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    Dr. Heny - Peroneal Palsy

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    Anonymous FfZm5kOkYF
    Fibular (peroneal) neuropathy is the most common mononeuropathy of the lower limbs. It results in ankle dorsiflexor weakness and foot drop. The most common site of injury is at the fibular head, where the nerve is susceptible to compression and stretching. Electrodiagnostic studies can help determine the level and type of injury (axonal vs demyelinating). Treatment involves reducing external pressure and compression through bracing, padding, or orthotics, along with medications to relieve pain. Surgery may be considered in severe cases that do not improve with conservative treatment.

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    Dr. Heny - Peroneal Palsy

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    Anonymous FfZm5kOkYF
    47 views16 pages
    Fibular (peroneal) neuropathy is the most common mononeuropathy of the lower limbs. It results in ankle dorsiflexor weakness and foot drop. The most common site of injury is at the fibular head, where the nerve is susceptible to compression and stretching. Electrodiagnostic studies can help determine the level and type of injury (axonal vs demyelinating). Treatment involves reducing external pressure and compression through bracing, padding, or orthotics, along with medications to relieve pain. Surgery may be considered in severe cases that do not improve with conservative treatment.

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    Fibular (peroneal) neuropathy is the most common mononeuropathy of the lower limbs. It results in ankle dorsiflexor weakness and foot drop. The most common site of injury is at the fibular head, where the nerve is susceptible to compression and stretching. Electrodiagnostic studies can help determine the level and type of injury (axonal vs demyelinating). Treatment involves reducing external pressure and compression through bracing, padding, or orthotics, along with medications to relieve pain. Surgery may be considered in severe cases that do not improve with conservative treatment.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    47 views16 pages

    Dr. Heny - Peroneal Palsy

    Uploaded by

    Anonymous FfZm5kOkYF
    Fibular (peroneal) neuropathy is the most common mononeuropathy of the lower limbs. It results in ankle dorsiflexor weakness and foot drop. The most common site of injury is at the fibular head, where the nerve is susceptible to compression and stretching. Electrodiagnostic studies can help determine the level and type of injury (axonal vs demyelinating). Treatment involves reducing external pressure and compression through bracing, padding, or orthotics, along with medications to relieve pain. Surgery may be considered in severe cases that do not improve with conservative treatment.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 16

    Peroneal palsy

    dr. Heny
    Key points
    Fibular (peroneal) neuropathy is the most
    common mononeuropathy encountered in the
    lower limbs.
    Clinically, sciatic mononeuropathies,
    radiculopathies of the 5th lumbar root, and
    lumbosacral plexopathies may present with
    similar findings of ankle dorsiflexor weakness,
    thus evaluation is needed to distinguish these
    disorders.
    The most common site of injury to the fibular
    nerve is at the fibular head.
    contd
    The deep fibular branch is more frequently
    abnormal than the superficial branch.
    Electrodiagnostic studies are useful to determine
    the level and type (axonal, demyelinating) of
    injury.
    The presence of any compound muscle action
    potential response on motor nerve conduction
    studies, recorded from either the tibialis anterior
    or extensor digitorum brevis, is associated with
    good long-term outcome.
    Anatomy
    Common Fibular (Peroneal) Nerve
    derived from the lateral division of the sciatic
    nerve (L4-S2)
    the common fibular nerve travels along the lateral
    side of the fossa at the border of the biceps
    femoris muscle to the lateral knee
    travels superficially at the lateral fibula and is
    located about 1 to 2 cm distal to the fibular head
    before entering the anterior compartment of the
    leg
    Deep Fibular (Peroneal) Nerve
    supplies motor innervation to all anterior
    compartment muscles (the tibialis anterior, the
    extensor digitorum longus, and extensor hallucis
    longus)
    supply sensation to the skin between the first and
    second toes.
    Superficial Fibular (Peroneal) Nerve
    travels distally in the leg through the lateral
    compartment
    the terminal sensory branch supplies sensation to
    the lower two-thirds of the anterolateral leg and
    the dorsum of the foot
    Accessory Fibular (Peroneal) Nerve
    Causes
    most often traumatic in origin; stretch or
    compression
    Recurring external pressure at the fibular head,
    such as that seen in patients at bed rest or in
    individuals who habitually cross their legs
    Intrinsic compression, such as that occurring from
    fascial bands or intraneural ganglia
    Acute fibular neuropathies located at the fibular
    head may be found in the setting of recent
    weight loss
    injury following surgical procedures
    Knee or fibular head
    Anaphylactoid purpura Knee stabilization by helicopter pilots
    Arthroplasty (knee) Kneepads
    Arthroscopy (Knee) Kneeling
    Baker cyst Lacerations
    Bed rest Lipoma
    Birth trauma Knee surgery
    Boney exostoses Schwannoma
    Casts Sequential compression devices
    Crossed-leg sitting Sesamoid bone of the lateral head of
    Cryotherapy gastrocnemius
    Fractures (femur, tibia, fibular) Severe valgus or varus deformity at the
    Fibrous arch knee
    Foot boards Splints
    Ganglion Squatting (childbirth, strawberry picking,
    farm workers)
    Gun shot wounds
    Synovial cysts
    Heterotopic ossification
    Traction
    Hematoma
    Varicose vein surgery
    Hemangiomas
    Venous thrombosis
    Intravenous infiltration or injections
    Water ski kneeboards
    Knee dislocation
    Weight loss
    Ankle or distal leg
    Ankle sprain Fasciotomy for
    Arthroscopy compartment syndrome
    Boots Fascia
    Burn scar Fracture
    Edema Ganglion cyst
    Exertional Inferior extensor
    compartment syndrome retinaculum
    External fixator Kneeling in prayer
    position
    Tightly fitting shoes
    Pathophysiology
    Compression and entrapment neuropathies are
    predominantly demyelinating.
    Myelin loss results in slowing of the nerve conduction
    through the area involved, when acute compression
    conduction block
    When compression is severe ischemic secondary
    axonal damage recovery is slower and longer and may
    not be complete
    Pure demyelinating lesions typically have a better capacity
    to recover.
    Nerve conduction studies and electromyography (EMG)
    can aid in defining the lesion location and type.
    Clinical features
    foot drop, weakness in ankle dorsiflexion and great toe extension
    sensory loss over the foot dorsum
    Foot slapping
    Deep branch : weakness in ankle dorsiflexion and great toe
    extension and Sensory loss may be found in the first web spaces
    Superficial branch : eversion weakness and sensory loss may be
    found over the foot dorsum
    Deep fibular neuropathy in conjunction with an accessory deep
    fibular nerve supplying complete innervation of the extensor
    digitorum brevis muscle, foot drop with preserved toe extension
    anterior tarsal tunnel syndrome have more sensory symptoms
    include numbness and paresthesias in the first dorsal web space
    Assessement
    Electrodiagnostic Evaluation
    Motor conduction studies
    Sensory Nerve Conduction Studies
    Needle Electromyography
    Complementary Assessment Techniques :
    USG, MRI
    Treatment
    Padding the knee
    Corticosteroids injection
    Pain relievers include gabapentin,
    carbamazepine, or tricyclic antidepressants such
    as amitriptyline
    Orthopedic devices may improve your ability to
    walk and prevent contractures include braces,
    splints, orthopedic shoes, or other equipment.
    Vocational counseling, occupational therapy
    Surgery

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