A simple test to assist with the diagnosis of common fibular nerve entrapment and predict outcomes of surgical decompression

Nirenberg, Michael S.

doi:10.1007/s00701-020-04344-3

Cited by 10 publications

(15 citation statements)

References 32 publications

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“…Based on the current literature, the percentage of patients with good outcome varies from 0 to 100% for conservatively treated patients and from 40% to 100% after surgery. Outcome of surgical treatment was extracted from 18 papers [2,10,19,48–58,61,65,67,68] including one systematic review of different surgical techniques in the treatment of peroneal neuropathy [65] one prospective follow‐up study [67] and one large retrospective case series of 200 patients [2], all reporting good outcome in around 85% of patients. Outcome of conservative treatment was extracted from 13 papers [10,24,45,49,59–64,66–68], including one multicentre, prospective follow‐up study reporting improvement of ankle dorsiflexion in 79% of patients at 6 months [66].…”

Section: Discussionmentioning

confidence: 99%

“…All but four papers identified as reporting on treatment of peroneal nerve entrapment were case series [2,10,19,24,45,[48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64]. One systematic review on the surgical treatment of peroneal neuropathy, with a variety of surgical techniques and patients, was included [65].…”

Section: Source Characteristics and Level Of Evidencementioning

confidence: 99%

“…Five articles on conservative [10,59,61,62,64] treatment and seven articles [2,51,[54][55][56]58,67] on outcome after neurolysis reported recovery (or improvement of muscle strength) within the first weeks to months. In a monocentric, surgical follow-up study, the median MRC equalled 4 at 1 month [67].…”

Section: Treatment Of Peroneal Nerve Entrapmentmentioning

confidence: 99%

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Evidence in peroneal nerve entrapment: A scoping review

Oosterbos

Decramer

Rummens

et al. 2021

Euro J of Neurology

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Background and purpose Daily management of patients with foot drop due to peroneal nerve entrapment varies between a purely conservative treatment and early surgery, with no high‐quality evidence to guide current practice. Electrodiagnostic (EDX) prognostic features and the value of imaging in establishing and supplementing the diagnosis have not been clearly established. Methods We performed a literature search in the online databases MEDLINE, Embase, and the Cochrane Library. Of the 42 unique articles meeting the eligibility criteria, 10 discussed diagnostic performance of imaging, 11 reported EDX limits for abnormal values and/or the value of EDX in prognostication, and 26 focused on treatment outcome. Results Studies report high sensitivity and specificity of both ultrasound (varying respectively from 47.1% to 91% and from 53% to 100%) and magnetic resonance imaging (MRI; varying respectively from 31% to 100% and from 73% to 100%). One comparative trial favoured ultrasound over MRI. Variable criteria for a conduction block (>20%–≥50) were reported. A motor conduction block and any baseline compound motor action potential response were identified as predictors of good outcome. Based predominantly on case series, the percentage of patients with good outcome ranged 0%–100% after conservative treatment and 40%−100% after neurolysis. No study compared both treatments. Conclusions Ultrasound and MRI have good accuracy, and introducing imaging in the standard diagnostic workup should be considered. Further research should focus on the role of EDX in prognostication. No recommendation on the optimal treatment strategy of peroneal nerve entrapment can be made, warranting future randomized controlled trials.

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Section: Discussionmentioning

confidence: 99%

Section: Source Characteristics and Level Of Evidencementioning

confidence: 99%

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Evidence in peroneal nerve entrapment: A scoping review

Oosterbos

Decramer

Rummens

et al. 2021

Euro J of Neurology

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“…Aside from the clinical presentation of CPN neuropathy described in the previous section, the diagnosis may be aided by eliciting a Tinel's sign or performing a diagnostic nerve block. 22 Motor nerve conduction studies are another helpful tool for diagnosis for localization. A recording electrode is placed over the extensor digitorum brevis, and the nerve is stimulated at three separate locations: the anterior ankle, fibular head, and popliteal fossa.…”

Section: Common Peroneal Nerve (Cpn)mentioning

confidence: 99%

An Update on Peroneal Nerve Entrapment and Neuropathy

et al. 2021

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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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“…We have found that if there was a substantive increase in motor function there was a very high correlation of a positive outcome after neurolysis as we report in this article. It is imperative to differentiate the predictive ability of peripheral nerve blocks when comparing a planned decompression surgery versus some type of neuroablative or denervation surgery, as with decompression the predictive value is much higher than with any nerve destructive procedures [1] [4].…”

Section: Introductionmentioning

confidence: 99%

Predictive Reliability of the Phoenix Sign for the Outcome of Common Fibular (Peroneal) Nerve Decompression Surgery

Barrett¹,

Khan²,

Brown³

et al. 2020

OJO

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A positive Phoenix sign occurs when a patient, with a suspected focal nerve entrapment of the Common Fibular (Peroneal) Nerve (CFN) at the level of the fibular neck, demonstrates an improvement in dorsifexion after an ultrasound guided infiltration of a sub-anesthetic dose of lidocaine. Less than 5 cc's of 1% or 2% lidocaine is utilized and the effect is seen within minutes after the infiltration, but usually lasts only 10 minutes. This effect may be due to the vasodilatory action of lidocaine on the microcirculation in the area of infiltration. This nerve block has significant diagnostic utility as it is highly specific in the confirmation of true focal entrapment of the CFN, has high predictive value for a patient who may undergo surgical nerve decompression if they have demonstrated a positive Phoenix Sign, and may help in the surgical decision-making process in patients who have had a drop foot for many years but still may regain some motor function after decompression. In this retrospective review, 26 patients were tested, and 25 of this cohort demonstrated a Positive Phoenix Sign (an increase in dorsiflexion strength of the Extensor Hallucis Longus muscle (EHL)). One patient had no response to the peripheral nerve block. Of the 25 patients who demonstrated a positive "Phoenix Sign" and underwent nerve decompression of the CFN, and 25 (100%) showed an increase in dorsiflexion strength of the EHL after nerve decompression surgery of the CFN. The one patient in this cohort who did not demonstrate any improvement in dorsiflexion of the EHL after the nerve block did not have any improvement after surgery.

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A simple test to assist with the diagnosis of common fibular nerve entrapment and predict outcomes of surgical decompression

Cited by 10 publications

References 32 publications

Evidence in peroneal nerve entrapment: A scoping review

Evidence in peroneal nerve entrapment: A scoping review

An Update on Peroneal Nerve Entrapment and Neuropathy

Predictive Reliability of the Phoenix Sign for the Outcome of Common Fibular (Peroneal) Nerve Decompression Surgery

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