Balasubramanian N, Nielsen M, Prabhu VC. Surgical Results of Common Peroneal Nerve Neuroplasty at Lateral Fibular Neck. World Neurosurg. 2018 Apr. 112:e465-e472. [Medline].

Ozkan T, Tuncer S, Ozturk K, Aydin A, Ozkan S. Tibialis posterior tendon transfer for persistent drop foot after peroneal nerve repair. J Reconstr Microsurg. 2009 Mar. 25(3):157-64. [Medline].

Nath RK, Lyons AB, Paizi M. Successful management of foot drop by nerve transfers to the deep peroneal nerve. J Reconstr Microsurg. 2008 Aug. 24(6):419-27. [Medline].

Vigasio A, Marcoccio I, Patelli A, Mattiuzzo V, Prestini G. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin Orthop Relat Res. 2008 Jun. 466(6):1454-66. [Medline]. [Full Text].

Kennedy JG, Baxter DE. Nerve disorders in dancers. Clin Sports Med. 2008 Apr. 27(2):329-34. [Medline].

Campbell WW. Focal Neuropathies. Essentials of electrodiagnostic medicine. 1999. 255-278.

Katirji B. Peroneal neuropathy. Neurol Clin. 1999 Aug. 17(3):567-91, vii. [Medline].

Katirji B, Wilbourn AJ. High sciatic lesion mimicking peroneal neuropathy at the fibular head. J Neurol Sci. 1994 Feb. 121(2):172-5. [Medline].

Marciniak C, Armon C, Wilson J. Practice parameter: utility of electrodiagnostic techniques in evaluating patients with suspected peroneal neuropathy: an evidence-based review. Muscle Nerve. 2005 Apr. 31(4):520-7. [Medline].

Masakado Y, Kawakami M, Suzuki K, Abe L, Ota T, Kimura A. Clinical neurophysiology in the diagnosis of peroneal nerve palsy. Keio J Med. 2008 Jun. 57(2):84-9. [Medline].

Stewart JD. Foot drop: where, why and what to do?. Pract Neurol. 2008 Jun. 8(3):158-69. [Medline].

Turner OA, Taslitz N, Ward S. Common peroneal nerve entrapment. Handbook of peripheral nerve entrapments. 1990. 119-124.

Wilbourn AJ. AAEE case report #12: Common peroneal mononeuropathy at the fibular head. Muscle Nerve. 1986 Nov-Dec. 9(9):825-36. [Medline].

Williams FH, Johns JS, Weiss JM, et al. Neuromuscular rehabilitation and electrodiagnosis. 1. Mononeuropathy. Arch Phys Med Rehabil. 2005 Mar. 86(3 Suppl 1):S3-10. [Medline].

Ankle dorsiflexion and eversion

Toe extension

Ankle dorsiflexion and partial eversion > inversion

Toe extension

Shaheen E Lakhan, MD, PhD, MS, MEd Chief of Pain Management, Carilion Clinic and Virginia Tech Carilion School of Medicine

Shaheen E Lakhan, MD, PhD, MS, MEd is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Pain Society, International Association for the Study of Pain

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University in St Louis School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Alnylam Pharmaceuticals<br/>Received income in an amount equal to or greater than $250 from: Alnylam Pharmaceuticals; GLG.

Nicholas Lorenzo, MD, MHA, CPE Co-Founder and Former Chief Publishing Officer, eMedicine and eMedicine Health, Founding Editor-in-Chief, eMedicine Neurology; Founder and Former Chairman and CEO, Pearlsreview; Founder and CEO/CMO, PHLT Consultants; Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, MHA, CPE is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Aashit K Shah, MD, FAAN, FANA Professor and Associate Chair of Neurology, Director, Comprehensive Epilepsy Program, Program Director, Clinical Neurophysiology Fellowship, Detroit Medical Center, Wayne State University School of Medicine

Aashit K Shah, MD, FAAN, FANA is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Neurological Association

Disclosure: Received research grant from: Lundebck pharma.

Pinky Agarwal, MD Clinical Associate Professor, Department of Neurology, University of Washington School of Medicine; Attending Neurologist, Medical Director, Booth Gardner Parkinson’s Care Center

Pinky Agarwal, MD is a member of the following medical societies: American Academy of Neurology, International Parkinson and Movement Disorder Society

Disclosure: Nothing to disclose.

Alida Griffith, MD Movement Disorders Neurologist, Booth Gardner Parkinson’s Care Center

Disclosure: Nothing to disclose.

Peroneal Mononeuropathy

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