Fibular (Peroneal) Neuropathy: Electrodiagnostic Features and Clinical Correlates

Common peroneal nerve (CPN) injury is a rare but significant complication of knee trauma. Given its low incidence, there is limited published evidence, but reports have shown dislocations and fractures associated with varus deformity are more likely to injure the nerve, causing foot drop. This study aims to document the incidence and outcome of CPN palsy in tibial plateau fractures (TPF).

We reviewed 746 cases of tibial plateau fractures treated between 2011 and 2020. We analysed patients' demographics, injury mechanisms, clinical course, and complications, and identified those with CPN palsies. Fractures were classified using the Schatzker, Luo and AO/OTA systems. The details of the CPN injury, including nerve conduction studies, duration of symptoms and outcome were recorded.

We identified 11 patients who had concurrent TPFs and CPN palsies, an overall incidence of 1.47 %. Most fractures involved the medial column (n = 9), with the C3 fragmentary TPF pattern being the most common (n = 4). The incidence of CPN injury was higher in medial fractures (5 %) and bicondylar fractures (3 %). We also found that most patients (n = 9) recovered full neurological function within 2 years.

This is the first study looking at a patient cohort sustaining concurrent TPFs and CPN injuries. It is a rare complication but should be looked for in high-risk medial and bicondylar fractures. We found that prognosis is better in TPF-associated CPN palsy than in other knee trauma, and that the majority of patients can expect a full recovery of nerve function.

Peripheral nerve injury caused by leprosy can lead to foot drop, resulting in an altered gait pattern that has not been previously described using 3D gait analysis.

Gait kinematics and dynamics were analyzed in 12 patients with unilateral foot drop caused by leprosy and in 15 healthy controls. Biomechanical data from patients' affected and unaffected limbs were compared with controls using inferential statistics and a standard distance, based on principal components analysis (PCA).

Patients walked slower than controls (0.8 ± 0.2 vs. 1.1 ± 0.2 m/s, p = 0.003), with a reduced stance and increased swing percentage. The affected limb increased (p < 0.05) plantar flexion at the initial contact (−16.8^o ± 8.3), terminal stance (−29.1^o ± 11.5), and swing (−12.4^o ± 6.2) in the affected limb compared to unaffected (−6.6^o ± 10.3; −14.6^o ± 11.6; 2.4^o ± 7.6) and controls (−5.4^o ± 2.5; −18.8^o ± 5.8; −1.4^o ± 3.9). Increased pelvic tilt and knee adduction/abduction range, with lower hip adduction, were observed. The second peak of ground reaction force (98.6 ± 5.2 %BW), ankle torque (0.99 ± 0.33 Nm/kg), and net ankle work in stance (−0.03 ± 5.4 J/Kg) decreased in the affected limb compared to controls (104.1 ± 5.5 %BW; 1.24 ± 0.4 Nm/kg; −4.58 ± 5.19 J/kg; p < 0.05). There were decreasing multivariate standard distances in the affected limb compared with the unaffected and controls. PCA loading factors highlighted the major differences between groups.

Leprosy patients with foot drop presented altered gait patterns in affected and unaffected limbs. There were remarkable differences in ankle kinematics and dynamics. Rehabilitation devices, such as ankle foot orthosis or tendon transfer surgeries to increase ankle dorsiflexion, could benefit these patients and reduce deviations from normal gait.

Polyneuropathy tends to progress in a distal to proximal fashion beginning at the tips of the toes. Sensory nerve conduction testing in the distal foot may identify early polyneuropathic changes. Deep fibular (DFN) sensory conduction techniques have been described to assess the distal dorsal foot, however, there has been no accommodation for reported anatomic communication between the DFN and superficial fibular nerve (SFN) in the dorsal foot. This study aims to stimulate both the DFN and SFN at the ankle to evaluate the function of the observed anatomic sensory nerve variations in the first dorsal web space. Normal nerve conduction values will also be presented in a sample of young adults and sex and BMI effects will be evaluated.

The study participants included 201limbs tested in 101 subjects (31 males and 70 females) between the ages of 18 and 47 (mean age 24.6 ± 4.8 years). The DFN and intermediate branch of the SFN (IDCN) were stimulated at the ankle 12 cm proximal to a surface recording electrode over the first dorsal web space of the foot. The obtained sensory nerve amplitude and latency values were recorded and velocity values were calculated.

The current study identified a first dorsal web space response in 78% of limbs tested. Web space responses were variable in origin with SFN only, DFN only and both SFN and DFN recorded responses in the web space. The mean DFN peak to trough amplitude was 5.8 ± 2.3 μV, while the peak velocity was 31.2 ± 2.9 m/s. The mean SFN-IDCN peak to trough amplitude was 5.9 ± 2.3 μV and the mean peak velocity was 32.1 ± 3.8 m/s. There was a statistically significant sex effect for SFN-IDCN onset latency and velocity with women demonstrating shorter onset latencies and faster velocities than the men. There was a significant SFN-IDCN BMI effect for onset latency and velocity, such that those with low BMI had shorter latency and faster nerve conduction values. A significant DFN sex effect was also identified for amplitude with males and females demonstrating a mean amplitude of 5.4 μV and 6.0 μV, respectively.

There is a high degree of anatomic and functional variability in sensory supply to the first dorsal web space of the foot requiring exploration of the DFN and SFN when assessing focal nerve entrapments or generalized polyneuropathy. A general dorsal foot sensory velocity and amplitude value may serve as an index for evaluation of early polyneuropathy.

Actualmente nos encontramos ante una situación excepcional de pandemia por SARS-CoV-2 que requirió el confinamiento de la población general durante semanas. Presentamos 6 casos de afectación esporádica de nervio peroneal en la rodilla remitidos al servicio de Neurofisiología Clínica del Hospital General Universitario de Castellón que ocurrieron durante el estado de alarma (desde el 14 de marzo al 21 de junio de 2020), lo cual constituye un incremento del 50% con respecto a los 3 años anteriores. La mayoría fueron varones jóvenes sin antecedentes médicos. Tres refirieron posturas mantenidas durante horas. El EMG descartó otras afectaciones y objetivó una neuroapraxia moderada-grave con leve-moderada degeneración axonal. Es importante evitar posturas inadecuadas de forma prolongada (cruce de piernas o apoyo de rodilla sobre superficies duras) para prevenir la compresión del nervio peroneal en la rodilla. El estudio EMG es útil para confirmar el diagnóstico, descartar otros procesos y emitir un pronóstico temprano.

Disturbances associated with Multiple Sclerosis (MS) can be due to the pathologic process of the disease or insufficient physical fitness. The benefits of exercise in improving cardiopulmonary fitness have been demonstrated in animal studies and also clinical trials on cardiovascular patients and healthy human cases; however, its effectiveness in people with MS(pwMS) is still unknown. people with MS often engage in rehabilitation programs for exercise tolerance improvement. Therefore, it is necessary to investigate the effect of this specific intervention on cardiopulmonary fitness of these patients. The present study intended to illustrate the etiology of exercise intolerance in pwMS and also the effects of exercise on these etiological factors.

The present interventional study included 21 female patients suffering from Relapsing-Remitting MS (RR-MS) who had a mean age of 35 ± 5.18 years and the Expanded Disability Status Scale (EDSS) scores of 1 to 4. All the participants underwent Cardiopulmonary Exercise Testing (CPET) on an ergometer pre- and post-intervention. The intervention included 18 sessions of endurance training using a stationary bicycle with an intensity of 70% of the peak Heart Rate (HR) or 60% of the peak VO₂ (Volume of oxygen consumption) under the supervision and cardiac monitoring. A total of 24 variables, including the parameters cardiopulmonary fitness (aerobic fitness), were investigated. Also, all the maximal variables were analyzed in the same RER(Respiratory Exchange Ration) (a mean RER of 0.92) pre- and post-intervention. According to the results, a total of 17 variables out of 24 study variables had significant changes (P < 0.05).

The present study showed that even a short, 6-week course of aerobic exercise could change the peak HR and VO₂, improving the cardio pulmonary fitness in these patients. This indicates the adaptation of the cardiopulmonary system to exercise in pwMS. In other words, these cardiopulmonary fitness variables improvement due to exercise demonstrates that this pathology is not merely caused by the MS-induced Central Nervous System (CNS) involvement and can be improved by improving cardiopulmonary fitness.

Peroneal nerve entrapment is a frequent cause of foot drop. Despite being frequent, no guidelines exist to recommend surgical or non-invasive treatment, leading to important variations in daily practice.

To map variation in daily practice.

An online Qualtrics survey was distributed among neurosurgeons, neurologists, orthopaedic surgeons and physical medicine and rehabilitation physicians through various national and international scientific organizations, mapping current treatment strategies. Descriptive statistics and non-parametric tests were used to analyse data with SPSS.

Responses from 181 out of 221 participants from 35 countries were analysed. A large majority of participants agreed that good evidence supporting any treatment strategy is lacking (77.9%) and that daily practice is mostly guided by own beliefs and experience (84.0%). Both non-invasive treatment and neurolysis are well established treatment strategies (supported by respectively 92.3% and 93.4% of physicians). Timing of neurolysis and duration of non-invasive treatment varied considerably. Duration of non-invasive treatment was significantly shorter in the group of surgeons compared to non-surgeons (p ​= ​0.033). Most physicians consider neurolysis a valid treatment option. However, significant more non-surgeons than surgeons were opposed to surgical treatment (p ​= ​0.001).

Important differences in attitudes were observed not only between, but also within specialisms, regardless of physician experience. This survey highlights important variations in daily practice for foot drop due to peroneal entrapment and emphasizes the need for future controlled studies.