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Capodici A, Hagert E, Darrach H, Curtin C. An overview of common peroneal nerve dysfunction and systematic assessment of its relation to falls. Int Orthop 2022; 46:2757-2763. [PMID: 36169699 PMCID: PMC9674763 DOI: 10.1007/s00264-022-05593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE Compression of the peroneal nerve is recognized as a common cause of falls. The superficial course of the peroneal nerve exposes it to trauma and pressure from common activities such as crossing of legs. The nerve can be exposed also to distress due to metabolic problems such as diabetes. The purpose of our manuscript is to review common peroneal nerve dysfunction symptoms and treatment as well as provide a systematic assessment of its relation to falls. METHODS We pooled the existing literature from PubMed and included studies (n = 342) assessing peroneal nerve damage that is related in any way to falls. We excluded any studies reporting non-original data, case reports and non-English studies. RESULTS The final systematic assessment included 4 articles. Each population studied had a non-negligible incidence of peroneal neuropathy. Peroneal pathology was found to be consistently associated with falls. CONCLUSION The peroneal nerve is an important nerve whose dysfunction can result in falls. This article reviews the anatomy and care of the peroneal nerve. The literature review highlights the strong association of this nerve's pathology with falls.
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Affiliation(s)
- Angelo Capodici
- Department of Biomedical and Neuromotor Science, Alma Mater Studiorum - University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy.
- Department of Medicine (Biomedical Informatics), Stanford University - School of Medicine, Stanford, CA, USA.
| | - Elisabet Hagert
- Aspetar Orthopedic- and Sports Medicine Hospital, Doha, Qatar
- Deparment of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Halley Darrach
- Division of Plastic Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | - Catherine Curtin
- Department of Surgery - Veterans' Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
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Georgeanu VA, Russu OM, Obada B, Iliescu MG, Popescu MN, Iliescu DM, Predescu V. Common peroneal nerve palsy after primary total hip arthroplasty. Int Orthop 2022; 46:1963-1970. [PMID: 35711003 DOI: 10.1007/s00264-022-05477-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The study wants to evaluate the incidence, the clinical evolution, and treatment of common peroneal nerve (CPN) palsy after primary total hip arthroplasty. METHODS Our clinical prospective study was made between January 2016 and December 2020. The study group comprised 1240 total hip replacements over a period of five years. Six cases were diagnosed with CPN palsy (0.48%). Five were women and one man, aged from 52 to 71 years old. The common peroneal nerve lesion was diagnosed clinically and by electromyography. RESULTS The follow-up period was at least 24 months post-operatively. In all six cases, there was a complete common peroneal nerve palsy, documented by electromyography. The poorest results were obtained in the older patients and those who had the highest body mass index, which at two years post-operatively achieved only a partial sensory rehabilitation, with complete motor deficit. All patients can walk unassisted, without support, with one case having complete rehabilitation achieved 18 months postoperatively and three with partial rehabilitation. CONCLUSION CPN palsy after primary THA is a very serious complication with poor functional outcome. There is no consensus regarding the treatment. The age and the intensity of the rehabilitation program are the only significant factors for the medical rehabilitation after this debilitating post-operative complication.
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Affiliation(s)
- Vlad Alexandru Georgeanu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Clinic of Orthopaedics and Trauma Surgery, "St. Pantelimon" Hospital, Bucharest, Romania
| | - Octav Marius Russu
- Department of Orthopaedics and Traumatology, Clinical County Hospital, Tîrgu Mureș, Romania
- Department of General Medicine, University of Medicine, Pharmacy, Sciences and Technology "George Emil Palade", Tîrgu Mureș, Romania
| | - Bogdan Obada
- Department of Orthopedics, Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania.
| | - Madalina-Gabriela Iliescu
- Department of Rehabilitation, Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Marius Nicolae Popescu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Department of Rehabilitation, Elias Teaching Hospital, Bucharest, Romania
| | - Dan Marcel Iliescu
- Department of Anatomy, Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Vlad Predescu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
- Ponderas Academic Hospital, Bucharest, Romania
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Poppler LH, Yu J, Mackinnon SE. Subclinical Peroneal Neuropathy Affects Ambulatory, Community-Dwelling Adults and Is Associated with Falling. Plast Reconstr Surg 2020; 145:769e-778e. [PMID: 32221217 DOI: 10.1097/prs.0000000000006637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Peroneal neuropathy with an overt foot drop is a known risk factor for falling. Subclinical peroneal neuropathy caused by compression at the fibular neck is subtler and does not have foot drop. A previous study found subclinical peroneal neuropathy in 31 percent of hospitalized patients. This was associated with having fallen. The purpose of this study was to determine the prevalence of subclinical peroneal neuropathy in ambulatory adults and investigate if it is associated with falling. METHODS A cross-sectional study of 397 ambulatory adults presenting to outpatient clinics at a large academic hospital was conducted from 2016 to 2017. Patients were examined for dorsiflexion weakness and signs of localizing peroneal nerve compression to the fibular neck. Fall risk was assessed with the Activities-Specific Balance Confidence Scale and self-reported history of falling. Multivariate logistic regression was used to correlate subclinical peroneal neuropathy with fall risk and a history of falls. RESULTS The mean patient age was 54 ± 15 years and 248 patients (62 percent) were women. Thirteen patients (3.3 percent) were found to have subclinical peroneal neuropathy. After controlling for various factors known to increase fall risk, patients with subclinical peroneal neuropathy were 3.74 times (95 percent CI, 1.06 to 13.14) (p = 0.04) more likely to report having fallen multiple times in the past year than patients without subclinical peroneal neuropathy. Similarly, patients with subclinical peroneal neuropathy were 7.22 times (95 percent CI, 1.48 to 35.30) (p = 0.02) more likely to have an elevated fall risk on the Activities-Specific Balance Confidence fall risk scale. CONCLUSION Subclinical peroneal neuropathy affects 3.3 percent of adult outpatients and may predispose them to falling. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Louis H Poppler
- From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Jenny Yu
- From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Susan E Mackinnon
- From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
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Sobol G, Gibson P, Patel P, Koury K, Sirkin M, Reilly M, Adams M. Low Incidence of Neurovascular Complications After Placement of Proximal Tibial Traction Pins. Orthopedics 2017; 40:e1004-e1008. [PMID: 29058756 DOI: 10.3928/01477447-20171012-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/05/2017] [Indexed: 02/03/2023]
Abstract
Skeletal tibial traction is a temporizing measure used preoperatively for femoral fractures to improve the length and alignment of the limb and provide pain relief. The goal of this study was to identify possible neurovascular morbidity associated with the use of bedside skeletal tibial traction to treat femur fractures. All femoral fractures treated with proximal tibial traction during a 10-year period at an urban level I trauma center were retrospectively reviewed. The medical record was reviewed to determine whether a pin-related complication had occurred. Records also were reviewed to identify ipsilateral multi-ligamentous knee injuries that were not diagnosed until after the application of traction. In total, 303 proximal tibial traction pins were placed. A total of 7 (2.3%; 95% confidence interval, 0.60%-4.0%) pin-related neurologic complications and zero vascular complications were noted. All complications involved motor and/or sensory deficits in the distribution of the peroneal nerve. Of the 7 complications, 6 resolved fully after surgery and removal of the pin. After traction placement, 6 (2.0%) ipsilateral multiligamentous knee injuries were diagnosed. None of these patients had a neurovascular complication. This study suggests that bedside placement of proximal tibial traction for femoral fractures is associated with a low incidence of neurovascular complications and that traction can be safely placed at the bedside by residents. A thorough neurovascular examination should be performed before insertion, and care should be taken to identify the proper starting point and reduce soft tissue trauma during pin placement. [Orthopedics. 2017; 40(6):e1004-e1008.].
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Abstract
INTRODUCTION The incidence of peroneal neuropathy (PN), occurring predominantly in the left leg, increases after the incorporation of intermittent pneumatic compression (IPC) devices among adult liver transplantation (OLT) recipients in our hospital. The aim of this study was to investigate the possible risk factors for PN and the reason for the left-leg predominance. METHODS We retrospectively reviewed the medical records of 501 OLT recipients. The patients were first divided into 2 groups, PN (n = 33) and non-PN (n = 468), to assess possible risk factors. The patients were then categorized into IPC (n = 262) and non-IPC (n = 239) groups according to the use of IPC devices. In a subsequent prospective study, we measured the degree and duration of the tilt of the operating table during OLT to investigate their relationship to the predominant left-leg PN. RESULTS The rate of IPC device use was significantly greater among the PN than non-PN group (78.8% vs 50.4%, P < .01). The incidence of PN was significantly higher among the IPC than non-IPC group (9.9% vs 2.9%, P < .01). The degree and duration of left tilt of the operating table were greater and longer than the right tilt. CONCLUSIONS The use of IPC devices during OLT increased the occurrence of PN and the left tilt of the operating table was strongly related to the predominant left-leg PN. Careful protection of the vulnerable point and minimization of the tilting of the operating table is advised during OLT, especially when IPC devices are used.
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Affiliation(s)
- J S Yoon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea
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Aprile I, Caliandro P, Giannini F, Mondelli M, Tonali P, Foschini M, Padua L. Italian multicentre study of peroneal mononeuropathy at the fibular head: study design and preliminary results. Acta Neurochir Suppl 2005; 92:63-8. [PMID: 15830970 DOI: 10.1007/3-211-27458-8_14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The most common entrapment in the lower extremity is peroneal mononeuropathy (PM) at the fibular head. Several studies of this condition have been published but, until now, no wide multicenter clinical-neurophysiological studies on PM are available. In recent years, multicenter studies have been suggested; moreover it is commonly accepted that a multiperspective approach provides more comprehensive results. METHOD The Italian CTS and other entrapments Study Group has designed a strict clinical and neurophysiological protocol to carry out a wide multicentre study on PM at the fibular head. In addition to traditional clinical-neurophysiological evaluation, the group has also adopted validated disability and patient-oriented measurements in order to obtain more comprehensive and reliable data about this entrapment. The study was designed: 1) to identify predisposing factors; 2) to better assess the clinical picture; 3) to evaluate relationships between etiological, clinical and neurophysiological findings; 4) to evaluate the natural evolution of the entrapment. Study design is described. FINDINGS During the period from November 2002 to January 2004, 69 patients were enrolled consecutively in eleven Italian centres. Our preliminary data show that PM involves men more frequently than women (M:F = 3.9:1). With regard to the predisposing factors, PM is idiopathic (16%) or due to surgery (21.7%), prolonged posture (23.2%), weight loss (14.5%), external compression (5.8%), arthrogenic cyst at the fibula (1.4%), trauma (10.1%); it also occurred in bedridden patients (7.3%). Unexpectedly, peroneal nerve lesions were due not only to surgical operation close to the peroneal region, but were also associated with thoracic-abdominal surgery. Usually PM involves both terminal branches; patients complain of motor deficit in 99.5% of cases, sensory symptoms in 87.9% and pain in 19.7%. CONCLUSIONS Our preliminary results provide some interesting information and confirm the usefulness of multicentre and multiperspective studies to standardise the approach to nerve entrapment.
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Affiliation(s)
- I Aprile
- Department of Neuroscience, Institute of Neurology, Università Cattolica, Roma, Italy.
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Wong CA, Scavone BM, Dugan S, Smith JC, Prather H, Ganchiff JN, McCarthy RJ. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 2003; 101:279-88. [PMID: 12576251 DOI: 10.1016/s0029-7844(02)02727-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Neurological injury associated with present day labor and delivery is thought to be unusual. The purpose of this study was to estimate the incidence, severity, and duration of postpartum lumbosacral spine and lower extremity nerve injury and identify factors related to nerve injury. METHODS All women who delivered a live-born infant from July 1997 through June 1998 were asked about symptoms of lumbosacral spine and lower extremity nerve injury the day after delivery. Women with symptoms were examined by a physiatrist to confirm injury, and their cases were then followed by telephone until the symptoms resolved. Maternal variables (including prospective documentation of time spent pushing in various positions) and fetal variables that might be associated with risk of nerve injury were compared between women with injury and those without. RESULTS Six thousand fifty-seven women delivered live-born infants; 6,048 were interviewed and 56 had a confirmed new nerve injury, an incidence of 0.92%. Factors found by logistic regression analysis to be associated with nerve injury were nulliparity and prolonged second stage of labor. Women with nerve injury spent more time pushing in the semi-Fowler-lithotomy position than women without injury. The median duration of symptoms was 2 months. CONCLUSION The estimated incidence of postpartum nerve injury was greater than reported from previous studies and is associated with nulliparity and prolonged second stage of labor.
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Affiliation(s)
- Cynthia A Wong
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Pedrazzini M, Pogliacomi F, Cusmano F, Armaroli S, Rinaldi E, Pavone P. Bilateral ganglion cyst of the common peroneal nerve. Eur Radiol 2002; 12:2803-6. [PMID: 12386777 DOI: 10.1007/s00330-002-1322-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2001] [Revised: 12/03/2001] [Accepted: 12/17/2001] [Indexed: 11/29/2022]
Abstract
Ganglion cysts of the common peroneal nerve are rarely described in the literature and a bilateral lesion has not been previously reported. We present a case of a 41-year-old man with a bilateral cyst of the common peroneal nerve diagnosed with ultrasound and magnetic resonance imaging.
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Affiliation(s)
- Massimo Pedrazzini
- Institute of Radiology, University of Parma, Viale Gramsci 14, 43100 Parma, Italy.
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