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In seven patients, peroneal nerve palsies developed while they were on weight-reduction diets. Five palsies were unilateral; two, bilateral. All patients recovered following diet modification. Therapeutic weight loss, of itself, can cause foot-drop. The prognosis is uniformly good.
The innervation of the right M. extensor digitorum brevis was investigated in 52 subjects with the aid of stimulation electromyography. In 13 cases (25%) a particular branch of the superficial branch of the peroneal nerve, the accessory deep peroneal nerve, could be identified. In 1 case it alone, and in 12 cases, together with the deep peroneal nerve, innervated the M. ext. dig. brevis. The significance of the awareness of this anomalous innervation is pointed out.
In a series of 70 patients (75 cases of common peroneal nerve palsy) the common causes were trauma about the knee or about the hip, compression, and underlying neuropathy. A few palsies occurred spontaneously for no apparent reason. The prognosis was uniformly good in the compression group; recovery was delayed but usually satisfactory in patients who had suffered stretch injuries. In the acute stage, when clinical paralysis appears to be complete, electrophysiological studies are a useful guide to prognosis. They may also indicate an underlying neuropathy and they detect early evidence of recovery. The anatomical peculiarities of the common peroneal nerve are noted and aspects of the clinical picture, management, and prognosis of palsy are discussed.
The F-wave has been used for estimations of motor nerve conduction velocity (MNCV) along the proximal segment (anterior horn cells to the knee) of the axons of the deep peroneal nerve in patients with renal failure and limb-girdle muscular dystrophy. MNCV and terminal latencies with conventional methods have also been estimated. Patients with chronic renal failure show marked F-chronodispersion (i.e. F-wave temporal dispersion) and impaired conduction along proximal and distal segments of the deep peroneal nerve. There is no evidence of motor nerve impairment, with conventional and F-wave methods, in patients with limb-girdle muscular dystrophy. It is shown that F-wave measurements are useful in electrophysiological studies of patients and may be more sensitive than conventional MNCV methods.
A retrospective analysis of 26 consecutive cases of traumatic common peroneal nerve palsy seen during a four-year period in the Department of Rehabilitation Medicine at New York Medical College was carried out. Fifteen were complete lesions, nine were incomplete lesions, and there were two cases of neurapraxia. Among the factors studied were etiology, age, sex, associated injuries, electrodiagnostic findings, and prognosis for recovery. The ultimate functional status of the patients was evaluated up to three years following injury. Of the patients, 19.2% recovered fully, and 26.9% showed partial recovery. The maximum time of recovery was achieved in 15.5 months in complete lesions and 9.5 months in incomplete lesions. The relationship of peronneal nerve injury to fractures of the femur is emphasized. The indications for medical, surgical and rehabilitative management are discussed.
Adequate hemostasis is extremely important in extensor reconstruction of the knee and possibly all knee injury. Hemarthrosis postoperatively contributes to postoperative discomfort and may increase the risk of infection. Hematoma formation is also responsible for neurovascular complications. Peroneal nerve palsies were associated with hematoma formation in this series and probably represented a pressure palsy. Release of the tourniquet with good hemostasis and a pressure dressing prior to cast application will aid in the prevention of hemarthroses and consequent neurovascular complications. Peroneal nerve palsy is probably more common in reconstruction of the extensor mechanism of the knee than has previously been reported.
Several atypical features of myelination of the peripheral nervous system are reported in common peroneal nerve of dystrophic mice (129 Re J dy/dy): (i) central nervous system-like contact between myelin sheaths of adjacent nerve fibres; (ii) nodes and internodes of myelinated fibres enwrapped with cytoplasmic processes of Schwann cells from adjacent nerve fibres; (iii) Schwann cells of adjacent nerve fibres co-operating in formation of a single myelin sheath; and (iv) a single Schwann cell myelinating two separate axons. In view of the presence of similar features of myelination in the central nervous system, where the myelin producing cells lack basement membrane, we suggest that in the dystrophic peripheral nerves the development of these features can be attributed to the partial deficiency of the Schwann cell basement membrane. Two types of widened nodes of Ranvier are also identified: (i) nodes with paranodal damage; and (ii) nodes without paranodal damage. In addition, abnormal features of myelination are described which are likely to represent altered Schwann cell/axon relationships during demyelination and remyelination and/or decreased myelinating ability of Schwann cells. We interpret these findings as indicating a metabolic disorder of Schwann cells. They provide an experimental model for the investigation of factors involved in the origin and maintenance of the structural organization of peripheral nerve.
In a 38-year-old woman, the entire muscle belly of the peroneus longus was replaced by a ganglion. Signs of peroneal nerve dysfunction resulted from direct pressure of the ganglion. Excision of the ganglion required a tenodesis of the peroneus longus tendon to provide a normal gait pattern which was maintained during a 17 month follow-up period. This entity needs careful, prompt evaluation to avoid neurological damage and to distinguish it from compartment syndrome.
The authors report a fifteen-year-old patient with an intraneural ganglion cyst of the common peroneal nerve, with paralysis of the anterior tibial muscles which was subacute in onset. The lesion was radically removed using microtechniques. Such a purely intraneural location has rarely been described. The use of the surgical microscope and pathological study of the peroneal articular branches allows one to reject the possible synovial origin of this lesion. The different hypotheses regarding aetiology are discussed, as well as the possible lines of treatment.
The morphological and functional recovery of the peripheral nerve, motor endplate, and muscle has been studied in rabbits after different periods of denervation of the muscles and secondary suture of the supplying nerve, by electrophysiological (electromyography and electroneurography) and histological methods (electron microscopy, including freeze fracture techniques and histochemistry). In rabbit peroneal nerve, 10 months of denervation appears as the critical interval. Longer periods of denervation are not followed by a sufficient functional recovery.
The F-wave has been used to estimate the motor nerve conduction velocity (MNCV) along the proximal segment (spinal cord to knee) of the axons of the deep peroneal nerve in patients with Charcot-Marie-Tooth disease and those with dystrophia myotonica. A new, modified method has been applied to estimate proximal MNCV in patients in whom F-waves or M-responses cannot be obtained from the small muscles of the foot. Terminal latencies and MNCV along the distal nerve segment (knee to ankle) have also been estimated using conventional techniques. The results have been compared with those obtained for control subjects. Proximal MNCV was severely slowed in every patient with Charcot-Marie-Tooth disease; the degrees of proximal and distal MNCV decreases were related. In patients with dystrophia myotonica, distal and proximal MNCVs were significantly reduced in comparison with control subjects, the MNCV slowing was not related to the degree of muscle atrophy. This is consistent with the hypothesis that the nerves and muscles are independently affected in dystrophia myotonica. It is concluded that the F-wave MNCV technique is as useful as, and may be more sensitive than, the conventional MNCV method.
An electrophysiological method is described for estimating the conduction velocity in the proximal segments (anterior horn cells to the knee) of the motor fibres of the deep peroneal nerve. The method utilizes large numbers of F-waves which are late muscle responses due to antidromically activated motoneurones. The results in 58 healthy subjects are presented. A detailed literature review concerning the nature of F-wave is presented.
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Author describe a rare condition of long peroneal muscle hernia, which caused severe nerve compression pain. After nerve decompression and fasciotomy the complains could be eliminated. The condition when discovered, operation should be done in a short time in order to avoid permanent nerve damage.