Download entrapment of the superficial peroneal nerve

ENTRAPMENT
OF
THE
SUPERFICIAL
THREE
JAMES
From
the Royal
Entrapment
cases
cases
of the
decompression
are
KERNOHAN,
Orthopaedic
superficial
Hospital,
nerve
peroneal
of the nerve
B.
at the point
REPORTS
LEVACK,
J. N.
London,
and
is an unusual
of exit
in the superficial
by Mr A. K. Henry
nerve entrapment.
be reproduced
by pressing
emerged
the
from
from
deep
peroneal
was
nerve”
the nerve
at the point
Case
3.
where
it
fascia.
pain,
He
which
was
had
There
incapacitated
led him
was
the lower
of pain
fascia
Hospital,
in the
Whitechapel
ankle
will produce
and
a good
foot.
In such
result.
Three
A
which
valgus.
Tinel’s
sign
history
diminished
leg and
and
to seek
distracted
many
sensation
dorsum
was
of the right
by
medical
to light
foot,
strongly
peroneal
The nerve
REPORTS
A 39-year-old
man
presented
with
a six-year
of pain in the right foot below
and in front of the
malleolus;
his symptoms
had started
after patel-
lectomy.
The London
33-year-old
woman
presented
with a nineof pain
over the right
lateral
malleolus
had
developed
after
manipulation
for
hallux
The pain was severe,
but sensation
was normal.
month
in 1945 to describe
superficial
He noted
that the pain could
CASE
1.
WILSON
cause
the deep
superficial
Case
history
lateral
NERVE
described.
“Mononeuralgia
coined
peroneal
National
CASE
PERONEAL
positive
nerve
in the
was exposed
over
lower
and freed
a distance
of several
centimetres.
and complete
pain relief.
the
course
of the
leg.
from
There
the fascia
was
for
permanent
the
opinions.
touch
over
with
localised
tenderness
about
10 cm above
the lateral
malleolus.
Percussing
the tender
area reproduced
the pain.
The superficial
peroneal
nerve
was dissected
and,
where
incised.
it emerged
through
the deep fascia,
This gave immediate
and lasting
the fascia
relief.
was
Case 2. A 25-year-old
woman
presented
with a 10-month
history
of pain in her right leg; this pain had developed
after
she had sprained
her right
ankle.
The pain
was
mainly
over
the lateral
and the dorsum
over the distal
about
pain.
side ofthe
lower
quarter
ankle.
There
was a slight
of the fibula,
and percussing
third
8 cm above
the lateral
malleolus
Sensation
was normal.
(The patient
been
investigated
at another
hospital
biopsy
had been performed.)
The nerve was explored
and found
it
emerged
ofthe
of the
under
Decompression
the
produced
crescent
almost
shin
swelling
a point
reproduced
the
had previously
where
a
tibial
to be flattened
of the
immediate
deep
fascia.
total
relief
of pain.
Fig.
as
lateral
J. G. Kernohan,
FRCS
Ed,
J. N. Wilson,
ChM.
FRCS.
Royal
National
Orthopaedic
WIP
8AD.
England.
B. Levack,
The London
Requests
for
reprints
should
Editorial
$2.00
malleolus.
divides
Registrar
Surgeon
Street,
London
As it emerges
from
into
two
branches.
the
fascia
it
DISCUSSION
FRCS,
Senior
Orthopaedic
Hospital,
Turner
Street,
.
1985 British
0301-620X/85/1006
60
FRCS,
Senior
Orthopaedic
Consultant
Orthopaedic
Hospital,
45-5 1 Bolsover
1
The common
peroneal
nerve is prominent
behind
the head
of the fibula.
The
superficial
peroneal
nerve
can be seen in the lateral
compartment;
it
emerges
through
the deep
fascia
approximately
one-quarter
of the
way
up the
leg from
the
be sent
Society
Registrar
London
El
to Mr
of Bone
J. G.
and
_________________________________
Joint
IBB,
England.
Kernohan.
Surgery
The superficial
peroneal
nerve
the
lateral
one-quarter
peroneal
nerve
arises
from
the common
at the neck of the fibula
and runs down
compartment
of the distance
THE
JOURNAL
of the
up the
OF
BONE
leg.
Approximately
leg from
the lateral
AND
JOINT
SURGERY
ENTRAPMENT
malleolus,
the nerve
pierces
into medial
and intermediate
(Fig.
before
I). The
leaving
the
deep
dorsal
OF
fascia,
and
cutaneous
nerve
may
divide
into
the deep fascia
(Romanes
THE
SUPERFICIAL
PERONEAL
1981).
divides
nerves
been
these
branches
1972).
Direct
injury
ofthe
reported
(Tibrewal
The
supplied
comprises
skin
the
61
NERVE
nerve
and
in the
lower
Goodfellow
third
of the
peroneal
front
of the
dorsum
of the foot (Fig. 2). Entrapment
exit through
the deep
fascia
causes
loss.
Retrograde
Thompson
cause
pain
1963).
may
Pressure
an increase
in the
the
A not uncommon
ankle.
Occasionally
due
to a root
be
at
at the
level
of
the
lower
leg
can
should
incident
is a twist of
are thought
to be
of the
lumbar
which
a laminectomy
may,
mistakenly,
(Banerjee
and Koons
1981).
A reliable
diagnostic
test is temporary
the pain after injecting
nerve leaves
the deep
and
exit
pain.
precipitating
the symptoms
lesion
the
point
of
sensory
(Kopell
point
radiating
nerve
leg and
at the
pain
and
a feature
the
also
1984).
by the superficial
distal
leg has
spine
be
for
performed
alleviation
of
lignocaine
at the point
where
fascia.
Operative
decompression
be
expected
to
alleviate
the
the
in
pain
permanently.
We wish
to thank
the Department
Surgeons
of England,
for allowing
would
also like to thank
Mr Derek
of Anatomy,
Royal
College
the use of anatomical
material.
Sayers
for the photographs.
of
We
REFERENCES
The superficial
peroneal
the skin of the great toe,
toes, and the dorsum
Kaushal
et al. (1976)
and
reported
peroneal
nerve
palsy
direct
Bianco
injury
and
neuropathy
fibular
The
distally,
during
MacCarty
of
total
neck.
peroneal
nerve
so forced
inversion
is
and
its fascial
opening
and Thompson
VOL.
I. JANUARY
No.
1985
Rose
et al. (1982)
have
at the knee
caused
by
nerve
taut against
1945; Kopell
67-B.
Henry
tethered
at
the
proximally
plantarfiexion
and
1963;
level
can
cause
injury
Banerjee
and
of
and
(Henry
Koons
Kaushal
SP,
following
Kopell
HP,
Baltimore:
Extensile
1945:296.
Superficial
exposure.
peroneal
1981 ;55:991-2.
Edinburgh
Galante
JO, McKenna
total
knee replacement.
Thompson
Williams
WAL.
and
entrapment:
London:
R, Bachmann
Clin Orthop
Peripheral
& Wilkins,
1963.
textbook
1972.
nerve
E & S LivingF. Complications
1976; 121 : 18 1-7.
entrapment
ofanatomy.
report
neuropathies.
1 1 th ed.
London:
HA, Hood RW, Otis JC, Ranawat CS, Insall JN. Peroneal-nerve
palsy
following
total
knee arthroplasty:
a review
of the Hospital
for Special
Surgery
experience.
J Bone
Joint
Surg
[Am]
1982;
64-A: 347-51.
Stack
RE, Bianco
AJ Jr, MacCarty
CS. Compression
of the common
peroneal
nerve by ganglion
cysts: report
of nine cases. J Bone Joint
Surg [Am] 1965;47-A:773-8.
Rose
the
pull
AK.
stone,
DD.
J Neurosurg
Romanes
GJ, ed. Cunningham’s
Oxford
University
Press,
knee
replacement.
Stack,
(I 965)
reported
compression
peroneal
the
Banerjee
T, Koons
of two cases.
nerve
supplies
the middle
three
of the foot.
it
Tibrewal
SB, Goodfellow
lower
third
of the
leg.
JW. Peroneal
nerve palsy
J R Soc Med
1984:77:72-3.
at the
level
of the