Peroneal nerve: Normal anatomy and pathologic findings on routine MRI of the knee

Abstract

BackgroundPeroneal nerve lesions are not common and are often exclusively assessed clinically and electromyographically.MethodsOn a routine MR examination without dedicated MR-neurography sequences the peroneal nerve can readily be assessed. Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.ResultsThe purpose of this article is to review the normal anatomy and pathologic conditions of the peroneal nerve around the knee.ConclusionIn the first part the variable anatomy of the peroneal nerve around the knee will be emphasized, followed by a discussion of the clinical findings of peroneal neuropathy and general MR signs of denervation. Six anatomical features may predispose to peroneal neuropathy: paucity of epineural tissue, biceps femoris tunnel, bifurcation level, superficial course around the fibula, fibular tunnel and finally the additional nerve branches. In the second part we discuss the different pathologic conditions: accidental and surgical trauma, and intraneural and extraneural compressive lesions.Teaching Points• Six anatomical features contribute to the vulnerability of the peroneal nerve around the knee.• MR signs of muscle denervation within the anterior compartment are important secondary signs for evaluation of the peroneal nerve.• The most common lesions of the peroneal nerve are traumatic or compressive.• Intraneural ganglia originate from the proximal tibiofibular joint.• Axial T1-weighted images are the best sequence to visualise the peroneal nerve on routine MRI.

Is diffusion tensor imaging useful in the assessment of the sciatic nerve and its pathologies? Our clinical experience

“…The last pattern is muscle fatty replacement, suggesting a long-standing denervation in which the involved muscle fibres are inevitably lost. 9 This is vital information for the surgeon as a muscle with fatty infiltration is unlikely to recover after surgical nerve repair. In this context, the information provided by DTI before the presence of muscle fatty replacement may be of value.…”

Lower Limb Nerve Supply

“…3.3.13.3.1 Common Peroneal Nerve Injury Pathologies of the common peroneal nerve, and its associated branches, can be classified into two categories -traumatic and compressive lesions (Van den Bergh et al, 2013). For those cases that are traumatic in origin, it is due to the superficial nature of the common peroneal nerve as it winds round the head of the fibula, combined with the epineural supporting tissue at this site (Van den Bergh et al, 2013).…”

Branching Patterns and Anatomical Course of the Common Fibular Nerve

“…www.e-arm.org femoris tendon in the popliteal fossa and progresses to wrap the fibular head (FH). Further, it distributes the articular branch right after and eventually is separated into the superficial and deep fibular nerves [1].…”