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The main objective of this study is to assess the course of peroneal mononeuropathy (PM). The study design includes Clinical and Prospective study. The setting involves neurophysiological Service. From November 2002 to January 2004, we enroled 69 consecutive patients and prospectively followed up 49 patients with multiple measurements. Comparison w...
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Context 1
... the re-evaluated sample (46 cases at follow-up) the age distribution was normal (mean 48.4, SD 20.3, range 17-80, Kolmogorov-Smirnov P \ 0.20, Lilliefors P \ 0.01) (Fig. 1). Males were 76% of the cases, con- firming that PM is a male dominant disease, as reported in our previous study [6]; in fact sex was not associated with a definitive factor. No significant differences were observed between the re-evaluated sample (n = 46) and the drop-out sample (n = 20) in the clinical, electrophysiological, ...
Citations
... No guidelines are available and studies comparing non-invasive treatment and neurolysis are lacking. Good outcome has been reported for both treatment strategies, with percentages ranging from 0 to 100% for conservatively treated patients [5][6][7][8][9][10][11][12][13][14][15][16][17] and 40% to 100% after surgery [2,9,10,12,13,[17][18][19][20][21][22][23][24][25][26][27][28][29]. Good outcome was not uniformly defined making direct comparison of studies even more difficult. ...
Background
High-quality evidence is lacking to support one treatment strategy over another in patients with foot drop due to peroneal nerve entrapment. This leads to strong variation in daily practice.
Methods/design
The FOOTDROP (Follow-up and Outcome of Operative Treatment with Decompressive Release Of The Peroneal nerve) trial is a randomized, multi-centre study in which patients with peroneal nerve entrapment and persistent foot drop, despite initial conservative treatment, will be randomized 10 (± 4) weeks after onset between non-invasive treatment and surgical decompression. The primary endpoint is the difference in distance covered during the 6-min walk test between randomization and 9 months later. Time to recovery is the key secondary endpoint. Other secondary outcome measures encompass ankle dorsiflexion strength (MRC score and isometric dynamometry), gait assessment (10-m walk test, functional ambulation categories, Stanmore questionnaire), patient-reported outcome measures (EQ5D-5L), surgical complications, neurological deficits (sensory changes, motor scores for ankle eversion and hallux extension), health economic assessment (WPAI) and electrodiagnostic assessment.
Discussion
The results of this randomized trial may elucidate the role of surgical decompression of the peroneal nerve and aid in clinical decision-making.
Trial registration
ClinicalTrials.gov NCT04695834. Registered on 4 January 2021.
... We identified one prospective multicentre follow-up study [66] on conservative treatment of peroneal neuropathy (including peroneal nerve entrapment) and one monocentric follow-up study on surgical treatment of idiopathic peroneal nerve entrapment [67]. One literature review on peroneal nerve entrapment after weight loss included a narrative description of treatment outcome [68]. ...
... Outcome of neurolysis at 1-year follow-up is limited to one nonrandomized follow-up study [67] Literature discussing predictors of good and bad outcome is scarce and mostly limited to case series [2,45,58,61,77,78]. Apart from these case series, we identified one meta-analysis on predictors of favourable and unfavourable surgical outcome in peroneal neuropathy [54] and one multicentre prospective study on conservative treatment [66]. In general, a postural peroneal neuropathy was considered prognostic of favourable outcome by several authors [45,58,61,77,78], with complete recovery in 80% [58] to 100% [77,78] of conservatively treated patients. ...
... In general, a postural peroneal neuropathy was considered prognostic of favourable outcome by several authors [45,58,61,77,78], with complete recovery in 80% [58] to 100% [77,78] of conservatively treated patients. Aprile et al. [66] found that patients with a subacute onset of foot drop scored significantly higher on mental aspects of quality of life. Identified predictors of bad outcome are an associated polyneuropathy [58,77], alcohol abuse [58,77], diabetes [66] and smoking [54]. ...
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.
... In Asia, squatting or sitting "taylor" style with legs crossed is quite common, causing peroneal nerve compromise [27]. Peroneal palsy, especially bilateral, is disabling [28] while entirely preventable by avoiding the offending postures. The same considerations are valid in cases of ulnar nerve compression, of which we observed 4 cases. ...
Abstract Background Obesity is a major global health problem. Kuwait has a very high prevalence of obesity, and consequently, the number of bariatric surgeries is rising. Objectives The aim of this study is to analyze the clinical presentation and electrodiagnostic features of peripheral nerve complications following bariatric surgery. Subjects and methods We retrospectively involved a convenience sample of patients presenting at a tertiary referral center and analyzed the patterns and frequency of peripheral nerve involvement, correlations with operative techniques, perioperative complications, nutritional status, possible risk factors, and functional impairment. Results Among the 58 cases, 23 presented with chronic distal symmetrical sensorimotor neuropathy, 10 suffered from small fiber neuropathy, 22 had mononeuropathies, 2 patients had acute axonal sensorimotor neuropathy, and only 1 patient had lumbar plexopathy. In 22 patients, we observed mononeuropathies (10 cases of carpal tunnel syndrome, 7 cases of peroneal compression at the knee, 4 cases of ulnar neuropathies at the elbow, and 1 case of meralgia paresthetica). Rapid weight loss and protracted postoperative vomiting tended to correlate with generalized neuropathies, while focal compression with loss of the protective subcutaneous tissue pad was associated with mononeuropathies. All patients suffered from a deficiency of at least 1 micronutrient. Compliance with supplementary therapy was poor. Some post-bariatric neuropathies interfere severely with patients’ functional status. Conclusion Prevention by close follow-up, nutritional intervention, and patient education to avoid habitual postures related to nerve compression is appropriate.
... Patients in both the RG and CG were evaluated twice, at baseline (T0) and at the end of the rehabilitation program (T1). The clinical evaluations included scales for the upper limb function (the Fugl-Meyer [11] and the Motricity Index [12]), spasticity (the Modified Ashworth Scale for shoulder, elbow and wrist [13]), lower limb performance (the Deambulation Index [14]), and activities of daily living (the modified Barthel Index [15]). The instrumental evaluations included the evaluation of the muscle strength (handgrip dynamometer) and the finger pinch (pinch gauge). ...
Robot-mediated therapy is a viable approach for upper limb rehabilitation. The upper limb is a highly complex segment and the identification of the appropriate devices capable of rehabilitating it globally (from the shoulder to the hand) in clinical practice is crucial. In this work, we aimed: (i) to describe an approach used in identifying a set of technological and robotic devices to globally treat the upper limb, and (ii) to evaluate the feasibility of the identified set in clinical practice. Using an ad-hoc form, a multidisciplinary team identified a set of four robotic and sensor-based devices to treat globally the upper limb. Then, 30 stroke patients were enrolled and assigned to two groups: the robotic group (RG), where patients were treated with the robotic set, or the conventional group (CG). All patients were evaluated before and after the treatment. In the RG the patients used all the devices (one in each rehabilitation session); the treatment was well accepted, without drop-outs or adverse events. Using a multidisciplinary approach, we identified a set of technological and robotic devices to treat the upper limb globally, and then we experimented to ascertain its feasibility, in a pilot study. Robotics offers a considerable number of devices for rehabilitation that should be selected according to rehabilitation aims and feasibility in clinical practice.
... (i) Demyelinating lesion, (ii) Compound muscle action potential axonal damage, (iii) Mixed involvement (conduction block plus axonal damage), and (iv) Sensory nerve action potential axonal loss [26][27][28]. ...
Aim This study aimed to evaluate neuropathic foot pain in patients with rheumatoid arthritis (RA) using electrophysiological studies and musculoskeletal ultrasound (MSUS) to address the association between these findings and disease activity. Evaluation of the usefulness of this combination was undertaken.
Design The present study was designed as a cross-sectional study.
Patients and methods A total of 50 RA patients underwent a complete history-taking and rheumatologic examination. According to the cut-off point of Disease Activity Score in 28 joints, patients were divided into two equal groups (25 patients each): active and inactive. In total, 25 healthy individuals were included as controls. Routine tibial and peroneal nerve conduction studies, as well as electromyography of tibialis anterior and abductor hallucis muscles, were carried out. MSUS assessment of the ankle joint and extra-articular portion of the foot complex was also performed.
Results Electrophysiological findings of foot neuropathy were observed in 78% of the patients, irrespective of the disease activity level. In total, 48% of the patients had mononeuropathies of a demyelinating pattern (entrapment neuropathies), whereas the other 30% had symmetrical polyneuropathy with axonal degeneration. Combined distal tibial and peroneal nerve entrapments were reported in 16% of the patients. A positive power Doppler signal and joint erosions showed a highly statistical significant prevalence among the active group in comparison with patients in remission (P ≤ 0.001).
Conclusion Peripheral nerve affection is common in the rheumatoid foot, irrespective of the disease activity status. The most common neuropathies were posterior tarsal tunnel syndrome, peroneal nerve entrapment at the fibular neck, and pure sensory axonal neuropathy. A positive power Doppler signal and bone erosions of the ankle joint, detected by MSUS, were associated with RA disease activity. Electrophysiology was superior to MSUS for the diagnosis of posterior tarsal tunnel syndrome.
... Nerve lesions after orthopaedic surgery are not uncommon [1,2] and may be due to several well-known causes: direct damage by the surgeon, distractors, postures, ischemia and surgical instruments. The mononeuropathy arising after surgery may require weeks or months to recover, often incompletely [3]. Sometimes, although high attention is paid, nerve lesions occur without an ascertainable cause [4] and surgeons and anaesthetists are considered ethically and legally responsible for the damage. ...
Mononeuropathy after surgery may occur and hereditary neuropathy with liability to pressure palsies is a possible pathological condition related to paresis after hip surgery. We present a case of 66-year-old man presenting severe weakness at inferior limb muscles after hip prosthesis revision. Clinic and electrophysiology showed severe right fibular nerve damage and ultrasound found a marked enlargement of the same nerve, associated with focal enlargements in other nerves. A diagnosis of hereditary neuropathy with liability to pressure palsies was suspected and confirmed by genetic test. The patient gradually recovered returning to a normal daily active life. Ultrasound was crucial for diagnosis. The suspicion and diagnosis of latent neuropathy, which can occur after surgical intervention, may lead to a better understand of the risks of the surgery, specific for the patient, and avoid the wrong attribution to surgical malpractice.
... Several studies describe the natural history of chronic nerve compressions such as the carpal tunnel syndrome and ulnar neuropathy at the elbow [1][2][3][4]. However, little is known about the spontaneous evolution of acute mononeuropathies due to non-traumatic nerve compression such as peroneal and radial mononeuropathy [5,6]. Also, little is known about the prognostic value of nerve conduction studies [7] and peripheral nerve sonography in these mononeuropathies, whereas a prognostic value of ultrasound in ulnar neuropathy of the elbow and carpal tunnel syndrome has been suggested [8][9][10][11]. ...
... A good outcome of compressive peroneal mononeuropathies has been reported before [5,15,16]. Although not fully comparable because of slightly different methodology, the present results suggest a better prognosis than previous research [5,15,16]. ...
... A good outcome of compressive peroneal mononeuropathies has been reported before [5,15,16]. Although not fully comparable because of slightly different methodology, the present results suggest a better prognosis than previous research [5,15,16]. This might be explained by the fact that these studies included patients with various causes of PM whereas the present study included only patients with postural or idiopathic palsies. ...
Background and purpose:
Little is known about the natural history of non-traumatic compressive mononeuropathies. To improve patient management, prognostic factors and outcome in patients with non-traumatic peroneal and radial mononeuropathies were studied.
Methods:
Retrospective clinical, electrophysiological and sonographic data of patients with non-traumatic peroneal and radial mononeuropathies were evaluated. Clinical, electrophysiological and sonographic evaluations had to take place 2-12 weeks after symptom onset and follow-up had to be for >6 months.
Results:
Twenty-five patients with peroneal mononeuropathy and 58 with radial mononeuropathy were included. Mean follow-up was 8.9 ± 2.4 months. Approximately 90% of patients recovered to a muscle strength of British Medical Research Council grade 4 or 5. Multiple logistic regression analysis revealed conduction block on nerve conduction studies, younger age and less severe initial weakness as indicators for a good prognosis. Peripheral nerve ultrasound was not prognostic in the 40 patients where it was available.
Conclusions:
The present study shows a good prognosis for spontaneous recovery after non-traumatic acute-onset compressive peroneal and radial mononeuropathies. Patients with denervation on needle electromyography, older age and severe initial weakness have a poorer prognosis and should be closely monitored to facilitate timely surgery whenever weakness persists. Peripheral nerve ultrasound seems to be of limited prognostic value in these mononeuropathies.
Peripheral neuropathies are diseases of the peripheral nervous system that can be divided into mononeuropathies, multifocal neuropathies, and polyneuropathies. Symptoms usually include numbness and paresthesia. These symptoms are often accompanied by weakness and can be painful. Polyneuropathies can be divided into axonal and demyelinating forms, which is important for diagnostic reasons. Most peripheral neuropathies develop over months or years, but some are rapidly progressive. Some patients only suffer from mild, unilateral, slowly progressive tingling in the fingers due to median nerve compression in the wrist (carpal tunnel syndrome), while other patients can be tetraplegic, with respiratory insufficiency within 1–2 days due to Guillain–Barré syndrome. Carpal tunnel syndrome, with a prevalence of 5% and incidence of 1–2 per 1000 person-years, is the most common mononeuropathy. Population-based data for chronic polyneuropathy are relatively scarce. Prevalence is estimated at 1% and increases to 7% in persons over 65 years of age. Incidence is approximately 1 per 1000 person-years. Immune-mediated polyneuropathies like Guillain–Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy are rare diseases, with an annual incidence of approximately 1–2 and 0.2–0.5 per 100 000 persons respectively. Most peripheral neuropathies are more prevalent in older adults and in men, except for carpal tunnel syndrome, which is more common in women. Diabetes is a common cause of peripheral neuropathy and is associated with both mono- and polyneuropathies. Among the group of chronic polyneuropathies, in about 20–25% no direct cause can be found. These are slowly progressive axonal polyneuropathies.
Mononeuropathy after surgery may occur and hereditary neuropathy with liability to pressure palsies is a possible pathological condition related to paresis after hip surgery. We present a case of 66-year-old man presenting severe weakness at inferior limb muscles after hip prosthesis revision. Clinic and electrophysiology showed severe right fibular nerve damage and ultrasound found a marked enlargement of the same nerve, associated with focal enlargements in other nerves. A diagnosis of hereditary neuropathy with liability to pressure palsies was suspected and confirmed by genetic test. The patient gradually recovered returning to a normal daily active life. Ultrasound was crucial for diagnosis. The suspicion and diagnosis of latent neuropathy, which can occur after surgical intervention, may lead to a better understand of the risks of the surgery, specific for the patient, and avoid the wrong attribution to surgical malpractice.
Lower extremity mononeuropathies are not as prevalent as those of the upper extremities. However, they may cause a diagnostic challenge since they are commonly confused with lumbosacral radiculopathies or, less often, lumbosacral plexopathies. This is particularly true in elderly patients where lumbosacral radiculopathies, due to lumbar spine disease, are common, and incorrect diagnoses may lead to unnecessary spine surgery. These nerve lesions are also debilitating since they often interfere with standing and walking and may results in falls. This chapter discusses in details the applied anatomy of lower extremity peripheral nerves and the clinical and electrodiagnostic aspects of lower extremity mononeuropathies. © 2014 Springer Science+Business Media New York. All rights are reserved.
