Diagnostic value of ultrasonography in peroneal neuropathy

Abstract

Introduction Peroneal neuropathy is one of the most common mononeuropathies in the lower extremities and usually occurs at the fibular head where the nerve is superficial and vulnerable to injury. Peroneal neuropathy at the fibular head (PNFH) can result from a variety of conditions such as trauma, traction injuries, masses, entrapment, and external compression from prolonged immobilization. Patients with PNFH usually have weak toe and ankle dorsiflexion, weak foot eversion, and numbness over the lower lateral calf and the dorsum of the foot. Therefore, patients with sciatic neuropathy, lumbosacral plexopathy, or L5 radiculopathy may present a similar clinical pattern and differentiating PNFH from these conditions may sometimes be difficult (1,2). The diagnosis of PNFH is based on clinical findings and electrophysiological studies. Electrophysiological evaluation is usually adequate for the diagnosis of PNFH. However, additional tests may be required, especially in nonlocalizing peroneal nerve lesions with severe axonal loss. Although ultrasonography has proven to be useful in entrapment neuropathies of the upper extremities (3,4), there are few studies that investigated the validity of ultrasonography in the diagnosis of PNFH (5-8). In this study, we analyzed ultrasonographic findings in patients with PNFH and evaluated the efficiency of ultrasonography in the diagnosis of PNFH. 2. Materials and methods 2.1. Patients and controls This study included 15 peroneal nerves of 12 patients with PNFH and 24 peroneal nerves of 12 healthy controls. Three patients had PNFH bilaterally. The inclusion criteria were based on both clinical and electrophysiological findings. To make the clinical diagnosis, we looked for weak toe and ankle dorsiflexion, weak foot eversion, and sensory loss over the lateral calf and the dorsum of the foot. Local pain or Tinel's sign may also be present at the fibular head. Patients with any symptoms of polyneuropathy were excluded from the study. Patients with diseases related to polyneuropathy, hypothyroidism, diabetes mellitus, amyloidosis rheumatoid arthritis, or pregnancy were also excluded from the study. Histories of acute trauma, peroneal surgery, and duration of symptoms longer than Background/aim: Peroneal neuropathy at the fibular head (PNFH) is one of the most common entrapment neuropathies. Our aim in this study was to analyze the efficiency of ultrasonography in the diagnosis of PNFH. Materials and methods: The study included 15 peroneal nerves of 12 patients with PNFH and 24 peroneal nerves of 12 healthy controls. PNFH confirmation was based on clinical and electrophysiological findings. All patients and controls underwent ultrasonographic evaluations for peroneal nerves. The cross-sectional area (CSA) was measured. Echogenicity of the nerve was evaluated by comparing it with the adjacent connective tissue deep under the subcutaneous fat. Results: CSA measurement of the peroneal nerve is a valuable diagnostic tool in predicting PNFH (AUC: 0.87, 95% CI: 0.73-1.00, P < 0.01). The CSA ...

Bilateral common peroneal neuropathy due to rapid and marked weight loss after biliary surgery: A case report

“…If a patient experiences foot drop symptoms, not only peroneal neuropathy but also sciatic neuropathy, lumbosacral plexopathy, L5 radiculopathy and peripheral polyneuropathy should be included in the list of differential diagnoses[ 2 ]. In particular, a deficiency of vitamins (B1, B6, B9, and B12) and minerals can cause peripheral polyneuropathy, and dietary modifications such as supplementation of insufficient nutrients can help recovery.…”

“…Peroneal neuropathy is one of the most common form of mononeuropathy in the lower extremities, accounting for approximately 15% of all mononeuropathies in adults[ 1 ]. The known causes of damage to the peroneal nerve are trauma, external compression, or traction injuries[ 2 ]. In addition, nerve damage caused by tumors or cysts in the course of the peroneal nerve can be considered[ 3 ].…”

Evidence in peroneal nerve entrapment: A scoping review

“…Seven papers focused on diagnostic performance of US [32][33][34][35][36][37][38], and four papers reported on diagnostic performance of MRI [32,[39][40][41].…”

“…We identified 10 studies reporting on criteria for conduction block [16,22,33,36,37,[42][43][44][45][46] and six studies stating criteria for slowing of motor nerve conduction velocity [33,36,37,42,43,46].…”

“…Visser et al [33] reported only a moderate specificity of 69% with CSA measurements at maximal diameter. Here, a cutoff value of >8 mm 2 was used, instead of 11.5-12 mm 2 as reported in the other papers [32,36]. Data on the prognostic value of CSA measures is very limited, with one paper [45] reporting no difference in outcome between groups of patients with increased CSA and without increased CSA.…”