Dynamic neuropathy of the common peroneal nerve at the level of the fibular head (literature review and case report)

The study objective is to report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head and to discuss diagnostic methods and neurosurgical treatment. Materials and methods. We report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head in a female patient. The patient was treated in the Neurology Clinic of I.M. Sechenov First Moscow State Medical University. We analyzed clinical manifestations and compared them with the data described in research literature. Results. Upon admission, the patient complained of pain in the anterolateral surface of the right shin and in the dorsum of the foot during walking. At rest, the patient experienced no pain. We observed no motor or sensory disorders typical of nerve root disorders at the level of L₅. Lasegue’s test was negative. The patient had a positive Tinel’s sign in the area of the right fibular head. In order to clarify the diagnosis, we performed a repeated extension test in the right ankle joint and it was positive. The patient underwent surgery that included peroneal nerve decompression and neurolysis at the level of the fibular head. In the postoperative period, the patient had complete pain relief. Conclusion. Due to the difficulties in the diagnostics of dynamic neuropathy of the common peroneal nerve, this disease is often mistaken for radiculopathy at the level of L₅ . Thorough clinical examination, testing for Tinel’s sign in the area of the fibular head, and repeated extension test in the ankle joint ensure the correct diagnosis and reduce the frequency of ineffective surgeries on the lumbar spine. Surgical decompression of the common peroneal nerve at the level of the fibular head with obligatory opening of the entrance to the nerve canal is an effective method of treatment in such patients.

1. Craig A. Entrapment neuropathies of the lower extremity. PM R 2013;5(5 Suppl):S31–40. DOI: 10.1016/j.pmrj.2013.03.029. PMID: 23542774.

2. Swong K., Freeman D., McCoyd M. et al. Common peroneal nerve neuroplasty at lateral fibular neck: part I – anatomy, clinical presentation, and electrophysiology. Contemp Neurosurg 2017;39(12):1–5.DOI: 10.1097/01.CNE.0000524413.97885.76.

3. Myers R.J., Murdock E.E., Farooqi M. et al. A unique case of common peroneal nerve entrapment. Orthopedics 2015;38(7):644–6. DOI: 10.3928/01477447-20150701-91. PMID: 26186329.

4. Woltman H.W. Crossing the legs as a factor in the production of peroneal palsy. JAMA 1929;93(9):670–2.

5. Mozolevsky Yu.V., Barinov A.N. Combination treatment for tunnel neuropathies of the lower extremities. Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics 2013;(4):10–20. (In Russ.)]. DOI: 10.14412/2074-2711-2013-2449.

6. Khabirov F.A. Clinical variants of peroneal neuropathy. Prakticheskaya meditsina = Practical Medicine 2014;2(78):7–16. (In Russ.)].

7. Van Langenhove M., Pollefliet A., Vanderstraeten G. A retrospective electrodiagnostic evaluation of footdrop in 303 patients. Electromyogr Clin Neurophysiol 1989;29(3):145–52. PMID: 2721427.

8. Desai J. Common peroneal nerve palsy in maxillofacial surgery setting. Natl J Maxillofac Surg 2017;8(1):85–6. DOI: 10.4103/njms.NJMS_16_16. PMID: 28761284.

9. Kitamura T., Kim K., Morimoto D. et al. Dynamic factors involved in common peroneal nerve entrapment neuropathy. Acta Neurochir (Wien) 2017;159(9):1777–81. DOI: 10.1007/s00701-017-3265-2. PMID: 28702813.

10. Yılmaz Ö., Bodur H. Bilateral peroneal nerve palsy due to prolonged squatting

11. in a farmer. Fiziksel Tup ve Rehabilitasyon Bilimleri Dergisi = J Phys Med Rehabil Sci 2015;18(1).

12. Sangwan S.S., Marya K.M., Kundu Z.S. et al. Compressive peroneal neuropathy during harvesting season in Indian farmers. Trop Doct 2004;34(4):244–6. DOI: 10.1177/004947550403400424. PMID: 15510960.

13. Kitamura T., Morimoto D., Kim K., Morita A. Peroneal nerve entrapment neuropathy induced by playing the drum. Acta Neurochir (Wien) 2016;158(5):967–8. DOI: 10.1007/s00701-016-2770-z. PMID: 26979180.

14. Iwamoto N., Kim K., Isu T. et al. Repetitive plantar flexion test as an adjunct tool for the diagnosis of common peroneal nerve entrapment neuropathy. World Neurosurg 2016;86: 484–9. DOI: 10.1016/j.wneu.2015.09.080.

15. Morimoto D., Isu T., Kim K. et al. Microsurgical decompression for peroneal nerve entrapment neuropathy. Neurol Med Chir (Tokyo) 2015;55(8):669–73. DOI: 10.2176/nmc.oa.2014-0454. PMID: 26227056.

16. Kim K., Isu T., Kokubo R. et al. Repetitive plantar flexion (provocation) test for the diagnosis of intermittent claudication due to peroneal nerve entrapment neuropathy: case report. NMC Case Rep J 2015;2(4):140–2. DOI: 10.2176/ nmccrj.2014-0430. PMID: 28663985.

17. Zywiel M.G., Mont M.A., McGrath M.S. et al. Peroneal nerve dysfunction after total knee arthroplasty: characterization and treatment. J Arthroplasty 2011;26(3):379–85.

18. Iwamoto N., Isu T., Chiba Y. et al. [Clinical feathers and treatment of peroneal nerve entrapment neuropathy (In Japanese)]. No Shinkei Geka 2015;43(4):309–16.DOI: 10.11477/ mf.1436203012. PMID: 25838301.