Combined peroneal and proximal tibial nerve palsies

Williams, Eric H.; Williams, Colin J.; Rosson, Gedge D.; Dellon, A. Lee

doi:10.1002/micr.20613

Cited by 13 publications

(10 citation statements)

References 15 publications

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“…[27][28][29] Tibial nerve injury in Zone III, i.e. the soleal sling, did emerge as one of the zones independently associated with the clinical score.…”

Section: Zones Of Injurymentioning

confidence: 90%

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Reddy

Amrami

Howe

et al. 2015

FOC

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OBJECT Knee dislocations are often accompanied by stretch injuries to the common peroneal nerve (CPN). A small subset of these injuries also affect the tibial nerve. The mechanism of this combined pattern could be a single longitudinal stretch injury of the CPN extending to the sciatic bifurcation (and tibial division) or separate injuries of both the CPN and tibial nerve, either at the level of the tibiofemoral joint or distally at the soleal sling and fibular neck. The authors reviewed cases involving patients with knee dislocations with CPN and tibial nerve injuries to determine the localization of the combined injury and correlation between degree of MRI appearance and clinical severity of nerve injury. METHODS Three groups of cases were reviewed. Group 1 consisted of knee dislocations with clinical evidence of nerve injury (n = 28, including 19 cases of complete CPN injury); Group 2 consisted of knee dislocations without clinical evidence of nerve injury (n = 19); and Group 3 consisted of cases of minor knee trauma but without knee dislocation (n = 14). All patients had an MRI study of the knee performed within 3 months of injury. MRI appearance of tibial and common peroneal nerve injury was scored by 2 independent radiologists in 3 zones (Zone I, sciatic bifurcation; Zone II, knee joint; and Zone III, soleal sling and fibular neck) on a severity scale of 1–4. Injury signal was scored as diffuse or focal for each nerve in each of the 3 zones. A clinical score was also calculated based on Medical Research Council scores for strength in the tibial and peroneal nerve distributions, combined with electrophysiological data, when available, and correlated with the MRI injury score. RESULTS Nearly all of the nerve segments visualized in Groups 1 and 2 demonstrated some degree of injury on MRI (95%), compared with 12% of nerve segments in Group 3. MRI nerve injury scores were significantly more severe in Group 1 relative to Group 2 (2.06 vs 1.24, p < 0.001) and Group 2 relative to Group 3 (1.24 vs 0.13, p < 0.001). In both groups of patients with knee dislocations (Groups 1 and 2), the MRI nerve injury score was significantly higher for CPN than tibial nerve (2.72 vs 1.40 for Group 1, p < 0.001; 1.39 vs 1.09 for Group 2, p < 0.05). The clinical injury score had a significantly strong correlation with the MRI injury score for the CPN (r = 0.75, p < 0.001), but not for the tibial nerve (r = 0.07, p = 0.83). CONCLUSIONS MRI is highly sensitive in detecting subclinical nerve injury. In knee dislocation, clinical tibial nerve injury is always associated with simultaneous CPN injury, but tibial nerve function is never worse than peroneal nerve function. The point of maximum injury can occur in any of 3 zones.

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“…[27][28][29] Tibial nerve injury in Zone III, i.e. the soleal sling, did emerge as one of the zones independently associated with the clinical score.…”

Section: Zones Of Injurymentioning

confidence: 90%

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Reddy

Amrami

Howe

et al. 2015

FOC

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“…MRN may depict a spectrum of nerve injuries, from minor stretch injury related nerve abnormality (seen as T2 signal abnormality/minor or no demonstrable fascicular abnormality) (Fig 6) to severe nerve abnormality, such as nerve discontinuity related to penetrating trauma or iatrogenic causes, which is an indication for immediate surgery (Fig 7). 29,30 TN may also be entrapped by the popliteal artery, a condition called the popliteal artery syndrome. PNST can be seen in isolation or in association with neurocutaneous syndromes.…”

Section: Proximal Tibial Neuropathymentioning

confidence: 99%

“…These patients may benefit from soleal sling release. 29,30 TN may also be entrapped by the popliteal artery, a condition called the popliteal artery syndrome. 31 These patients may present with calf pain and weakness in plantar flexion activities.…”

Section: Proximal Tibial Neuropathymentioning

confidence: 99%

3T Magnetic Resonance Neurography of Tibial Nerve Pathologies

Chalian

Soldatos

Faridian-Aragh

et al. 2012

Journal of Neuroimaging

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Diagnosis of tibial neuropathy has been traditionally based on clinical examination and electrodiagnostic studies; however, cross-sectional imaging modalities have been used to increase the diagnostic accuracy and provide anatomic mapping of the abnormalities. In this context, magnetic resonance neurography (MRN) offers high-resolution imaging of the tibial nerve (TN), its branches and the adjacent soft tissues, and provides an objective assessment of the neuromuscular anatomy, abnormality, and the surrounding pathology. This review describes the pathologies affecting the TN and illustrates their respective 3 Tesla (T) MRN appearances with relevant case examples.

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“…Surgical release of the sling has been reported as a successful strategy in these cases. [39][40][41] Both intraneural and extraneural ganglia may involve the tibial nerve. Tibial intraneural ganglia are less common than peroneal intraneural ganglia and arise from the proximal tibiofibular joint in two fashions: extending along an articular branch arising from the popliteal nerve or extending along the peroneal nerve and crossing over to the tibial nerve at the sciatic bifurcation.…”

Section: Compressive Neuropathymentioning

confidence: 99%

Imaging Nerve Pathology of the Knee: Magnetic Resonance Imaging and Ultrasound

Morag

Yang

2017

Semin Musculoskelet Radiol

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Peripheral neuropathies are not uncommon, and the diagnostic evaluation includes a clinical assessment and electrophysiologic studies as well as diagnostic imaging. Magnetic resonance imaging (MRI) and high-resolution ultrasound (HRUS) are of special importance in providing the surgeon with information in the context of nerve trauma, entrapment, and nerve involvement by tumors. Peripheral neuropathy about the knee can occur in the context of associated knee pathology such as trauma, as part of a systemic disease, or as an isolated finding. In this review, we discuss the role of MRI and HRUS in the evaluation of peripheral neuropathy and present imaging examples of peripheral neuropathy involving the knee.

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Combined peroneal and proximal tibial nerve palsies

Cited by 13 publications

References 15 publications

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation

3T Magnetic Resonance Neurography of Tibial Nerve Pathologies

Imaging Nerve Pathology of the Knee: Magnetic Resonance Imaging and Ultrasound

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