1
|
Ishii M, Nishimura Y, Hara M, Yamamoto Y, Nagashima Y, Tanei T, Takayasu M, Saito R. Surgical Outcomes of Common Peroneal Nerve Entrapment Neuropathy Associated with L5 Radiculopathy. Neurol Med Chir (Tokyo) 2023; 63:350-355. [PMID: 37286483 PMCID: PMC10482487 DOI: 10.2176/jns-nmc.2022-0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/27/2023] [Indexed: 06/09/2023] Open
Abstract
Impingement of the common peroneal nerve, a branch of the L5 nerve root, causes common peroneal nerve entrapment neuropathy (CPNE). Although there are cases of CPNE associated with L5 radiculopathy, surgical intervention's effectiveness remains to be elucidated. This retrospective case-control study aimed to evaluate the efficacy of surgery in patients with CPNE associated with L5 radiculopathy. Twenty-two patients (25 limbs) with surgically treated CPNE between 2015 and 2022 were retrospectively reviewed. The limbs were classified into two groups: group R (limbs of CPNE associated with L5 radiculopathy) and group O (limbs of CPNE without L5 radiculopathy). The durations from onset to surgery, the nerve conduction studies (NCSs), and postoperative improvement rates for motor weakness, pain, and dysesthesia were compared between the groups. Group R included 15 limbs (13 patients), and group O included 10 limbs (9 patients). There were no significant differences in the duration from onset to surgery or abnormal findings of NCS between the two groups. The postoperative improvement rates were 88% and 100% (p = 0.62) for muscle weakness, 87% and 80% (p = 0.53) for pain, and 71% and 56% (p = 0.37) for dysesthesia in group R and group O, respectively, without significant differences between groups. CPNE associated with L5 radiculopathy is common, and the results of the present study showed that the surgical outcomes in such cases were satisfactory and comparable to those in CPNE without L5 radiculopathy.
Collapse
Affiliation(s)
| | | | - Masahito Hara
- Department of Neurosurgery, Aichi Medical University
| | - Yu Yamamoto
- Department of Neurosurgery, Inazawa Municipal Hospital
| | | | | | | | - Ryuta Saito
- Department of Neurosurgery, Nagoya University
| |
Collapse
|
2
|
Iborra Á, Villanueva M, Barrett SL, Vega-Zelaya L. The role of ultrasound-guided perineural injection of the tibial nerve with a sub-anesthetic dosage of lidocaine for the diagnosis of tarsal tunnel syndrome. Front Neurol 2023; 14:1135379. [PMID: 37139063 PMCID: PMC10150003 DOI: 10.3389/fneur.2023.1135379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
Background Tarsal tunnel syndrome (TTS) involves entrapment of the tibial nerve at the medial ankle beneath the flexor retinaculum and its branches, the medial and lateral plantar nerves, as they course through the porta pedis formed by the deep fascia of the abductor hallucis muscle. TTS is likely underdiagnosed, because diagnosis is based on clinical evaluation and history of present illness. The ultrasound-guided lidocaine infiltration test (USLIT) is a simple approach that may aid in the diagnosis of TTS and predict the response to neurolysis of the tibial nerve and its branches. Traditional electrophysiological testing cannot confirm the diagnosis and only adds to other findings. Methods We performed a prospective study of 61 patients (23 men and 38 women) with a mean age of 51 (29-78) years who were diagnosed with idiopathic TTS using the ultrasound guided near-nerve needle sensory technique (USG-NNNS). Patients subsequently underwent USLIT of the tibial nerve to assess the effect on pain reduction and neurophysiological changes. Results USLIT led to an improvement in symptoms and nerve conduction velocity. The objective improvement in nerve conduction velocity can be used to document the pre-operative functional capacity of the nerve. USLIT may also be used as a possible quantitative indicator of whether the nerve has the potential to improve in neurophysiological terms and ultimately inform prognosis after surgical decompression. Conclusion USLIT is a simple technique with potential predictive value that can help the clinician to confirm the diagnosis of TTS before surgical decompression.
Collapse
Affiliation(s)
- Álvaro Iborra
- Unit for Ultrasound-Guided Surgery, Hospital Beata María Ana, Madrid, Spain
- Avanfi Institute, Madrid, Spain
- Department of Podiatry, School of Health Sciences, University of La Salle, Madrid, Spain
- *Correspondence: Álvaro Iborra
| | - Manuel Villanueva
- Unit for Ultrasound-Guided Surgery, Hospital Beata María Ana, Madrid, Spain
- Avanfi Institute, Madrid, Spain
| | | | - Lorena Vega-Zelaya
- Avanfi Institute, Madrid, Spain
- Clinical Neurophysiology, Hospital Universitario de La Princesa, Madrid, Spain
| |
Collapse
|
3
|
Oosterbos C, Rummens S, Bogaerts K, Hoornaert S, Weyns F, Dubuisson A, Lemmens R, Theys T. Conservative versus surgical treatment of foot drop in peroneal nerve entrapment: rationale and design of a prospective, multi-centre, randomized parallel-group controlled trial. Trials 2022; 23:1065. [PMID: 36581937 PMCID: PMC9801603 DOI: 10.1186/s13063-022-07009-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND High-quality evidence is lacking to support one treatment strategy over another in patients with foot drop due to peroneal nerve entrapment. This leads to strong variation in daily practice. METHODS/DESIGN The FOOTDROP (Follow-up and Outcome of Operative Treatment with Decompressive Release Of The Peroneal nerve) trial is a randomized, multi-centre study in which patients with peroneal nerve entrapment and persistent foot drop, despite initial conservative treatment, will be randomized 10 (± 4) weeks after onset between non-invasive treatment and surgical decompression. The primary endpoint is the difference in distance covered during the 6-min walk test between randomization and 9 months later. Time to recovery is the key secondary endpoint. Other secondary outcome measures encompass ankle dorsiflexion strength (MRC score and isometric dynamometry), gait assessment (10-m walk test, functional ambulation categories, Stanmore questionnaire), patient-reported outcome measures (EQ5D-5L), surgical complications, neurological deficits (sensory changes, motor scores for ankle eversion and hallux extension), health economic assessment (WPAI) and electrodiagnostic assessment. DISCUSSION The results of this randomized trial may elucidate the role of surgical decompression of the peroneal nerve and aid in clinical decision-making. TRIAL REGISTRATION ClinicalTrials.gov NCT04695834. Registered on 4 January 2021.
Collapse
Affiliation(s)
- Christophe Oosterbos
- grid.5596.f0000 0001 0668 7884Research Group experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Sofie Rummens
- grid.410569.f0000 0004 0626 3338Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Locomotor and Neurological disorders, KU Leuven, Leuven, Belgium
| | - Kris Bogaerts
- grid.12155.320000 0001 0604 5662Department of public health and critical care, I-BioStat, KU Leuven, Belgium and I-BioStat, UHasselt, Hasselt, Belgium
| | - Sophie Hoornaert
- grid.5596.f0000 0001 0668 7884Research Group experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Frank Weyns
- grid.470040.70000 0004 0612 7379Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium ,grid.12155.320000 0001 0604 5662Neurosciences, Faculty of Medicine and Life Sciences, UHasselt, Hasselt, Belgium
| | - Annie Dubuisson
- Department of Neurosurgery, University Hospitals Liège, Liège, Belgium
| | - Robin Lemmens
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, Experimental Neurology, KU Leuven – University of Leuven, Leuven, Belgium ,grid.11486.3a0000000104788040VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Theys
- grid.5596.f0000 0001 0668 7884Research Group experimental Neurosurgery and Neuroanatomy and the Leuven Brain Institute, KU Leuven, Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Muacevic A, Adler JR. Common Peroneal Nerve Palsy at the Level of Proximal Fibula After Total Hip Arthroplasty: A Case Report. Cureus 2022; 14:e30741. [PMID: 36320793 PMCID: PMC9606723 DOI: 10.7759/cureus.30741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/07/2022] Open
Abstract
Sciatic nerve injury is a well-known devastating complication and is the most commonly involved nerve after total hip arthroplasty (THA). Most of these injuries occur at the level of the hip and surgery site rather than a distal location. In this case report, a 62-year-old male presented with common peroneal nerve (CPN) palsy at the level of the knee immediately after undergoing left THA via posterior hip approach. This likely occurred due to direct compression during the surgical positioning or intraoperative leg manipulation. It was associated with excruciating uncontrolled neuropathic pain around the ipsilateral lateral leg and foot and absence of motor function. The patient's THA was performed elsewhere, seven weeks prior to his presentation to us. His clinical examination and electromyographic (EMG) findings confirmed focal peroneal nerve entrapment around the neck of the fibula. An urgent distal peroneal nerve decompression was performed followed by a dramatic improvement in the pain. Consequently, the patient discontinued all pain medications within three days after the decompression. On follow up, he demonstrated remarkable improvement in his motor and sensory functions. In conclusion, direct or indirect CPN injury at the level of the knee is extremely rare after THA. Early distal peroneal nerve decompression after THA can be beneficial in selected patients based on the clinical presentation and EMG findings.
Collapse
|
5
|
Peripheral Nerve Injections. Phys Med Rehabil Clin N Am 2022; 33:489-517. [DOI: 10.1016/j.pmr.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
6
|
Fortier LM, Markel M, Thomas BG, Sherman WF, Thomas BH, Kaye AD. An Update on Peroneal Nerve Entrapment and Neuropathy. Orthop Rev (Pavia) 2021; 13:24937. [PMID: 34745471 DOI: 10.52965/001c.24937] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022] Open
Abstract
Peroneal neuropathy is the most common compressive neuropathy of the lower extremity. It should be included in the differential diagnosis for patients presenting with foot drop, the pain of the lower extremity, or numbness of the lower extremity. Symptoms of peroneal neuropathy may occur due to compression of the common peroneal nerve (CPN), superficial peroneal nerve (SPN), or deep peroneal nerve (DPN), each with different clinical presentations. The CPN is most commonly compressed by the bony prominence of the fibula, the SPN most commonly entrapped as it exits the lateral compartment of the leg, and the DPN as it crosses underneath the extensor retinaculum. Accurate and timely diagnosis of any peroneal neuropathy is important to avoid progression of nerve injury and permanent nerve damage. The diagnosis is often made with physical exam findings of decreased strength, altered sensation, and gait abnormalities. Motor nerve conduction studies, electromyography studies, and diagnostic nerve blocks can also assist in diagnosis and prognosis. First-line treatments include removing anything that may be causing external compression, providing stability to unstable joints, and reducing inflammation. Although many peroneal nerve entrapments will resolve with observation and activity modification, surgical treatment is often required when entrapment is refractory to these conservative management strategies. Recently, additional options including microsurgical decompression and percutaneous peripheral nerve stimulation have been reported; however, large studies reporting outcomes are lacking.
Collapse
Affiliation(s)
| | | | | | | | | | - Alan D Kaye
- Louisiana State University Health Science Center Shreveport
| |
Collapse
|
7
|
Oosterbos C, Decramer T, Rummens S, Weyns F, Dubuisson A, Ceuppens J, Schuind S, Groen J, van Loon J, Rasulic L, Lemmens R, Theys T. Evidence in peroneal nerve entrapment: A scoping review. Eur J Neurol 2021; 29:665-679. [PMID: 34662481 DOI: 10.1111/ene.15145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/14/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Daily management of patients with foot drop due to peroneal nerve entrapment varies between a purely conservative treatment and early surgery, with no high-quality evidence to guide current practice. Electrodiagnostic (EDX) prognostic features and the value of imaging in establishing and supplementing the diagnosis have not been clearly established. METHODS We performed a literature search in the online databases MEDLINE, Embase, and the Cochrane Library. Of the 42 unique articles meeting the eligibility criteria, 10 discussed diagnostic performance of imaging, 11 reported EDX limits for abnormal values and/or the value of EDX in prognostication, and 26 focused on treatment outcome. RESULTS Studies report high sensitivity and specificity of both ultrasound (varying respectively from 47.1% to 91% and from 53% to 100%) and magnetic resonance imaging (MRI; varying respectively from 31% to 100% and from 73% to 100%). One comparative trial favoured ultrasound over MRI. Variable criteria for a conduction block (>20%-≥50) were reported. A motor conduction block and any baseline compound motor action potential response were identified as predictors of good outcome. Based predominantly on case series, the percentage of patients with good outcome ranged 0%-100% after conservative treatment and 40%-100% after neurolysis. No study compared both treatments. CONCLUSIONS Ultrasound and MRI have good accuracy, and introducing imaging in the standard diagnostic workup should be considered. Further research should focus on the role of EDX in prognostication. No recommendation on the optimal treatment strategy of peroneal nerve entrapment can be made, warranting future randomized controlled trials.
Collapse
Affiliation(s)
- Christophe Oosterbos
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium.,Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
| | - Thomas Decramer
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium.,Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
| | - Sofie Rummens
- Department of Physical Medicine and Rehabilitation, University Hospitals of Leuven, Leuven, Belgium.,Locomotor and Neurological Disorders, Catholic University of Leuven, Leuven, Belgium
| | - Frank Weyns
- Department of Neurosurgery, East Limburg Hospital, Genk, Belgium.,Neurosciences, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Annie Dubuisson
- Department of Neurosurgery, University Hospitals of Liège, Liège, Belgium
| | - Jeroen Ceuppens
- Department of Neurosurgery, Groeninge General Hospital, Kortrijk, Belgium
| | - Sophie Schuind
- Department of Neurosurgery, Erasme Hospital, Brussels, Belgium
| | - Justus Groen
- Nerve Centre, University of Leiden, Leiden, the Netherlands
| | - Johannes van Loon
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium.,Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
| | - Lukas Rasulic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Neurosurgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, Catholic University of Leuven, Leuven, Belgium.,Centre for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals of Leuven, Leuven, Belgium
| | - Tom Theys
- Research Group Experimental Neurosurgery and Neuroanatomy and Leuven Brain Institute, Catholic University of Leuven, Leuven, Belgium.,Department of Neurosurgery, University Hospitals of Leuven, Leuven, Belgium
| |
Collapse
|
8
|
Vetrano IG, Devigili G, Nazzi V. Common peroneal nerve entrapment: the need for a complete assessment before surgery. Acta Neurochir (Wien) 2020; 162:1925-1926. [PMID: 32462313 DOI: 10.1007/s00701-020-04410-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
|