Peroneal Mononeuropathy medscape

7/24/2019 Peroneal Mononeuropathy medscape

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Peroneal Mononeuropathy Treatment &

ManagementAuthor

Shaheen E Lakhan, MD, PhD, MS, MEdAssociate Professor of Neurology and Medical

Education, Assistant Dean of Curriculum (Years 3-4, California !ni"ersity of #cience and

Medicine #chool of Medicine

#haheen E $a%han, MD, PhD, M#, MEd is a mem&er of the follo'ing medical societies

American Academy of Neurology

Disclosure Nothing to disclose)

#*ecialty Editor +oard

Francisco Talavera, PharmD, PhDAdunct Assistant Professor, !ni"ersity of Ne&ras%a

Medical Center College of Pharmacy Editor-in-Chief, Medsca*e Drug .eference

Disclosure .ecei"ed salary from Medsca*e for em*loyment) for Medsca*e)

Glenn Lopate, MDAssociate Professor, De*artment of Neurology, Di"ision of

Neuromuscular Diseases, /ashington !ni"ersity #chool of Medicine Consulting #taff,

De*artment of Neurology, +arnes-0e'ish 1os*ital

2lenn $o*ate, MD is a mem&er of the follo'ing medical societiesAmerican Academy ofNeurology,American Association of Neuromuscular and Electrodiagnostic Medicine,Phi

+eta a**a


Chief Editor

Nicholas Lorenzo, MD, MHA, PEounding Editor-in-Chief, eMedicine Neurology

ounder and CE56CM5, P1$7 Consultants Chief Medical 5fficer, MeMD 8nc

Nicholas $oren9o, MD, M1A, CPE is a mem&er of the follo'ing medical societies Al*ha5mega Al*ha,American Association for Physician $eadershi*,American Academy of

Neurology


Additional Contri&utors

Aashit ! Shah, MD, FAAN, FANAProfessor and Associate Chair of Neurology, Director,

Com*rehensi"e E*ile*sy Program, Program Director, Clinical Neuro*hysiology ello'shi*,

Detroit Medical Center, /ayne #tate !ni"ersity #chool of Medicine
http://www.aan.com/http://www.aan.com/http://www.aan.com/http://www.aan.com/http://www.aanem.org/http://www.aanem.org/http://www.aanem.org/http://www.pbk.org/home/index.aspxhttp://www.pbk.org/home/index.aspxhttp://www.alphaomegaalpha.org/http://www.alphaomegaalpha.org/http://www.alphaomegaalpha.org/http://www.physicianleaders.org/http://www.aan.com/http://www.aan.com/http://www.aan.com/http://www.aan.com/http://www.aan.com/http://www.aanem.org/http://www.pbk.org/home/index.aspxhttp://www.pbk.org/home/index.aspxhttp://www.alphaomegaalpha.org/http://www.alphaomegaalpha.org/http://www.physicianleaders.org/http://www.aan.com/http://www.aan.com/http://www.aan.com/


2/13

Aashit #hah, MD, AAN, ANA is a mem&er of the follo'ing medical societies American

Academy of Neurology,American Neurological Association,American Clinical

Neuro*hysiology #ociety,American E*ile*sy #ociety

Disclosure .ecei"ed consulting fee from !C+ *harma for s*ea%ing and teaching .ecei"ed

grant6research funds from !C+ Pharma for other .ecei"ed consulting fee from #uno"ion fors*ea%ing and teaching .ecei"ed consulting fee from $und&ec% for s*ea%ing and teaching)

Pink" A#ar$al, MDClinical Associate Professor, De*artment of Neurology, !ni"ersity of

/ashington #chool of Medicine Attending Neurologist, Medical Director, +ooth 2ardner

Par%inson:s Care Center

Pin%y Agar'al, MD is a mem&er of the follo'ing medical societiesAmerican Academy of

Neurology,8nternational Par%inson and Mo"ement Disorder #ociety


Alida Gri%%ith, MDMo"ement Disorders Neurologist, +ooth 2ardner Par%inson;s Care

Center


&ack#ro'nd

Mononeuro*athies are a form of *eri*heral neuro*athy characteri9ed &y sensory distur&ances

and6or motor deficits in the distri&ution of the affected ner"e) 7hey can occur secondary to

direct trauma, com*ression, stretch inury, ischemia, infection, or inflammatory disease) 8n

the lo'er e


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7he *atho*hysiology of ischemic inuries and ner"e transection is a(onaldamage) /hen

a


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Peroneal mononeuro*athy is uncommon in children &ut has &een re*orted in all age grou*s)

Pro%ession

Dancers are also *rone to su*erficial and dee* *eroneal ner"e entra*ments)>@

Pro#nosis

Common *eroneal ner"e decom*ression is a useful *rocedure to im*ro"e sensation and

strength as 'ell as to decrease *ain)>3@

A retros*ecti"e study e"aluated electrodiagnostic *rognostic factors after *eroneal ner"e

inury in 3B su&ects) 5utcome 'as associated 'ith com*ound muscle action *otential

res*onses from e


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8n milder cases, 'ea%ness of foot e"ersion and dorsifle@


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8solated acute re*etiti"e strain inury such as re*etiti"e %ic%ing>F@ and dancing>@ )

#hort casts or &races around this area can &e factors in eB@ 7he su*erficial *eroneal ner"e is at ris% for traction inury during an an%le

in"ersion s*rain)>?I@ Jarus deformity in osteoarthritis of the %nee can result in *eroneal

ner"e inury 'ith conduction &loc% at the fi&ular nec%)>??@

$ac% or loss of the fat *ad o"er the fi&ular head due to a thin &ody ha&itus or sudden

'eight loss such as after &ariatric surgery>?@ or anore?@ 1o'e"er, ner"e conduction studies sho'ing a more generali9ed or

multifocal neuro*athy may aid in the diagnosis)

8ntermittent *neumatic com*ression to *re"ent dee* "ein throm&osis causing

com*ression of the *eroneal ner"e at the fi&ula head may cause &ilateral *eroneal

ner"e *alsy)>?B@


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Peroneal neuro*athy can occur follo'ing li"er trans*lantation) .is% factors include

intrao*erati"e *ositioning, *oor nutritional status, tall and slender &ody sha*e, and

alcoholic li"er disease)>I@

Dee* *eroneal neuro*athy resulting in foot dro* 'ith *reser"ed toe e


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Polyarteritis Nodosa

#ystemic $u*us Erythematosus (#$E

7o4@

1igh resolution sonogra*hy of the common *eroneal ner"e may identify structural

lesions of the *eroneal ner"e such as intraneural ganglion >@ and inflammatory

changes in "asculitic neuro*athy>F@ )

ther Tests

Ner"e conduction studies and needle EM2 aid in defining the location and ty*e of lesion)

Ner"e conductions should sho' isolated *eroneal ner"e a&normalities) 8f the lesion is

at the %nee, then conduction &loc% or, less commonly, conduction "elocity slo'ing

o"er that segment of the ner"e should &e documented) /hen a


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A grou* from 7ur%ey has re*orted good results after ti&ialis *osterior tendon transfer for

*ersistent foot dro* after *eroneal ner"e re*air)>B@

Another grou* has re*orted good results from *atients 'ith dee* *eroneal ner"e inuries

resulting in foot dro* undergoing ner"e transfer of functional fascicles of either the

su*erficial *eroneal ner"e or of the ti&ial ner"e as donor for dee* *eroneal-inner"ated musclegrou*s)>3I@

A grou* from 8taly has re*orted good motor im*ro"ement 'ith a dou&le tendon transfer

method from the ti&ialis *osterior to ti&ialis anterior, and fle


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??) #eyyed 1ossein9adeh 1., Eaa9i A, a9emi #M, Daftari +esheli $, 1assas Yeganeh

M, Aydanloo A) #udden *eroneal ner"e *alsy in a "arus arthritic %nee) Orthopedics)

IIB Dec) 3(?BI-3) >Medline@)

?) /eyns 0, +ec%ers , Janormelingen $, Jandersteen M, Ni"ille E) oot dro* as a

com*lication of 'eight loss after &ariatric surgery is it *re"enta&leO) Obes Surg) IIH

#e*) ?H(B?IB-?) >Medline@)

?3) /e&er P, .ost +) >AnoreMedline@)

?B) u%uda 1) +ilateral *eroneal ner"e *alsy caused &y intermittent *neumatic

com*ression)&ntern Med) IIF) 4(B3-4) >Medline@)

I) #inghal A, Jarma M, 2oyal N, Ji J, /adha'an M, 2u*ta #) Peroneal neuro*athy

follo'ing li"er trans*lantation *ossi&le *redis*osing factors and outcome)E'p Clin

ransplant) IIB Dec) H(4-) >Medline@)

?) ayal ., atiri +) Aty*ical dee* *eroneal neuro*athy in the setting of an accessory

dee* *eroneal ner"e)Muscle Nerve) IIB Aug) 4I(3?3-) >Medline@)

) El Demella'y D, +ain 0, Alga'ad 1, Pro"ias 0P) 8nflammatory *seudotumor of the

*eroneal ner"e case re*ort and literature re"ie')Ann (iagn Pathol) II e&)

?(?44-H) >Medline@)

3) Jieira .$, .osen&erg #, i*ro"s%i ) M.8 of the distal &ice*s femoris muscle

normal anatomy, "ariants, and association 'ith common *eroneal entra*ment

neuro*athy)AJR Am J Roentgenol) IIH #e*) ?B(34B-) >Medline@)
http://reference.medscape.com/medline/abstract/19968227http://reference.medscape.com/medline/abstract/18074496http://reference.medscape.com/medline/abstract/18074496http://reference.medscape.com/medline/abstract/19739065http://reference.medscape.com/medline/abstract/19423978http://reference.medscape.com/medline/abstract/19584995http://reference.medscape.com/medline/abstract/15803485http://reference.medscape.com/medline/abstract/19205143http://reference.medscape.com/medline/abstract/20436011http://reference.medscape.com/medline/abstract/16484746http://reference.medscape.com/medline/abstract/20353377http://reference.medscape.com/medline/abstract/19609929http://reference.medscape.com/medline/abstract/19609929http://reference.medscape.com/medline/abstract/18164415http://reference.medscape.com/medline/abstract/18164415http://reference.medscape.com/medline/abstract/17715099http://reference.medscape.com/medline/abstract/17715099http://reference.medscape.com/medline/abstract/19968227http://reference.medscape.com/medline/abstract/18074496http://reference.medscape.com/medline/abstract/19739065http://reference.medscape.com/medline/abstract/19423978http://reference.medscape.com/medline/abstract/19584995http://reference.medscape.com/medline/abstract/15803485http://reference.medscape.com/medline/abstract/19205143http://reference.medscape.com/medline/abstract/20436011http://reference.medscape.com/medline/abstract/16484746http://reference.medscape.com/medline/abstract/20353377http://reference.medscape.com/medline/abstract/19609929http://reference.medscape.com/medline/abstract/18164415http://reference.medscape.com/medline/abstract/17715099


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4) Erso9lu #, 59ul%u M, Yildirim E, 7andogan .) Common *eroneal ner"e *alsy from

an untreated *o*liteal *seudoaneurysm after *enetrating inury)J )asc Surg) e&

IIH) 4(4I-?I) >Medline@)

) Jisser $1) 1igh-resolution sonogra*hy of the common *eroneal ner"e detection of

intraneural ganglia)Neurology) IIF 5ct 4) FH(?4H3-) >Medline@)

F) Nodera 1, #ato , 7erasa'a Y, 7a%amatsu N, ai .) 1igh-resolution sonogra*hy

detects inflammatory changes in "asculitic neuro*athy)Muscle Nerve) IIF #e*)

34(33I-?) >Medline@)

H) #*inner .0, Amrami , Angius D, /ang 1, Carmichael #/) Peroneal and ti&ial

intraneural ganglia correlation &et'een intrae*ineurial com*artments o&ser"ed on

magnetic resonance images and the *otential im*ortance of these com*artments)

Neurosurg *ocus) IIH 0un ?) (FE?H) >Medline@)

) A*rile 8, 7onali P, Caliandro P, Pa99aglia C, oschini M, Di #tasio E, et al) 8talian

multicentre study of *eroneal mononeuro*athy multi*ers*ecti"e follo'-u*)Neurol

Sci) IIB e&) 3I(?3H-44) >Medline@)

B) 59%an 7, 7uncer #, 59tur% , Aydin A, 59%an #) 7i&ialis *osterior tendon transfer for

*ersistent dro* foot after *eroneal ner"e re*air)J Reconstr Microsurg) IIB Mar)

(3?H-F4) >Medline@)

3I) Nath ., $yons A+, Pai9i M) #uccessful management of foot dro* &y ner"e transfers

to the dee* *eroneal ner"e)J Reconstr Microsurg) II Aug) 4(F4?B-H)>Medline@)

3?) Jigasio A, Marcoccio 8, Patelli A, Mattiu99o J, Prestini 2) Ne' tendon transfer for

correction of dro*-foot in common *eroneal ner"e *alsy) Clin Orthop Relat Res) II

0un) 4FF(F?44-FF) >Medline@) >ull 7eMedline@)

3) atiri +, /il&ourn A0) 1igh sciatic lesion mimic%ing *eroneal neuro*athy at the

fi&ular head)J Neurol Sci) ?BB4 e&) ??(?H-) >Medline@)

3F) Marcinia% C, Armon C, /ilson 0) Practice *arameter utility of electrodiagnostic

techni=ues in e"aluating *atients 'ith sus*ected *eroneal neuro*athy an e"idence-

&ased re"ie')Muscle Nerve) II A*r) 3?(4I-H) >Medline@)
http://reference.medscape.com/medline/abstract/17264026http://reference.medscape.com/medline/abstract/17264026http://reference.medscape.com/medline/abstract/17060577http://reference.medscape.com/medline/abstract/16775830http://reference.medscape.com/medline/abstract/16775830http://reference.medscape.com/medline/abstract/17613208http://reference.medscape.com/medline/abstract/19153647http://reference.medscape.com/medline/abstract/19037849http://reference.medscape.com/medline/abstract/19037849http://reference.medscape.com/medline/abstract/18680090http://reference.medscape.com/medline/abstract/18414961http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2384039/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2384039/http://reference.medscape.com/medline/abstract/18346547http://reference.medscape.com/medline/abstract/18346547http://reference.medscape.com/medline/abstract/10393754http://reference.medscape.com/medline/abstract/8158211http://reference.medscape.com/medline/abstract/15768387http://reference.medscape.com/medline/abstract/17264026http://reference.medscape.com/medline/abstract/17060577http://reference.medscape.com/medline/abstract/16775830http://reference.medscape.com/medline/abstract/17613208http://reference.medscape.com/medline/abstract/19153647http://reference.medscape.com/medline/abstract/19037849http://reference.medscape.com/medline/abstract/18680090http://reference.medscape.com/medline/abstract/18414961http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2384039/http://reference.medscape.com/medline/abstract/18346547http://reference.medscape.com/medline/abstract/10393754http://reference.medscape.com/medline/abstract/8158211http://reference.medscape.com/medline/abstract/15768387


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3H) Masa%ado Y, a'a%ami M, #u9u%i , A&e $, 5ta 7, imura A) Clinical

neuro*hysiology in the diagnosis of *eroneal ner"e *alsy)#eio J Med) II 0un)

H(4-B) >Medline@)

3) #te'art 0D) oot dro* 'here, 'hy and 'hat to doO)Pract Neurol) II 0un)

(3?-FB) >Medline@)

3B) 7urner 5A, 7aslit9 N, /ard #) Common *eroneal ner"e entra*ment),andboo- o+

peripheral nerve entrapments) ?BBI) ??B-?4)

4I) /il&ourn A0) AAEE case re*ort ? Common *eroneal mononeuro*athy at the

fi&ular head)Muscle Nerve) ?BF No"-Dec) B(B-3F) >Medline@)

4?) /illiams 1, 0ohns 0#, /eiss 0M, et al) Neuromuscular reha&ilitation and

electrodiagnosis) ?) Mononeuro*athy)Arch Phys Med Rehabil) II Mar) F(3 #u**l

?#3-?I) >Medline@)
http://reference.medscape.com/medline/abstract/18677088http://reference.medscape.com/medline/abstract/18677088http://reference.medscape.com/medline/abstract/18502948http://reference.medscape.com/medline/abstract/18502948http://reference.medscape.com/medline/abstract/3023997http://reference.medscape.com/medline/abstract/3023997http://reference.medscape.com/medline/abstract/15761794http://reference.medscape.com/medline/abstract/18677088http://reference.medscape.com/medline/abstract/18502948http://reference.medscape.com/medline/abstract/3023997http://reference.medscape.com/medline/abstract/15761794

Peroneal Mononeuropathy medscape

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