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Andiappan K, Nyein Yin K, Zainudin MF. Unilateral Compressive Peroneal Neuropathy in Intensive Care Settings During the COVID-19 Pandemic: A Series of Three Cases. Cureus 2024; 16:e65789. [PMID: 39211702 PMCID: PMC11361767 DOI: 10.7759/cureus.65789] [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] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Peroneal nerve entrapment, typically associated with behaviors like cross-legged sitting or squatting, can also occur from extended periods of lying down where the lower limbs usually assume a position of hip external rotation and knee flexion. In such positions, the fibular head's prominence can exert sustained pressure on the peroneal nerve. We report three cases of unilateral peroneal neuropathy in intensive care unit (ICU) patients during the coronavirus disease (COVID-19) pandemic, highlighting the possible role of prolonged supine or lateral decubitus positions in the development of this condition. Electrophysiological studies confirmed peroneal nerve palsy in all cases, with two patients achieving full recovery, while the third required a permanent ankle foot orthosis for mobility due to a lack of neurological recovery. The COVID-19 pandemic has challenged ideal nursing care, including in ICU settings, leading to suboptimal nursing care standards and compromised frequent positioning regimes.
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Affiliation(s)
- Kavitha Andiappan
- Department of Rehabilitation Medicine, Hospital Sungai Buloh, Sungai Buloh, MYS
| | - Khin Nyein Yin
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, MYS
| | - Muhamad Faizal Zainudin
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA (Majlis Amanah Rakyat), Sungai Buloh, MYS
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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.
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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
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Yildirim A, Temel M. Bilateral peroneal nerve palsy due to prolonged squatting in farmers: clinical and electrophysiological outcome. Neurol Res 2023; 45:118-123. [PMID: 36111735 DOI: 10.1080/01616412.2022.2124793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Peroneal neuropathy is the most common mononeuropathy of the lower extremities. However, bilateral peroneal nerve palsy (BPNP) is extremely rare due to prolonged squatting. We aimed to evaluate the clinical-electrophysiological findings in patients with BPNP caused by long-term squatting for cotton harvesting in our region. METHODS Eight patients (16 limbs), admitted to our center between February 2018 and March 2021 with bilateral foot drop after prolonged squatting, were included in our study. The clinical and electrophysiological findings were re-evaluated six months later. RESULTS We observed that 18.75% of the limbs had pure conduction block, 31.25% had mixed involvement, and half had predominantly axonal damage. Good recovery was observed in ankle dorsiflexion in seven patients during follow-ups. None of the patients were referred for surgery. Electrophysiological examinations showed that the conduction block was resolved, and reinnervation was observed in all patients with axonal degeneration. CONCLUSION Since the etiology is nontraumatic compression, good recovery can be seen with conservative treatment in BPNP. Electrophysiological studies may determine reinnervation along with clinical examination. The patient should be followed-up for six months with conservative treatment before surgical intervention.
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Affiliation(s)
- Ahmet Yildirim
- Division of Clinical Neurophysiology, Department of Neurology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Turkey
| | - Musa Temel
- Department of Neurology, Sanliurfa Training and Research Hospital, Turkey
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Baharin J, Yusof Khan AHK, Abdul Rashid AM, Loh WC, Ibrahim A, Inche Mat LN, Wan Sulaiman WA, Hoo FK, Basri H. Slimmer’s palsy following an intermittent fasting diet. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Isolated common peroneal neuropathy (CPN) is the most common lower extremity mononeuropathy and the third most common mononeuropathy overall in adults. It often associated with multiple aetiologies, such as trauma, hereditary neuropathies and iatrogenic causes. We report a rare case of acute bilateral foot drop in a late adolescent female following a rapid weight loss attributable to intermittent fasting diet.
Case presentation
A 19-year-old female presented with worsening bilateral foot drop following a rapid intentional weight loss by intermittent fasting diet. She lost 20% of her baseline bodyweight within a period of 4 months. Systemic disease and metabolic screenings for neuropathy differentials were unremarkable. Electrophysiological studies revealed severe entrapment neuropathy involving bilateral common peroneal nerves (CPN). Her confounding risk factors for CPN injury include contact sport activities and habitual leg crossing during sitting. Following a dietary modification and physical therapy she achieved complete recovery of weakness and function on follow-up.
Conclusions
In a patient with bilateral PN rapid weight loss, prognosis is good and complete neurologic recovery can be attained through combination of cessation of extreme diet and physical therapy.
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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.
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Affiliation(s)
| | | | | | | | | | - Alan D Kaye
- Louisiana State University Health Science Center Shreveport
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Shields LBE, Iyer VG, Shields CB, Zhang YP, Rao AJ. Varied Presentation and Importance of MR Neurography of the Common Fibular Nerve in Slimmer's Paralysis. Case Rep Neurol 2021; 13:555-564. [PMID: 34720962 PMCID: PMC8460930 DOI: 10.1159/000518377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
Slimmer's paralysis refers to a common fibular nerve palsy caused by significant and rapid weight loss. This condition usually results from entrapment of the common fibular nerve due to loss of the fat pad surrounding the fibular head. Several etiologies of common fibular nerve palsy have been proposed, including trauma, surgical complications, improperly fitted casts or braces, tumors and cysts, metabolic syndromes, and positional factors. We present 5 cases of slimmer's paralysis in patients who had lost 32–57 kg in approximately 1 year. In 2 cases, MR neurogram of the knee demonstrated abnormalities of the common fibular nerve at the fibular head. Two patients underwent a common fibular nerve decompression at the fibular head and attained improved gait and sensorimotor function. Weight loss, diabetes mellitus, and immobilization may have contributed to slimmer's paralysis in 1 case. Awareness of slimmer's paralysis in patients who have lost a significant amount of weight in a short period of time is imperative to detect and treat a fibular nerve neuropathy that may ensue.
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Affiliation(s)
- Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA
| | - Vasudeva G Iyer
- Neurodiagnostic Center of Louisville, Louisville, Kentucky, USA
| | - Christopher B Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA.,Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Yi Ping Zhang
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA
| | - Abigail J Rao
- Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA
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Klifto KM, Azoury SC, Gurno CF, Card EB, Levin LS, Kovach SJ. Treatment approach to isolated common peroneal nerve palsy by mechanism of injury: Systematic review and meta-analysis of individual participants' data. J Plast Reconstr Aesthet Surg 2021; 75:683-702. [PMID: 34801427 DOI: 10.1016/j.bjps.2021.09.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/27/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND We reviewed the individual participant data of patients who sustained isolated common peroneal nerve (CPN) injuries resulting in foot drop. Functional results were compared between eight interventions for CPN palsies to determine step-wise treatment approaches for the underlying mechanisms of nerve injury. METHODS PubMed, Embase, Cochrane Library, Web of Science, Scopus, and CINAHL databases were searched. PRISMA-IPD and Cochrane guidelines were followed in the data search. Eligible patients sustained isolated CPN injuries resulting in their foot drop. Patients were stratified by mechanisms of nerve injury, ages, duration of motor symptoms, and nerve defect/zone of injury sizes, and were compared by functional results (poor = 0, fair = 1, good = 2, excellent = 3), using meta-regression between interventions. Interventions evaluated were primary neurorrhaphy, neurolysis, nerve grafts, partial nerve transfer, neuromusculotendinous transfer, tendon transfer, ankle-foot orthosis (AFO), and arthrodesis. RESULTS One hundred and forty-four studies included 1284 patients published from 1985 through 2020. Transection/Cut: Excellent functional results following tendon transfer (OR: 126, 95%CI: 6.9, 2279.7, p=0.001), compared to AFO. Rupture/Avulsion: Excellent functional results following tendon transfer (OR: 73985359, 95%CI: 73985359, 73985359, p<0.001), nerve graft (OR: 4465917, 95%CI: 1288542, 15478276, p<0.001), and neuromusculotendinous transfer (OR: 42277348, 95%CI: 3001397, 595514030, p<0.001), compared to AFO. Traction/Stretch: Good functional results following tendon transfer (OR: 4.1, 95%CI: 1.17, 14.38, p=0.028), compared to AFO. Entrapment: Excellent functional results following neurolysis (OR: 4.6, 95%CI: 1.3, 16.6, p=0.019), compared to AFO. CONCLUSIONS Functional results may be optimized for treatments by the mechanism of nerve injury. Transection/Cut and Traction/Stretch had the best functional results following tendon transfer. Rupture/Avulsion had the best functional results following tendon transfer, nerve graft, or neuromusculotendinous transfer. Entrapment had the best functional results following neurolysis.
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Affiliation(s)
- Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, University of Missouri School of Medicine, Columbia, MO, USA; Division of Plastic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Said C Azoury
- Division of Plastic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Caresse F Gurno
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elizabeth B Card
- Division of Plastic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - L Scott Levin
- Division of Plastic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Stephen J Kovach
- Division of Plastic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Chang LG, Zar S, Seidel B, Kurra A, Gitkind A. COVID-19 Proned Ventilation and Its Possible Association With Foot Drop: A Case Series. Cureus 2021; 13:e14374. [PMID: 33987045 PMCID: PMC8110298 DOI: 10.7759/cureus.14374] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causing the coronavirus disease 2019 (COVID-19) pandemic is known to lead to the complicated sequelae of severe acute respiratory distress syndrome. Proning has been used as an adjunctive treatment to improve oxygenation in both ventilated and non-ventilated patients. Although patients respond well to this strategy, complications from this arise as well. It is hypothesized that COVID-19 intensive care unit (ICU) proned ventilation is associated with new cases of foot drops or compressive unilateral ankle dorsiflexion weakness during the early 2020 COVID-19 pandemic. Five patients presented to an acute rehabilitation facility with unilateral ankle dorsiflexion weakness after ICU proned ventilation during the COVID-19 pandemic. Three patients were found to have primarily subacute left sensory-motor dysmyelinating common peroneal neuropathies located around the fibular head. Two patients were found to have primarily subacute sensory-motor dysmyelinating right-sided common peroneal neuropathies above the fibular head and distal to biceps femoris muscle. Compressive unilateral common peroneal neuropathies during the pandemic are possibly related to the impromptu, unconventional, and unfamiliar use of proned ventilation.
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Affiliation(s)
- Lawrence G Chang
- Sports Medicine, Montefiore Medical Center, Bronx, USA.,Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, USA
| | - Safwan Zar
- Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, USA
| | - Benjamin Seidel
- Physical Medicine and Rehabilitation/Brain Injury Medicine, Burke Rehabilitation Hospital, White Plains, USA
| | - Anupama Kurra
- Physical Medicine and Rehabilitation, Montefiore Medical Center, Bronx, USA
| | - Andrew Gitkind
- Physical Medicine and Rehabilitation, Montefiore Medical Center, Bronx, USA
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Demetriades AK, Mancuso-Marcello M, Baig Mirza A, Frantzias J, Bell DA, Selway R, Gullan R. Acute bilateral foot drop with or without cauda equina syndrome-a case series. Acta Neurochir (Wien) 2021; 163:1191-1198. [PMID: 33550516 PMCID: PMC7966217 DOI: 10.1007/s00701-021-04735-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h. Three had concomitant cauda equina syndrome; of these, the first two made a full motor recovery, one by 6 weeks follow-up and the second on the same-day post-op evaluation. Overall, five out of seven cases had full resolution of their ankle dorsiflexion pareses. One patient with 1/5 power has not improved. Another with 1/5 weakness improved to normal on the one side and to 3/5 on the other. Conclusion When bilateral foot drop occurs acutely, we encourage the consideration of degenerative spinal disease. Relevant discopathy was observed from L2/3 to L5/S1; aberrant innervation may be at play. Cauda equina syndrome is not necessarily associated with acute bilateral foot drop. The prognosis seems to be pretty good with respect to recovery of the foot drop, especially if partial at presentation and if treated within 48 h.
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Affiliation(s)
| | | | | | - Joseph Frantzias
- Department of Neurosurgery, Brighton and Sussex University Hospital, Brighton, UK
| | - David A Bell
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Richard Selway
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital, London, UK
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Oh MW, Gu MS, Kong HH. Bilateral common peroneal neuropathy due to rapid and marked weight loss after biliary surgery: A case report. World J Clin Cases 2021; 9:1909-1915. [PMID: 33748241 PMCID: PMC7953405 DOI: 10.12998/wjcc.v9.i8.1909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The causes of peroneal neuropathy are various, but are rarely due to weight loss. Bilateral peroneal neuropathy caused by weight loss after surgery has been reported only after bariatric surgery and there were no reports associated with other abdominal surgery. In this report, we describe a case of the bilateral peroneal neuropathy that occurred due to marked weight loss after biliary surgery.
CASE SUMMARY A 58-year-old male did not receive adequate nutritional support after biliary surgery, and showed a massive weight loss over a short period of time (body mass index; 24.1 kg/m2 to 20.5 kg/m2 for 24 d). Then, foot drop occurred on both sides. Physical examination, electromyography (EMG) and magnetic resonance imaging studies were conducted and he was diagnosed as bilateral common peroneal neuropathy around the fibular head level. The patient was treated electrical stimulation therapy on both lower legs along with exercise therapy, and received sufficient oral nutritional support. The patient gradually recovered to his original weight, and the power of the dorsiflexor of bilateral ankles improved after conservative treatment. In addition, the follow-up EMG showed signs of improvement.
CONCLUSION Any abdominal surgery that may have rapid and marked weight loss can lead to peroneal neuropathy as a complication.
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Affiliation(s)
- Min Woo Oh
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju 28644, South Korea
| | - Min Su Gu
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju 28644, South Korea
| | - Hyun Ho Kong
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju 28644, South Korea
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Liu Z, Yushan M, Liu Y, Yusufu A. Prognostic factors in patients who underwent surgery for common peroneal nerve injury: a nest case-control study. BMC Surg 2021; 21:11. [PMID: 33407374 PMCID: PMC7789468 DOI: 10.1186/s12893-020-01033-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022] Open
Abstract
Background Common peroneal nerve (CPN) injury is one of the most common nerve injuries in the lower extremities and the motor functional recovery of injured common peroneal nerve (CPN) was often unsatisfactory, the mechanism of which is still controversial. The purpose of this retrospective study was to determine the prognostic factors in patients who underwent surgery for CPN injury and provide a tool for clinicians to assess the patients’ prognosis. Methods This is a retrospective cohort study of all patients who underwent neural exploration for injured CPN from 2009 to 2019. A total of 387 patients with postoperative follow-up more than 12 months were included in the final analysis. We used univariate logistics regression analyses to explore explanatory variables which were associated with recovery of neurological function. By applying multivariable logistic regression analysis, we determined variables incorporated into clinical prediction model, developed a nomogram by the selected variables, and then assessed discrimination of the model by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results The case group included 67 patients and the control group 320 patients. Multivariate logistic regression analysis showed that area (urban vs rural, OR = 3.35), occupation(“blue trouser” worker vs “white-trouser” worker, OR = 4.39), diabetes (OR = 11.68), cardiovascular disease (OR = 51.35), knee joint dislocation (OR = 14.91), proximal fibula fracture (OR = 3.32), tibial plateau fracture (OR = 9.21), vascular injury (OR = 5.37) and hip arthroplasty (OR = 75.96) injury increased the risk of poor motor functional recovery of injured CPN, while high preoperative muscle strength (OR = 0.18) and postoperative knee joint immobilization (OR = 0.11) decreased this risk of injured CPN. AUC of the nomogram was 0.904 and 95% CI was 0.863–0.946. Conclusions Area, occupation, diabetes, cardiovascular disease, knee joint dislocation, proximal fibula fracture, tibial plateau fracture, vascular injury and hip arthroplasty injury are independent risk factors of motor functional recovery of injured CPN, while high preoperative muscle strength and postoperative knee joint immobilization are protective factors of motor functional recovery of injured CPN. The prediction nomogram can provide a tool for clinicians to assess the prognosis of injured CPN.
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Affiliation(s)
- Zhenhui Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Maimaiaili Yushan
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China.
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Reyhani A, Dortcan N. A Rare Etiology of Bilateral Foot Drop: Weight Loss. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Excessive weight loss especially when it occurs in a short period of time can lead to some neurological problems including peroneal nerve palsy. Foot drop is the most common presentation of peroneal neuropathies and they rarely occur bilaterally at the same time. Herein, we presented a 46-year-old male patient who developed bilateral foot drop after losing 25 kgs. in two months with an intensive weight reduction diet which was advised by a doctor as a therapeutic regimen. The electromyographic study confirmed the bilateral entrapment neuropathy of the peroneal nerves at the fibular necks and these findings could not be attributed to any other factor except the weight loss. After a balanced diet and a physiotherapy programme, he recovered completely. This case highlights an uncommon but a well documented etiology of peroneal neuropathies. Being aware of this complication and close follow-up are important for the prognosis of these patients.
Keywords: foot deformities, peroneal neuropathies, weight loss
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Affiliation(s)
- Aylin Reyhani
- Health Sciences University, Fatih Sultan Mehmet Education and Research Hospital
| | - Nimet Dortcan
- Health Sciences University, Fatih Sultan Mehmet Education and Research Hospital
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The results of surgical decompression in the treatment of foot drop due to peroneal nerve entrapment after bariatric surgery. Surg Obes Relat Dis 2020; 16:1684-1691. [PMID: 32800521 DOI: 10.1016/j.soard.2020.06.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/16/2020] [Accepted: 06/28/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The loss of the fat pad surrounding the fibular head after rapid and excessive weight loss after bariatric surgery can lead to foot drop symptoms due to peroneal nerve entrapment (PNE). Conservative and surgical approaches have been described for the treatment of this condition, but there is some controversy over the effectiveness of the treatment modalities. OBJECTIVE We aimed to investigate the causes and frequency of foot drop due to PNE after bariatric surgery and to investigate the effects of peroneal nerve decompression (PND) as a surgical treatment for PNE. SETTING Single center, university surgical department. METHODS We retrospectively evaluated a series of 2607 patients in terms of neurologic complications after bariatric surgery. Patients' age, sex, co-morbid diseases, vitamin and electrolyte levels, body mass index and postoperative excess weight loss, affected limb, duration of symptoms, and muscle strength scores (according to the Medical Research Council scale) were recorded. RESULTS A total of 14 (.5%) patients had foot drop symptoms due to PNE. Of these patients, 9 underwent PND. The mean excess weight loss of PND patients at postoperative months 6 and 12 were 68.8 ± 13.5 and 100.9 ± 10.8, respectively. Foot drop symptoms became evident 5 to 11 months after bariatric surgery, affecting only a unilateral lower extremity in all patients. In laboratory analysis, there were no signs of nutritional and vitamin deficiency or insufficiency in any of the PND cases. Muscular strength was Medical Research Council grade 0 in all patients. The median duration of symptoms was 9 days, and the median complete recovery time was 40 days after PND. Patients who had a duration of symptoms for a maximum of 12 days were completely healed 30 days after PND. CONCLUSION PND should be the first-choice treatment procedure for acute foot drop due to PNE after bariatric surgery.
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Margulis M, Ben-Zvi L, Brook I, Bernfeld B. A novel approach for simultaneous tibiofibular synostosis takedown and peroneus longus ligamentoplasty for posttraumatic tibiofibular synostosis: a case report and review of the literature. J Med Case Rep 2020; 14:104. [PMID: 32622364 PMCID: PMC7335440 DOI: 10.1186/s13256-020-02397-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/05/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction A singular procedure involving both a distal tibiofibular synostosis resection with syndesmosis repair by peroneus longus ligamentoplasty has not been reported in the English literature. We report a case of simultaneous distal tibiofibular synostosis resection and syndesmosis stabilization by peroneus longus ligamentoplasty for the treatment of symptomatic distal tibiofibular synostosis formation, following neglected syndesmosis injury. Case presentation A 42-year-old Caucasian man presented with ankle pain and painful range of motion 20 months following ankle trauma. Distal tibiofibular synostosis was identified, and our patient was successfully treated by simultaneous synostosis takedown and peroneus longus ligamentoplasty for distal tibiofibular syndesmosis repair. Conclusions Our experience illustrates that in cases of painful posttraumatic distal tibiofibular synostosis, simultaneous synostosis resection with peroneus longus ligamentoplasty may show good clinical results. Level of evidence 5
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Affiliation(s)
- Michael Margulis
- Lady Davis Carmel Medical Center, Mikhal Street 7, 3436212, Haifa, Israel
| | - Lior Ben-Zvi
- Lady Davis Carmel Medical Center, Mikhal Street 7, 3436212, Haifa, Israel
| | - Itzhak Brook
- Georgetown University Medical Center, 4431 Albemarle Street NW, Washington, DC, 20016, USA.
| | - Benjamin Bernfeld
- Lady Davis Carmel Medical Center, Mikhal Street 7, 3436212, Haifa, Israel
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[Surgical decompression of the peroneal nerve at the level of the fibular head]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:467-474. [PMID: 32100068 DOI: 10.1007/s00064-020-00648-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/10/2019] [Accepted: 08/17/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Functional and sensible regeneration of deficits related to common peroneal nerve palsy. INDICATIONS Functional deficits like foot drop, malfunctioning pronation, foot in supination and sensible deficits located at the anterior and lateral lower leg, the dorsum of the foot, the extension side of toes 1-4 and the interdigital space between toe 1 and 2, for positive Hoffmann-Tinel sign located at the fibular head and steppage gait. CONTRAINDICATIONS Infection, spinal cord damage and spinal cord tumors with related sensitivity disorders and paralysis, advanced multiple sclerosis, amyotrophic lateral sclerosis, pAVK IV, reinnervation refractory muscles with denervation >15-18 months, polyneuropathy, previous nerve lesions by direct trauma. SURGICAL TECHNIQUE Surgery in lateral position and thigh tourniquet. L‑Shaped incision made in accordance with the marking. Nerve release by fasciotomy first proximal, then distal up to the branching. Opening of the thigh tourniquet, careful coagulation. Insertion of a Mini Redovac Drainage, subcutaneous and skin sutures. Compression bandage. POSTOPERATIVE MANAGEMENT Full mobilization on postoperative day 1. An electric stimulation therapy can be considered after drainage removal. After suture removal physio- and ergotherapy indicated. Check ups should be performed every 3 months with clinical exams, photo and video documentation. Four months after surgery an electroneurographic exam should be done. Follow-up should be performed for 24 months. RESULTS From 2010-2018 15 patients received decompression of the common peroneal nerve. Sensibility, functionality and subjective feeling were evaluated. In 12 patients (80%) a full recovery, in one case (6.67%) a partial recovery and in 2 cases (13.33%) no recovery was observed.
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