scholarly journals Congenital Entrapment of the Lateral Cutaneous Nerve of the Calf Presenting as a Peroneal Sensory Neuropathy

1998 ◽  
Vol 25 (2) ◽  
pp. 168-170 ◽  
Author(s):  
Daniel G. Hackam ◽  
Thomas J. Zwimpfer
Keyword(s):  
Peroneal Nerve ◽  
Sensory Neuropathy ◽  
Common Peroneal Nerve ◽  
Biceps Femoris ◽  
Popliteal Fossa ◽  
Cutaneous Nerve ◽  
Biceps Femoris Muscle ◽  
Normal Tendon ◽  
The Common ◽  
Lateral Cutaneous Nerve

ABSTRACT:Objective:Presentation of an unusual case of congenital entrapment of the lateral cutaneous nerve of the calf (LCNC) mimicking a peroneal sensory neuropathy.Methods:We report the case of a 16-year-old girl with a 3 year history of progressive tingling, numbness and pain in her right calf precipitated by athletic activities involving repeated flexion and extension of the knee. A Tinel's sign was present over the common peroneal nerve in the distal popliteal fossa but absent at the fibular neck. Motor and sensory examination of the common peroneal nerve was normal as were electrophysiological studies and MRI.Results:At surgery, the LCNC, a sensory branch of the common peroneal nerve, was entrapped at a point where it pierced the tendon of the biceps femoris muscle. Transection of the part of the tendon overlying the LCNC resulted in complete and permanent relief of symptoms.Significance and Conclusion:The proximal location of the Tinel's sign, absence of motor or sensory deficits and normal electrophysiology suggested, preoperatively, that this was not an entrapment of the common peroneal nerve at the fibular neck but rather a more proximal abnormality likely involving only a part of the peroneal nerve or one of its sensory branches. As a result, more proximal exposure of the peroneal nerve within the popliteal fossa revealed entrapment of the LCNC due to its anomalous course through the biceps femoris tendon. This case has two noteworthy features. It is a unique example of an entrapment neuropathy of the common peroneal nerve or one of its branches, due to a normal nerve piercing an otherwise normal tendon. Secondly, there are no previously reported cases of surgically documented compression of the LCNC in an otherwise normal patient (i.e., non-diabetic).

scholarly journals A Cadaveric Study of the Distal Biceps Femoris Muscle in relation to the Normal and Variant Course of the Common Peroneal Nerve: A Possible Cause of Common Peroneal Entrapment Neuropathy

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Jeong-Hyun Park ◽  
Jinseo Yang ◽  
Kwang-Rak Park ◽  
Tae Woo Kim ◽  
Taeyeong Kim ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Gastrocnemius Muscle ◽  
Common Peroneal Nerve ◽  
Biceps Femoris ◽  
Biceps Femoris Muscle ◽  
Distal Biceps ◽  
The Common ◽  
The Relationship ◽  
Femoris Muscle ◽  
Lateral Head

The most frequent mononeuropathy in the lower extremity has been reported as the common peroneal nerve entrapment neuropathy (CPNe) around the head and neck of the fibula, although the mechanism of the neuropathy in this area cannot be fully explained. Therefore, the aim of this cadaveric study was to evaluate the relationship between morphologic variations of the distal biceps femoris muscle (BFM) and the course of the common peroneal nerve (CPN) and to investigate the incidence and morphological characteristics of anatomical variations in the BFM associated with CPNe. The popliteal region and the thigh were dissected in 115 formalin-fixed lower limbs. We evaluated consensus for (1) normal anatomy of the distal BFM, (2) anatomic variations of this muscle, and (3) the relationship of the muscle to the CPN. Measurements of the distal extents of the short and long heads of the BFM from insertion (fibular head) were performed. Two anatomic patterns were seen. First, in 93 knees (80.8%), the CPN ran obliquely along the lateral side of the BFM and then superficial to the lateral head of the gastrocnemius muscle. Second, in 22 cases (19.2%), the CPN coursed within a tunnel between the biceps femoris and lateral head of the gastrocnemius muscle (LGCM). There was a positive correlation between the distal extents of the short heads of the biceps femoris muscle (SHBFM) and the presence of the tunnel. The “popliteal intermuscular tunnel” in which the CPN travels can be produced between the more distal extension variant of the SHBFM and the LGCM. This anatomical variation of BFM may have a clinical significance as an entrapment area of the CPN in the patients in which the mechanism of CPNe around the fibula head and neck is not understood.

scholarly journals The blood supply of the common peroneal nerve in the popliteal fossa

2005 ◽  
Vol 87-B (3) ◽  
pp. 337-342 ◽  
Author(s):  
R. K. Kadiyala ◽  
A. Ramirez ◽  
A.E. Taylor ◽  
C. L. Saltzman ◽  
M. D. Cassell
Keyword(s):  
Blood Supply ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Popliteal Fossa ◽  
The Common

scholarly journals Entrapment of Common Peroneal Nerve by Surgical Suture following Distal Biceps Femoris Tendon Repair

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Aki Fukuda ◽  
Akinobu Nishimura ◽  
Shigeto Nakazora ◽  
Ko Kato ◽  
Akihiro Sudo
Keyword(s):  
Peroneal Nerve ◽  
Surgical Repair ◽  
Tendon Repair ◽  
Common Peroneal Nerve ◽  
Biceps Femoris ◽  
Complete Removal ◽  
Distal Biceps ◽  
Surgical Suture ◽  
The Common ◽  
Biceps Femoris Tendon

We describe entrapment of the common peroneal nerve by a suture after surgical repair of the distal biceps femoris tendon. Complete rupture of the distal biceps femoris tendon of a 16-year-old male athlete was surgically repaired. Postoperative common peroneal nerve palsy was evident, but conservative treatment did not cause any neurological improvement. Reexploration revealed that the common peroneal nerve was entrapped by the surgical suture. Complete removal of the suture and external neurolysis significantly improved the palsy. The common peroneal nerve is prone to damage as a result of its close proximity to the biceps femoris tendon and it should be identified during surgical repair of a ruptured distal biceps femoris tendon.

scholarly journals sSural nerve: anatomical study and clinical aspects.

1969 ◽  
Vol 40 (3) ◽  
pp. 252-258
Author(s):  
José Luis Nieto ◽  
Enrique Vergara Amador ◽  
José Armando Amador
Keyword(s):  
Sural Nerve ◽  
Peroneal Nerve ◽  
Anatomical Study ◽  
Common Peroneal Nerve ◽  
Lateral Malleolus ◽  
Cutaneous Nerve ◽  
Clinical Aspects ◽  
Lateral Border ◽  
Communicating Branch ◽  
The Common

Introduction: An anatomical study of the sural nerve in 20 fresh cadavers was carried out, with the main aim of knowing the anatomy of the sural nerve and the relationships with the anatomical points to facilitate its identification in different clinical and surgical procedures. Materials and methods: From fresh cadavers with ages between 20 and 40 years and less than 48 hours of death, 20 legs were studied. Through a posterior incision the sural nerve was dissected from the popliteal region until the lateral malleolus, identifying the medial sural cutaneous nerve and the communicating branch of the common peroneal nerve. Measures were made in centimeters. Results: In 70% of the cases, the sural nerve was composed by the connection of the medial sural cutaneous nerve and the communicating branch of the common peroneal nerve and in 30% only by the medial sural cutaneous nerve. This branch was present in 100% of the cases. The communicating branch was present without connection with the medial sural cutaneous nerve in 15%, and in the other 15% this branch was absent. In 57% the nervous connection was proximal to the miotendinous union of the gastrocnemius The width of the miotendinous union of the gastrocnemius were between 5 to 8 cm (average 6.5 cm). The sural nerve was found 2.6 cm on average medial to the lateral border of the union. In the 6 cases of connection distal to the miotendinous union, the sural medial nerve passed 2 cm in average medial to the lateral border of the union, and the sural lateral to 0.8 cm medial of the same reference mentioned. Regarding the insertion of the Achilles’ tendon, the sural nerve passed 2.25 cm previous to the same and in relation to the most prominent and posterior part of the lateral malleolus it passed 2 cm in average. Discussion: This study showed that is possible to find the sural nerve with security if the anatomical points are identified well to preserve it in different surgeries or to harvest the flaps in neurological studies and harvesting it for grafting or nerve biopsy.

scholarly journals Level options for the formation and branching of the common peroneal nerve

2019 ◽  
Vol 21 (2) ◽  
pp. 160-165
Author(s):  
D M Isaev ◽  
A I Gaivoronsky ◽  
I V Gaivoronsky ◽  
I A Goryacheva
Keyword(s):  
Clinical Picture ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Average Value ◽  
Fibula Head ◽  
Examination Techniques ◽  
Surface Location ◽  
The Common ◽  
Lateral Cutaneous Nerve ◽  
Variant Anatomy

The study of topographic and anatomical features of the common peroneal nerve and its main branches was performed on 72 lower extremities of adult corpses. Morphoscopic and morphometric established that the higher the level of development of the common peroneal nerve, the greater the diameter, it has held more distance to the branch of the lateral cutaneous nerve of the calf. The average value of the diameter of the common peroneal nerve at the place of formation is10,1±2,8 mm. Differences in the level of development of the common peroneal nerve play an important role in the evaluation of the clinical picture of his injuries. In the «high» version of the formation, the probability of isolated damage to the common peroneal nerve is higher with trauma to the upper and middle third of the thigh. In this embodiment, the formation between the tibial and the common peroneal nerve revealed «anastomoses». Their presence helps to explain the possible dissonance between the clinical picture and the anatomical substrate of the lesion. It is shown that the lower the level of nerve formation, the greater the angle at which the nerve departs. The loose type of branching of the common peroneal nerve at the level of the head of the fibula does not allow adequate mobilization of the nerve in this area. This, in turn, does not allow intraoperatively overcome diastasis with nerve injury at the level of the fibula head. The surface location of the nerve, as well as its immobility in this place cause a high risk of compression-ischemic neuropathy. These features of the formation and variant anatomy of the common peroneal nerve explain a small percentage of favorable outcomes of surgical treatment of lesions of the common peroneal nerve and its main branches. The obtained morphometric data should be used as an indicator of the range of anatomical norms in the conduct of neuroimaging examination techniques (ultrasound, magnetic resonance) in the diagnosis of damage to the common peroneal nerve.

scholarly journals The level of the sciatic nerve division and its relations to the piriform muscle

2005 ◽  
Vol 62 (1) ◽  
pp. 45-49 ◽  
Author(s):  
Sladjana Ugrenovic ◽  
Ivan Jovanovic ◽  
Vladislav Krstic ◽  
Vesna Stojanovic ◽  
Ljiljana Vasovic ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Lower Extremities ◽  
Common Peroneal Nerve ◽  
Popliteal Fossa ◽  
Terminal Branch ◽  
Sacral Plexus ◽  
The Common ◽  
Popliteal Block

Background. The sciatic nerve, as the terminal branch of the sacral plexus, leaves the pelvis through the greater sciatic foramen beneath the piriform muscle. Afterwards, it separates into the tibial and the common peroneal nerve, most frequently at the level of the upper angle of the popliteal fossa. Higher level of the sciatic nerve division is a relatively frequent phenomenom and it may be the cause of an incomplete block of the sciatic nerve during the popliteal block anesthesia. There is a possibility of different anatomic relations between the sciatic nerve or its terminal branches and the piriform muscle (piriformis syndrome). The aim of this research was to investigate the level of the sciatic nerve division and its relations to the piriform muscle. It was performed on 100 human fetuses (200 lower extremities) which were in various gestational periods and of various sex, using microdissection method. Characteristic cases were photographed. Results. Sciatic nerve separated into the tibial and common peroneal nerve in popliteal fossa in 72.5% of the cases (bilaterally in the 66% of the cases). In the remainder of the cases the sciatic nerve division was high (27.5% of the cases) in the posteror femoral or in the gluteal region. Sciatic nerve left the pelvis through the infrapiriform foramen in 192 lower extremities (96% of the cases), while in 8 lower extremities (4% of the cases) the variable relations between sciatic nerve and piriform muscle were detected. The common peroneal nerve penetrated the piriform muscle and left the pelvis in 5 lower extremities (2.5% of the cases) and the tibial nerve in those cases left the pelvis through the infrapiriform foramen. In 3 lower extremities (1.5% of the cases) common peroneal nerve left the pelvis through suprapiriform, and the tibial nerve through the infrapiriform foramen. The high terminal division of sciatic nerve (detected in 1/3 of the cases), must be kept in mind during the performing of popliteal block anesthesia. Conclusion. Although very rare, anatomical abnormalities of common peroneal nerve in regard to piriform muscle are still possible.

scholarly journals Establishment of a Sheep Model for Hind Limb Peripheral Nerve Injury: Common Peroneal Nerve

2021 ◽  
Vol 22 (3) ◽  
pp. 1401
Author(s):  
Rui D. Alvites ◽  
Mariana V. Branquinho ◽  
Ana C. Sousa ◽  
Federica Zen ◽  
Monica Maurina ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Small Sample ◽  
Therapeutic Options ◽  
Nerve Injuries ◽  
Sheep Model ◽  
The Common

Thousands of people worldwide suffer from peripheral nerve injuries and must deal daily with the resulting physiological and functional deficits. Recent advances in this field are still insufficient to guarantee adequate outcomes, and the development of new and compelling therapeutic options require the use of valid preclinical models that effectively replicate the characteristics and challenges associated with these injuries in humans. In this study, we established a sheep model for common peroneal nerve injuries that can be applied in preclinical research with the advantages associated with the use of large animal models. The anatomy of the common peroneal nerve and topographically related nerves, the functional consequences of its injury and a neurological examination directed at this nerve have been described. Furthermore, the surgical protocol for accessing the common peroneal nerve, the induction of different types of nerve damage and the application of possible therapeutic options were described. Finally, a preliminary morphological and stereological study was carried out to establish control values for the healthy common peroneal nerves regarding this animal model and to identify preliminary differences between therapeutic methods. This study allowed to define the described lateral incision as the best to access the common peroneal nerve, besides establishing 12 and 24 weeks as the minimum periods to study lesions of axonotmesis and neurotmesis, respectively, in this specie. The post-mortem evaluation of the harvested nerves allowed to register stereological values for healthy common peroneal nerves to be used as controls in future studies, and to establish preliminary values associated with the therapeutic performance of the different applied options, although limited by a small sample size, thus requiring further validation studies. Finally, this study demonstrated that the sheep is a valid model of peripheral nerve injury to be used in pre-clinical and translational works and to evaluate the efficacy and safety of nerve injury therapeutic options before its clinical application in humans and veterinary patients.

Displacement of the common peroneal nerve in posterolateral corner injuries of the knee

2005 ◽  
Vol 87-B (9) ◽  
pp. 1225-1226 ◽  
Author(s):  
N. Bottomley ◽  
A. Williams ◽  
R. Birch ◽  
A. Noorani ◽  
A. Lewis ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Posterolateral Corner ◽  
The Common

scholarly journals Dynamic neuropathy of the common peroneal nerve at the level of the fibular head (literature review and case report)

2019 ◽  
Vol 21 (1) ◽  
pp. 54-59
Author(s):  
M. G. Bashlachev ◽  
G. Yu. Evzikov ◽  
V. A. Parfenov ◽  
N. B. Vuitsyk ◽  
F. V. Grebenev
Keyword(s):  
Ankle Joint ◽  
Peroneal Nerve ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Common Peroneal Nerve ◽  
Diagnostic Methods ◽  
Fibular Head ◽  
Study Objective ◽  
The Common ◽  
The Right

The study objective is to report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head and to discuss diagnostic methods and neurosurgical treatment. Materials and methods. We report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head in a female patient. The patient was treated in the Neurology Clinic of I.M. Sechenov First Moscow State Medical University. We analyzed clinical manifestations and compared them with the data described in research literature. Results. Upon admission, the patient complained of pain in the anterolateral surface of the right shin and in the dorsum of the foot during walking. At rest, the patient experienced no pain. We observed no motor or sensory disorders typical of nerve root disorders at the level of L5. Lasegue’s test was negative. The patient had a positive Tinel’s sign in the area of the right fibular head. In order to clarify the diagnosis, we performed a repeated extension test in the right ankle joint and it was positive. The patient underwent surgery that included peroneal nerve decompression and neurolysis at the level of the fibular head. In the postoperative period, the patient had complete pain relief. Conclusion. Due to the difficulties in the diagnostics of dynamic neuropathy of the common peroneal nerve, this disease is often mistaken for radiculopathy at the level of L5. Thorough clinical examination, testing for Tinel’s sign in the area of the fibular head, and repeated extension test in the ankle joint ensure the correct diagnosis and reduce the frequency of ineffective surgeries on the lumbar spine. Surgical decompression of the common peroneal nerve at the level of the fibular head with obligatory opening of the entrance to the nerve canal is an effective method of treatment in such patients.

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