Applicability of Magnetic Resonance Imaging for Early Diagnosis of Common Peroneal Neuropathy

Objective: This study aimed to assess the clinical applicability of magnetic resonance imaging (MRI) for the early diagnosis of common peroneal neuropathy (CPNe).Methods: Over three years, the authors have treated 58 patients with CPNe. All patients had clinical or neurophysiological confirmation of CPNe. Among them, 35 (60%) patients underwent axial knee MRI with a 1.5-Tesla scanner. These 35 patients were selected for study and were classified into three groups according to the time of examination after the occurrence of dropped foot―acute, subacute, and chronic onset groups. According to muscle appearances (normal, edematous change, and atrophy), we diagnosed them with CPNe, except for those with normal morphology. We evaluated the applicability of MRI in the diagnosis of CPNe compared to that of electromyography (EMG).Results: The 18, 11, and six cases were included in the acute, subacute, and chronic onset groups, respectively. In the acute onset group, three cases had normal muscle appearance, while 15 cases had edematous changes in the affected muscles. In the subacute onset group, eight cases had edematous changes, while three cases showed muscle atrophy. In the chronic onset group, six cases had muscle atrophy. CPNe could be diagnosed using MRI in about 91% (32/35) of all the cases. Excluding the chronologically chronic stage, diagnosis rate was approximately 89%(26/29) of all the cases. However, only in 27 cases (77%) denervation potentials were presented on EMG.Conclusion: According to our results, MRI is a helpful diagnostic modality, especially in the early stage of CPNe, and may lead to proper management.

Surgical treatment of common peroneal neuropathy in schwannomatosis: illustrative cases

BACKGROUND Neurofibromatosis syndromes such as neurofibromatosis type 1, neurofibromatosis type 2, and schwannomatosis often result in painful symptoms related to tumor burden. OBSERVATIONS Painful symptoms classically associated with common points of peripheral nerve entrapment, such as common peroneal neuropathy at the fibular tunnel, may present in patients both with and without focal tumor involvement. LESSONS Surgical decompression at the point of entrapment, with or without resection of tumor, may provide symptomatic relief. Examples of surgical decompression at the point of entrapment, both with and without resection of tumor, are presented.

Neuropathy Case Seen After Bariatric Surgery

Peroneal neuropathy is a rare complication after bariatric surgery, but it occurs in 15% of mononeuropathy. The etiology of peroneal neuropathy is multifactorial and is often blamed for these factors due to rapid weight loss and nutritional imbalance. Emine Karaca, 25 years old, female Patient 1 year ago, she had a stomach reduction (obesity surgery) surgery due to her weight of 130 kg. Six months after the operation, it decreased to 60 kg. Meanwhile, numbness in his right foot began to be pain and loss of strength after the operation. In the EMG performed on May 10, 2016, he was diagnosed with Fibulahead entrapment neuropathy-low foot. He was tied to lie in the same position for a long time during the operation. After this diagnosis, 15% prolotherapy was applied around the peroneal nerve of the fibular head on 11.05.2016. Prolotherapy was applied 2 times with 10 days intervals. L4-5 and L5-S1 segmental neural therapy in the lumbar region and neural therapy around the fibular head of the peroneal nerve and along its trace were applied twice a week. After a total of 2 prolotherapy and 6 neuraltherapy applied in 3 weeks, complete clinical recovery was achieved. This complete recovery was confirmed by EMG. Since electrophysiological findings of denervation occur after 2-3 weeks, it is recommended that EMG examination be performed 3 weeks later. Treatment includes relief of complaints (analgesics and gabapentin), physical therapy applications and support immobilizers. In cases that do not respond to treatment, nerve exploration and relaxation is provided with a surgical approach. Prolotherapy and neural therapy, among complementary medicine modalities, can also be used in peroneal nerve neuropathy.

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

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.