Superficial peroneal nerve entrapment in ankle sprain in childhood and adolescence

Traumatic injuries of the ankle are the most common injuries in sports. Up to 40% of patients who have undergone inversion ankle sprain report residual symptoms. The primary purpose of the study is to evaluate the incidence of SPN entrapment as consequence of acute severe inversion ankle sprain in children and adolescents; the secondary is to report the diagnostic pathway and the results after surgical treatment. From 2000 to 2015 were reviewed to summarize patients under the age of 15 years treated for a first episode of severe inversion ankle sprain. Cases with persistent symptoms (more than 3 months) indicative for SPN neuropathy were then identified. Instrumental investigations were recovered and a pre-operative assessment of pain (VAS) was recorded. Patients were evaluated at minimum of 1-year post-operative follow-up. 981 acute ankle sprains have been evaluated. 122 were considered severe according to van Dijk criteria. 5 patients were considered affected by neuropathy of the SPN. All patients underwent surgery consisting in neurolysis and capsular retention and ligament reconstruction. At 25 months of follow-up AOFAS moved from 57.6 to 98.6. The study highlights a previously unreported condition of perineural fibrosis of the superficial peroneal nerve at the level of the ankle following first acute severe inversion ankle sprain in children.

Traumatic Rupture and Herniation of the Peroneus Tertius Muscle Leading to Compartment Syndrome and Entrapment of the Superficial Peroneal Nerve: A Case Report

We present a patient with compartment syndrome and entrapment of the superficial peroneal nerve due to a direct hit to the lateral part of the right lower extremity. The diagnosis of evolving compartment syndrome was made without delay and the patient was quickly taken to the operating theater. Intraoperatively, the entrapment of the superficial peroneal nerve caused by rupture and herniation of the peroneus tertius muscle was surprisingly observed at the site, where the nerve pierces the anterior compartment. The nerve was successfully released in conjunction with fasciotomies of the anterior and lateral compartments. Meticulous diagnosis of compartment syndrome is critical to prevent ischemic injury to muscles and nerves. Recognition of anatomy and anatomical variations is important to prevent iatrogenic injury in unusual circumstances.

The Intraseptal Course of the Superficial Peroneal Nerve: An Anatomic Study

Background: Anatomic and clinical studies show many variants of the superficial peroneal nerve (SPN) course and branching within the compartments and at the suprafascial layer. The anatomy of the transition zone from the compartment to the subcutaneous layer has been occasionally described in the literature, mainly in studies reporting the intraseptal SPN variant in 6.6% to 13.6% of patients affected by the SPN entrapment syndrome. Despite the little evidence available, the knowledge of the transition zone is relevant to avoid iatrogenic lesions to the SPN during fasciotomy, open approaches to the leg and ankle, and SPN decompression. Our anatomic study aimed to describe the SPN transition site and to evaluate the occurrence of a peroneal tunnel and of an intraseptal SPN variant. Methods: According to the institutional ethics committee requirements, 15 fresh-frozen lower limbs were dissected to study the SPN course and its branching, focusing on the transition site to the suprafascial layer. Results: The SPN was located in the anterior compartment in 2 cases and in the lateral in 13. An intraseptal tunnel was present in 10 legs (66%), at a mean distance of 10.67 cm from the lateral malleolus. Its mean length was 2.63 cm. The tunnel allowed the passage of the main SPN in 8 cases and of its branches in two. In the remaining 5 legs (33%), the SPN pierced a crural fascia window. Conclusion: in our sample a higher rate than expected of intraseptal SPN variants was found. Clinical relevance: the knowledge of the anatomy of the SPN course and intraseptal variant is relevant to avoid iatrogenic lesions during operative dissection. Further studies are needed to evaluate the effective prevalence of an intraseptal tunnel, independently from the SPN entrapment syndrome, and how to avoid associated iatrogenic complications.

A Case of Schwannoma of the Lateral Aspect of the Superficial Peroneal Nerve

A schwannoma is a benign tumor with a neurogenic origin that affects peripheral nerves. It arises from the neural sheath of the peripheral nerves. We present a case of a 54-year-old woman who presented to our clinic with a painful schwannoma of her superficial peroneal nerve at the level of the ankle. The patient was treated with surgical excision, and diagnosis was confirmed with pathologic analysis.

Superficial peroneal nerve neuroma after syndesmotic stabilisation surgery

The ankle is a region crowded with multiple neurovascular and musculotendinous structures. We describe a case of a rare neurological complication following ankle surgery.

Post-COVID-19 multiple mononeuritis in a patient from a city in São Paulo

Context: COVID-19 is a disease capable of harming the entire organism, especially the lungs. It may lead to hospitalization in Intensive Care Units (ICU) and neurological conditions due to the possibility of development of myopathy in critically ill patients (MCIP) and even Multiple Mononeuritis (MM). That disorder presents itself with symmetrical lesions, significant disability, and no evidence of myopathy or demyelination in the electroneuromyography (ENM). Case report: We bring the case of a 57-year-old man with diabetes, systemic arterial hypertension, and dyslipidemia without previous neurological alterations. He was interned in ICU for 31 days because of a COVID-19 infection requiring mechanical ventilation and developed MM proven by ENM after hospital discharge. He presented as symptoms of incoordination, weakness, and gait ataxia. The patient’s ENM exam showed evidence of a reduction in the amplitude of the sensory potentials of all researched nerves and reductions in the values of sensitive nerve conduction on both median and sural nerves. It also exhibited an absence of sensitive response of the left superficial peroneal nerve, bilateral increase in the latency times of the H reflex, and absence of distal responses from both peroneal nerves. Conclusions: COVID-19 is a new entity, and it can cause neurological sequels. Even though MCIP is the primary neurological complication in ICU COVID patients, it is necessary to investigate the possibility of differentials like MM.