Subclinical Peroneal Neuropathy: A Common, Unrecognized, and Preventable Finding Associated With a Recent History of Falling in Hospitalized Patients

Poppler, Louis H.; Groves, Andrew; Sacks, Gina; Bansal, Anchal; Davidge, Kristen M.; Sledge, Jenifer A.; Tymkew, Heidi Hahn; Yan, Yan; Hasak, Jessica M.; Potter, Patricia; Mackinnon, Susan E.

doi:10.1370/afm.1973

Cited by 17 publications

(9 citation statements)

References 58 publications

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“…Carpal tunnel is the most well-known and studied nerve compression syndrome. While anesthesia, dysesthesia, or pain are prominent symptoms of carpal tunnel, other compressions may present primarily with weakness or be subtler [25]. The physiology of nerve compression is the same at other points of compression [26,27].…”

Section: Pain Definitions and Biologymentioning

confidence: 99%

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Poppler

Mackinnon

2019

Neurotherapeutics

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Pain is a frequent cause of physician visits. Many physicians find these patients challenging because they often have complicated histories, emotional comorbidities, confusing examinations, difficult problems to fix, and the possibility of factitious complaints for attention or narcotic pain medications. As a result, many patients are lumped into the category of chronic, centralized pain and relegated to pain management. However, recent literature suggests that surgical management of carefully diagnosed generators of pain can greatly reduce patients' pain and narcotic requirements. This article reviews recent literature on surgical management of pain and four specific sources of chronic pain amenable to surgical treatment: painful neuroma, nerve compression, myofascial/ musculoskeletal pain, and complex regional pain syndrome type II.

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Section: Pain Definitions and Biologymentioning

confidence: 99%

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Poppler

Mackinnon

2019

Neurotherapeutics

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“…Even patients with subclinical peroneal neuropathy are at increased risk of falling [5][6][7]. The pathology being common, epidemiological data nevertheless are scarce.…”

Section: Rationalementioning

confidence: 99%

“…Foot drop causes gait difficulties, leading to an increased risk of falling [4]. Even patients with subclinical peroneal neuropathy are at increased risk of falling [5–7]. The pathology being common, epidemiological data nevertheless are scarce.…”

Section: Introductionmentioning

confidence: 99%

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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“…Для поражения ОМН характерны парез тыльных разгибателей стопы и возникающий вследствие этого степпаж, который грубо нарушает ходьбу. Даже субклиническая компрессионная невропатия ОМН с минимальным снижением силы тыльного сгибания стопы приводит к частым падениям пациентов, что может быть причиной травм и переломов [4].…”

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“…При выполнении операции мы проводили разрез кожи длиной 8-12 см от проекции нижней части сухожилия двуглавой мышцы бедра до области проекции верхних отде- (4) in the place where it is easiest to find -under the biceps femoris tendon; c -the fascia thickness that compresses the nerve is visualized; d -fascia is dissected; e -dissection of the entrance to the long peroneal muscle; f -view of the surgical wound after common peroneal nerve decompression; the change in the nerve structure is visualized at the level of compression (denoted by a curly bracket) 1 Цветные рисунки к этой статье представлены на сайте журнала: nnp.ima-press.net статистически значимого характера. В целом, после операций, проведенных в течение первых 12 мес, доля пациентов с полным восстановлением функции нерва составила 82%.…”

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Clinical manifestations, diagnosis, and surgical treatment of compressive common peroneal neuropathy at the level of the fibular head

Bashlachev

Evzikov

Parfenov

2021

RJTAO

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Common peroneal neuropathy (CPN) is the most common tunnel neuropathy in the lower extremities, many issues of diagnosis and treatment of which require further study.Objective: to analyze the clinical manifestations of CPN, methods of its diagnosis and treatment results.Patients and methods. Eighty patients (31 women and 49 men) aged 18 to 82 years (mean age, 51 years) with compressive CPN were followed up during 2012–2018. Unilateral CPN and bilateral CPN were found in 76 and 4 patients, respectively. Eighty-four common peroneal nerve decompression operations were performed.Results and discussion. There was paralytic CPN in 73 (87%) surgical cases, painful CPN in 8 (9.5%), and intermittent CPN in 3 (3.5%). Diagnostic errors (when CPN was regarded as discogenic radiculopathy or lumbar stenosis) were noted in the painful and intermittent forms of the disease. After surgical treatment, complete recovery of peroneal nerve function was observed in 61 (72.6%) of the 84 surgical cases; its partial recovery in 15 (17.9%). Positive results were seen in all cases of painful and intermittent CPN, whereas they were more often observed in paralytic CPN if the operation was performed early (up to 12 months) after the onset of the disease.Conclusion. Common peroneal nerve decompression is an effective and safe therapeutic method that, in painful and intermittent CPN, leads to complete reversal of symptoms and, in the paralytic form of the disease, it is most effective in the early stages of the disease.

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Subclinical Peroneal Neuropathy: A Common, Unrecognized, and Preventable Finding Associated With a Recent History of Falling in Hospitalized Patients

Abstract: Subclinical peroneal neuropathy is common in medical inpatients and is associated with a recent history of falling. Preventing or identifying SCPN in hospitalized patients provides an opportunity to modify activity and therapy, potentially reducing risk.

Cited by 17 publications

References 58 publications

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

The Role of the Peripheral Nerve Surgeon in the Treatment of Pain

Evidence in peroneal nerve entrapment: A scoping review

Clinical manifestations, diagnosis, and surgical treatment of compressive common peroneal neuropathy at the level of the fibular head

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