Harvester’s palsy – bilateral common peroneal nerve palsy: A descriptive case report

Peroneal neuropathy is the common mononeuropathy of the lower extremities in adults. The documented etiologies for peroneal nerve injury include trauma, traction, and external compression. Fibular neck is the most common site of common peroneal nerve (CPN) injury as the nerve lies superficial and vulnerable for injury. A 50-year-old male presented with foot drop in his left leg after working in squatting position for prolonged hours along with sensory disturbance in dorsum of left foot. Clinical examination showed poor dorsiflexion in both side ankle with preserved plantar flexion. Electrophysiological findings locate the site of lesion to be CPN at the level of fibular neck. We conclude that CPN is injured due to knee flexion in farmers repeatedly squatting for long hours. Superficial peroneal nerve may be spared due to their interfascicular arrangement at the level of fibular neck placing deep peroneal nerve near the fibula making them more susceptible to compression type of injury. Peroneal nerve may be damaged at multiple sites including ankle. The condition can be reversed with conservative treatment, primarily by avoiding the precipitating position.

Transferencia tendinosa del tibial posterior en pie caído por lesión del nervio peroneo común / Tendon transfer of the posterior tibial in fallen foot due to lesion of the common peroneal nerve i:en

Se describe el caso clínico de un paciente de 34 años de edad, con antecedente de salud, atendido en la consulta intermunicipal de II Frente, provincia de Santiago de Cuba, por presentar, desde hacía 8 meses, una lesión en el nervio peroneo común, en la cara lateral del tercio superior de la pierna derecha, a causa de una mordida de cerdo, la cual no fue diagnosticada inicialmente, sino que se trató como una herida sin lesión neurológica. Se realizó proceder quirúrgico, consistente en una transposición tendinosa del músculo tibial posterior. Se inmovilizó el pie con una férula de yeso por 15 días, se le retiró la sutura a las 6 semanas y se indicó rehabilitación. A las 12 semanas comenzó a caminar sin dificultad y logró reincorporarse a sus actividades cotidianas.

The case report of a 34 years patient with health history is described. He was assisted in the intermunicipal visit of II Frente, province of Santiago de Cuba, due to a lesion in the common peroneal nerve during 8 months, in the lateral face of the superior third of the right leg, because of a pig bite, which was not diagnosed initially, but instead it was treated as a wound without neurological lesion. A surgical procedure was carried out, with a tendon transposition of the posterior tibial muscle. The foot was immobilized with a plaster splint for 15 days, the suture was removed 6 weeks later and rehabilitation was indicated. Twelve weeks later he began to walk without difficulty and he was able to return to his daily activities.

Study on electrophysiological changes of peripheral nerves in type 2 diabetes mellitus

Background: Peripheral neuropathy is a common and disabling complication due to diabetes mellitus. In such neuropathy, the function of sensory neurons, motor neurons, and autonomic functions are affected. The involvement of sensory function predominates in majority of cases. The neuropathy when develops is not reversible and also can not be stopped with any modality of treatment. Aim and Objectives: The objective is to evaluate diabetic neuropathy using the electrodiagnostic studies which are considered as a valuable tool. These studies are sensitive, specific, reproducible, and easily standardized. Material and Methods: Forty patients were subjected to electrodiagnostic study to evaluate the status of peripheral nerves in type- 2 diabetic patients. The different conduction velocities (motor nerve conduction velocity [MNCV], sensory nerve conduction velocity [SNCV]), distal latency (DL), nerve action potential (sensory nerve action potential [SNAP], and combined muscle action potential [CMAP]) are studied. All the cases were divided into two groups based on normal and abnormal diabetic neuropathy score. Sex, body mass index matched thirty numbers of healthy adults of both sexes were included in the control group. Nerve conduction study (NCS) of all the three groups were compared. Result: Neuropathy mostly peripheral was observed in 15 (37.5%) cases. The age of majority of cases was from 50–60 (45%) with mean age of 52.42 ± 7.39, having predominance of male (66.67%) in cases with symptoms of neuropathy. Fourteen (93.33%) cases out of the above cases had abnormal NCS. Abnormal NCS was also found in cases without clinical neuropathy, i.e. 14 (56%). The mean values of CMAP, SNAP, MNCV, and SNCV with prolonged DL are observed which was statistically significant. The conduction defect was observed more in lower limbs than in upper limbs. In the category of the motor nerve (common peroneal) is the most affected whereas the most affected sensory nerve was Sural nerve. Conclusion: Affection of nerves with neuropathies due to diabetes was in Sensory nerve than motor nerve. Early screening for neuropathy in clinical practice with NCSs can help in early diagnosis and their management.

Unilateral higher division of sciatic nerve and its clinical importance

The sciatic nerve has a long course right from the pelvis to the apex of the popliteal fossa. The point of division of the sciatic nerve into tibial and common peroneal nerves is very variable. The variation in the division of the sciatic nerve described in the present study should be helpful for anaesthetists and orthopaedic surgeons. While doing the dissection and teaching of the gluteal region in the Post Graduate Department of Anatomy, government medical college, Jammu, it was found that on the left side tibial nerve and common peroneal nerve were present instead of sciatic nerve. It meant that the main nerve that is the sciatic nerve had already been divided into its terminal branches in the pelvis region. Both tibial and common peroneal nerve were seen coming out of the pelvis below the piriformis muscle, while on the right side there were no variation. The sciatic nerve was seen coming out of the pelvis below the piriformis muscle as usual. Because of this high division of the sciatic nerve in the pelvis, there are many complications like failed sciatic nerve block during anaesthesia while performing surgery, but high division of the sciatic nerve may result in escape of either tibial nerve or common peroneal nerve. The gluteal region, back of the thigh and leg of the lower limb were dissected to study further course of tibial nerve and the common peroneal nerve. Photographs were also taken.

A Cadaveric Study On Division Of Sciatic Nerve To Acheive Its Complete Nerve Blockage

Background: The sciatic nerve arises within the pelvis from the sacral plexus, enters into the gluteal regionthrough the greater sciatic notch and divides into two terminal branches at variable level in the posteriorcompartment of thigh. The variable level of division of sciatic nerve in the thigh leads to failure of sciatic nerveblockage. Considering this clinical problem, the present study has been undertaken with the object to measurethe distance of division of sciatic nerve from the popliteal crease.Materials and Methods: 32 embalmed formalin fixed cadavers were dissected in the gluteal region, back of thighand popliteal fossa and the sciatic nerve were exposed and the distance of division of sciatic nerve weremeasured from the popliteal crease.Results: Out of 32 cadavers dissected the sciatic nerve divides at a distance range of 5 cm–20 cm in malecadavers and 4 cm–11 cm in female cadavers. In 2 cadavers the sciatic nerve divides within the pelvis itself.Conclusion: So, to achieve complete blockage of sciatic nerve in most of the patients the needle should be insertedabout 14 cm (mean distance) above the popliteal crease in males and 8 cm (mean distance) above the poplitealcrease in females

Variations in Division of Sciatic Nerve and its Clinical Relevance: A Cadaveric Study

Introduction:The sciatic nerve emerges through the greater sciatic foramen, leaves pelvis and enters into gluteal region by passing below piriformis as a single nerve encompassed by a single epineural sheath. It descends along back of thigh and divides into tibial nerve and common peroneal nerve, usually at superior angle of popliteal fossa. Understanding of variations in the levels of division of sciatic nerve is important for the management of non- discogenic sciatica, posterior hip operations, failed sciatic nerve block. Objective: To study the variations in division of sciatic nerve and to define the level of its exit.Subjects and Methods:Seventeen cadavers (34 limbs) fixed in formalin were dissected and studied during routine dissection in department of Anatomy, Mysore Medical College and level of division of sciatic nerve were noted.Results:Out of 34 limbs, 5 cases (14.7%) were dividing at gluteal region, 2 cases (5.8%) at mid-thigh and 27 cases (79.4%) exited pelvis as a whole nerve and divided at superior angle of popliteal fossa. Type G was most common variation.Conclusion:The exit and level of division of sciatic nerve is important for surgeons as there is surgical maneuvering in this region during posterior hip operations and to avoid iatrogenic nerve injury during deep intramuscular injections in gluteal region.

Effect of red light combined with hot compress on peripheral neuropathy of diabetes / 中国基层医药

Objective@#To investigate the effect of red light combined with hot compress on diabetic peripheral neuropathy (DPN).@*Methods@#From June 2017 to June 2018, 110 patients with DPN admitted to the Department of Endocrinology, Hangzhou Hospital of Traditional Chinese Medicine were selected in the study.The patients were divided into study group (55 cases) and control group (55 cases) according to the random number table method.All patients were given DPN basic care and treatment, with red light in the control group, and red light combined with hot compress in the study group.The motor nerve conduction velocity (MCV) and the sensory nerve conduction velocity (SCV) of the ulnar nerve, median nerve and common peroneal nerve were compared between the two groups before and after treatment.The total scores of the Toronto clinical scoring system (TCSS) were compared between the two groups before and after treatment.The efficacy of the two groups was compared.@*Results@#Before treatment, there were no statistically significant differences in MCV [(40.45±5.33)m/s vs.(40.14±5.08)m/s, t=0.312, P=0.755; (41.15±5.51)m/s vs.(40.86±5.23)m/s, t=0.283, P=0.778; (42.27±5.84)m/s vs.(41.94±5.75)m/s, t=0.299, P=0.766] and SCV [(39.38±4.82)m/s vs.(39.08±4.60)m/s, t=0.334, P=0.739; (40.13±5.45)m/s vs.(39.86±5.15)m/s, t=0.267, P=0.790; (41.18±5.78)m/s vs.(40.89±5.46)m/s, t=0.278, P=0.782] between the ulnar nerve, median nerve and common peroneal nerve in the two groups.After treatment, the ulnar nerve, median nerve and common peroneal nerve of the two groups were treated.The MCV[(48.77±7.25)m/s vs.(44.62±6.30)m/s, t=3.204, P=0.002; (49.35±7.46)m/s vs.(45.36±6.45)m/s, t=3.001, P=0.003; (49.26±7.13)m/s vs.(46.35±6.22)m/s, t=2.281, P=0.025] and SCV[(47.67±6.52)m/s vs.(43.57±5.61)m/s, t=3.535, P=0.001; (47.77±6.63)m/s vs.(44.31±5.14)m/s, t=3.059, P=0.003; (48.33±7.17)m/s vs.(45.12±6.41)m/s, t=2.475, P=0.015] of the two groups were increased, while which of the study group increased more significantly.Before treatment, there was no statistically significant difference in the total scores of TCSS between the two groups [(10.15±1.23)points vs.(10.45±1.51)points, t=1.142, P=0.256]. After treatment, the total scores of TCSS decreased in the two groups, while which of the study group decreased more significantly[(7.22±0.85)points vs.(8.15±0.96)points, t=5.379, P=0.000]. After treatment, the effective rate of the study group was 87.27%, which of the control group was 63.64%, the difference was statistically significant(χ2=8.295, P=0.004).@*Conclusion@#The combination of red light and hot compress on DPN has a more prominent clinical effect, which is worthy of wide application.

Clinical importance of tensor fasciae suralis arising from linea aspera along with short head of biceps femoris: a rare anomaly / 대한해부학회지

Tensor fasciae suralis, also known as ischioaponeuroticus is a clinically relevant muscle variant located in the popliteal fossa. Though rare, when present the muscle may arise from any of the hamstrings and gets inserted to the crural fascia of leg or tendocalcaneus and is innervated by the tibial component of sciatic nerve. Here we report a variant of tensor fasciae suralis originated from the lowermost part of linea aspera along with the fibers of short head of biceps femoris in the left lower limb of a male cadaver aged approximately 58 years. The muscle was 16 cm in length and 1 cm breadth in its widest part. It was found inserted to the crural fascia over the lateral head of gastrocnemius and was found innervated by common peroneal nerve. To the best of our knowledge, the tensor fascia suralis muscle originated from linea aspera along with short head of biceps femoris and innervated by common peroneal nerve has not been reported in either cadaveric or imaging studies.

Effect of red light combined with hot compress on peripheral neuropathy of diabetes / 中国基层医药

Objective To investigate the effect of red light combined with hot compress on diabetic peripheral neuropathy (DPN).Methods From June 2017 to June 2018,110 patients with DPN admitted to the Department of Endocrinology,Hangzhou Hospital of Traditional Chinese Medicine were selected in the study. The patients were divided into study group (55 cases) and control group (55 cases) according to the random number table method.All patients were given DPN basic care and treatment,with red light in the control group,and red light combined with hot compress in the study group.The motor nerve conduction velocity ( MCV) and the sensory nerve conduction velocity (SCV) of the ulnar nerve,median nerve and common peroneal nerve were compared between the two groups before and after treatment.The total scores of the Toronto clinical scoring system ( TCSS) were compared between the two groups before and after treatment.The efficacy of the two groups was compared.Results Before treatment,there were no statistically significant differences in MCV [(40.45 ± 5.33)m/s vs.(40.14 ± 5.08)m/s,t=0.312,P=0.755;(41.15 ± 5.51)m/s vs.(40.86 ± 5.23)m/s,t=0.283,P=0.778;(42.27 ± 5.84)m/s vs.(41.94 ± 5.75)m/s, t=0.299,P=0.766] and SCV [(39.38 ± 4.82) m/s vs.(39.08 ± 4.60) m/s,t=0.334,P=0.739;(40.13 ± 5.45)m/s vs.(39.86 ± 5.15)m/s,t=0.267,P=0.790;(41.18 ± 5.78)m/s vs.(40.89 ± 5.46) m/s,t=0.278, P=0.782] between the ulnar nerve,median nerve and common peroneal nerve in the two groups.After treatment,the ulnar nerve,median nerve and common peroneal nerve of the two groups were treated.The MCV[(48.77 ± 7.25)m/s vs.(44.62 ± 6.30)m/s,t=3.204,P=0.002;(49.35 ± 7.46)m/s vs.(45.36 ± 6.45)m/s,t=3.001,P=0.003;(49.26 ± 7.13)m/s vs.(46.35 ± 6.22)m/s,t=2.281,P=0.025] and SCV[(47.67 ± 6.52)m/s vs.(43.57 ± 5.61)m/s,t=3.535,P=0.001;(47.77 ± 6.63)m/s vs.(44.31 ± 5.14) m/s,t=3.059,P=0.003;(48.33 ± 7.17)m/s vs.(45.12 ± 6.41)m/s,t=2.475,P=0.015] of the two groups were increased,while which of the study group increased more significantly.Before treatment,there was no statistically significant difference in the total scores of TCSS between the two groups [(10.15 ± 1.23) points vs.(10.45 ± 1.51) points,t=1.142,P=0.256].After treatment,the total scores of TCSS decreased in the two groups, while which of the study group decreased more significantly[(7.22 ± 0.85)points vs.(8.15 ± 0.96)points,t=5.379,P=0.000].After treatment,the effective rate of the study group was 87.27%,which of the control group was 63.64%,the difference was statistically significant (χ2 =8.295,P=0.004).Conclusion The combination of red light and hot compress on DPN has a more prominent clinical effect,which is worthy of wide application.

Experimental study on repairmen of high deep peroneal nerve injury by nerve transposition methods using different proximal tibialnerve muscular branches / 中华显微外科杂志

Objective To study the effect of using different tibial nerve proximal muscle branchs to repair deep peroneal nerve injury in animal experiment, and to screen out the most optimal donor nerve branch. Methods From June, 2016 to August, 2016, 64 adult female SD rats were randomly divided into 4 groups, which were LHG (using lateral head of gastrocnemius to repair peroneal nerve), MHG(using medial head of gastrocnemius to repair peroneal nerve), SNB (using soleus nerve branch to repair peroneal nerve), and blank. There were16 rats in each group. At 4 and 8 weeks after surgery, each group were tested on behavior, electrophysiology, muscle tension, muscle wet weight and histology, to evaluate function recovery of the muscles controlled by deep peroneal nerve in each group, and to compare recovery of the deep peroneal nerve repaired by different tibial nerve branches. Results Eight weeks after surgery,right foot of the rats in LHG,MHG and SNB group can be extended,toes can be completely opened. Rats in blank group showed limping gait, whose right foot can not be extended, right toe can not be opened, and muscle atrophied. At 4 and 8 weeks after the operation, the recovery rate of LHG, MHG, SNB group (at 4th weeks, 33.60 ±2.22)%, 33.07 ±2.38% and 35.91 ±2.02%; at 8th weeks, 67.16 ±5.74)%, 66.56 ±3.18% and 73.17 ± 5.33%, respectively)was higher than blank group(7.71±1.05% and 7.84±0.78%, respectively)on CMAP amplitude, tibialis anterior muscle contractility, tibialis anterior muscle cell area, muscle cell area. SNB group was superior to the LHG group and LHG group.And the difference was statistically significant(P<0.05). Conclusion All the proxi-mal tibial nerve muscle branchs can be used to repair the deep peroneal nerve injury, and the soleus nerve branch is the preferred donor nerve.

Common Peroneal Nerve Palsy Associated with Multiple Knee Ligament Injury / 대한스포츠의학회지

Common peroneal nerve (CPN) injury associated with multiple-ligament knee injury is relatively rare. A 38-year-old male presented with left knee pain occurred during ssireum (Korean wrestling). The patient exhibited positive Lachman, grade 3 varus stress, and also positive dial testing at 30°. Sensory loss of some area of left foot and foot drop were observed. Magnetic resonance imaging showed complete anterior cruciate ligament (ACL) rupture and posterolateral corner (PLC) injury. Motor nerve conduction velocity indicated left CPN palsy. ACL and PLC reconstructions were performed 10 days after injury and nerve exploration was done simultaneously. Neurolysis and primary repair were also performed. At 26 months after injury, muscle power of the tibialis anterior and extensor hallucis longus improved to grade 3, and sensation in CPN area recovered to about 60%. There was good stability in injured knee. To the best of our knowledge, this is the first case report describing CPN palsy with multiple-ligament knee injury during ssireum.

Comparison of NCV of Right and Left Limb in Right handed Male Subjects.

Background: Nerve Conduction Velocity is affected by various factors like age gender & temperature. Various studies have been done regarding development of brain and dominance of right or left side, some studies have found differences between left and right hand for nerve conduction. Our aim is to compare NCV of dominant limb to nondominant limb in right hand dominant subjects and to find out if different normal values should be considered in right and left hand. Methods: The Median and Common Peroneal Nerve (CPN) of dominant as well as Non- dominant limb were used for measuring Motor & Sensory Nerve Conduction Velocity (MNCV & SNCV) in age groups of 31-35 and 36- 40 years using Medicaid system. Results: We found p value was insignificant using unpaired t-test for MNCV & SNCV of Median and Common Peroneal Nerve of left and right side. Similarly, the MNCV & SNCV of dominant and nondominant limb for median and CPN were insignificant. Conclusion: Consideration of right or left side dominance is not necessary while measuring NCV in asymptomatic subjects and different set of normal values are not required for right and left hand.

COMPARISON OF HEALING RESULTS BETWEEN TIBIAL NERVE AND COMMON PERONEAL NERVE AFTER SCIATIC NERVE INJURY REPAIR IN RHESUS MONKEY / 中国修复重建外科杂志

OBJECTIVE: To investigate the regularity of myelin degeneration and regeneration and the difference of axonal density between tibial nerve and common peroneal nerve after sciatic nerve injury repair in rhesue monkey. METHODS: Nine adult rhesue monkeys (male or female, weighing 3.5-4.5 kg) were selected to establish the model of rat sciatic nerve transaction injury. The tibial nerve and common peroneal nerve of 5 mm in length were harvested at 5 mm from injury site as controls in 3 monkeys; the distal tibial nerve and common peroneal nerve were repaired with 9-0 suture immediately in the other 6 monkeys. And the gross observation and neural electrophysiological examination were performed at 3 and 8 weeks after repair respectively. Then, distal tibial nerve and common peroneal nerve at anastomotic site were harvested to observe the myelin sheath changes, and to calculate the number of axon counts and axonal density by staining with Luxol Fast Blue. RESULTS: Atrophy of the lower limb muscle and various degrees of plantar ulcer were observed. Gross observation showed nerve enlargement at anastomosis site, the peripheral connective tissue hyperplasia, and obvious adhesion. The compound muscle action potential (CMAP) of tibial nerve and common peroneal nerve could not be detected at 3 weeks; the CMAP amplitude of common peroneal nerve was less than that of the tibial nerve at 8 weeks. Different degrees of axonal degeneration was shown in the tibial nerve and common peroneal nerve, especially in the common peroneal nerve. The average axonal density of common peroneal nerve was lower than that of tibial nerve at 3 weeks (13.2% vs. 44.5%) and at 8 weeks (10.3% vs. 35.3%) after repair. CONCLUSIONS: The regeneration of tibial nerve is better and faster than that of common peroneal nerve, and gastrocnemius muscle CMAP recovers quicker, and amplitude is higher, which is the reason of better recovery of tibial nerve.

High Division of Sciatic Nerve with an Associated Variation in The Origin of Superior and Inferior Gluteal Nerves.

High division of sciatic nerve into two components with an associated variation in the origin of superior and inferior gluteal nerves was observed in 70 yrs old male cadaver on right side. The components of sciatic nerve rejoined in the middle 2/3rd of thigh, and they redivided at the superior angle of popliteal fossa. It is a rare variation. Such variation is important for surgeons and nurses too.

Unilateral High Division of Sciatic Nerve and its Relation to Bifid Piriformis.

Background: The sciatic Nerve can rarely be separated into tibial and common fibular Nerve within the Pelvis. In such cases the tibial nerve and common fibular nerve leave the pelvis through different routes. Materials and Method: The variation found during routine dissection for MBBS students in a 30 yr old male cadaver in the department of Anatomy, JJM Medical college Davangere, Karnataka, India. Results: The variation is High division of sciatic Nerve unilaterally on right side in 30yrs old male cadaver. Common peroneal Nerve is found passing between the two divisions of bifid piriformis while tibial Nerve passed below the inferior piriformis Conclusion: Knowledge of this variation is important clinically in sciatic nerve entrapment resulting in nondiscogenic sciatica and also requires reviewing of the piriformis syndrome

Bilateral high division of sciatic nerve.

Sciatic nerve is the thickest nerve in the body formed by the sacral plexus from L4 to S3 in the lesser pelvis. It emerges through the greater sciatic foramen below the piriformis and enter the gluteal region. Then the nerve passes on the back of the thigh and at the level of superior angle of popliteal fossa it terminates by dividing into tibial and common peroneal nerve. The knowledge of anatomical variations in the division of nerve is important for various surgical and anaesthetic procedures. During routine dissection in the department of anatomy, Mysore Medical College & Research Institute, Mysore, a rare bilateral high division of sciatic nerve was observed in a female cadaver aged about 40 years. In the present case there was bilateral high division of sciatic nerve. The nerve was seen dividing into two branches before it emerges through the greater sciatic foramen. The tibial nerve was entering the gluteal region below the piriformis muscle and common peroneal nerve was entering by piercing the piriformis. The knowledge of this variation is important as the nerve may get compressed with surrounding anatomical structures resulting in non discogenic sciatica. The awareness of variations is important for surgeons during various procedures like fracture, posterior dislocation of hip joint and hip joint replacement. The anatomical variations are important during deep intramuscular injections in gluteal region and also for anaesthetists during sciatic nerve block.

High division of sciatic nerve.

Background: The Sciatic nerve is the largest and thickest nerve in the human body with a long course in the inferior extremity. It divides into tibial and common peroneal nerves which can occur at any level from the sacral plexus to the inferior part of the popliteal space. Sciatic nerve variations are relatively common. These variations may contribute to clinical conditions ex sciatica, coccygodynia and piriformis syndrome and have important clinical implications in anaesthesiology, neurology, sports medicine and surgery. Methods: 10 cadavers were dissected with no previous history of trauma/surgery to study the anatomical variations of sciatic nerve. Results: In all except two cadavers, the nerve divided at the apex of the popliteal fossa. In two cadavers the sciatic nerve divided bilaterally in the upper part of thigh. Conclusion: The high division presented in this study can make popliteal nerve blocks partially ineffective. The high division of sciatic nerve must always be borne in mind as they have important clinical implications.

The effective injection zone at the popliteal crease for tibial and common peroneal nerve blocks and its relation with the origin point of the medial and lateral sural cutaneous nerves / Zona de inyección eficaz en el pliegue poplíteo para el bloqueo de los nervios tibial y fibular común y su relación con el punto de origen de los nervios cutáneo sural medial y lateral

A popliteal nerve block may be used to provide anesthesia and extended analgesia of the lower extremity, to ameliorate severe and long lasting postoperative pain. The aim of this study was to elucidate the anatomical location of tibial (TN) and common peroneal (CPN) nerves in the popliteal crease for effective nerve block. Fifty fresh specimens from 27 adult Chinese cadavers (16 males and 11 females, age range from 35 to 87 years) were investigated. Twenty-two cadavers were used to identify nerve locations and 5 cadavers were used to determine the depths of nerves in cross section. TN was found to be located at 50% from the most lateral point of the popliteal crease at 1.4 cm deep to the surface. In 20% of the 50 specimens, the medial sural cutaneous nerve branched out below or at the popliteal crease, whereas the CPN was located at 26.0% from the most lateral point of the popliteal crease and at 0.7 cm deep to the surface. Furthermore, in 6.0% of specimens the lateral sural cutaneous nerve branched out below or at the popliteal crease. This study suggests that the TN and CPN leave the sciatic nerve at variable distances from the popliteal crease. However, we believe that the results of the present study about the location of TN and CPN at the popliteal crease offer a good guide to optimal nerve block.

El bloqueo nervioso poplíteo puede ser utilizado para proporcionar anestesia y analgesia prolongada del miembro inferior y para aliviar el dolor postoperatorio severo y duradero. El objetivo fue determinar la localización anatómica de los nervios tibial (NT) y fibular común (NFC) en el pliegue poplíteo para un bloqueo nervioso efectivo. Se utilizaron 50 miembros inferiores frescos pertenecientes a 27 cadáveres adultos chinos (16 hombres y 11 mujeres, rango de edad entre 35-87 años). Se utilizaron 22 cadáveres para identificar la localización de los nervios y los 5 restantes para determinar la profundidad de los nervios en una sección transversal. El NT se encontró en el 50% de los casos desde el punto más lateral del pliegue poplíteo a 1,4 cm de la superficie. En el 20% de 50 muestras, el nervio cutáneo sural medial se ramificó por debajo o en el pliegue poplíteo, mientras que el NFC se encontró en el 26% de los casos desde el punto más lateral del pliegue poplíteo a 0,7 cm de la superficie. Además, en el 6% de las muestras, el nervio cutáneo sural lateral se ramificó por debajo o en el pliegue poplíteo. Nuestros resultados sugieren que el NT y NFC emergen del nervio ciático a distancias variables del pliegue poplíteo. Creemos que los resultados sobre la ubicación de NT y NFC en el pliegue poplíteo ofrecen una buena guía para el adecuado bloqueo nervioso.

Diffusion-weighted MR neurography of the tibial nerve and the common peroneal nerve with different motion probing gradients / 中华放射学杂志

Objective To compare the image quality of diffusion-weighted MR neurography (DW-MRN) of the tibial nerve and the common peroneal nerve prospectively using different motion probing gradients (MPGs).Methods A total of 21 healthy volunteers underwent DW-MRN at the knee (unilateral imaging) on a 3.0 T magnetic resonance system with unidirectional MPGs.The protocol included anteriorposterior unidirectional,right-left unidirectional,three-directional and six-directional MPGs.The apparent SNR and CNR of tibial nerve and common peroneal nerve were calculated.Three-dimensional MIP images of the nerves were evaluated blindly by two radiologists using a four-point grading scale on basis of entirety depiction and the signal intensity.Significance was determined by using Friedman and paired Wilcoxon tests.Results The SNR of tibial nerves on DW-MRN with anterior-posterior,right-left,three directional and six directional MPGs were 4.17 (2.70-5.65),4.35 (0.47-4.69),3.46 (2.27-4.62) and 3.30 (2.06-4.43),respectively.CNR were 0.61 (0.46-0.70),0.63 (0.36-0.73),0.55 (0.39-0.64) and 0.53(0.35-0.63),respectively.The scores of tibial nerve image quality were 4.0 (2.0-4.0),4.0 (3.0-4.0),2.5 (2.0-3.5),2.0 (1.0-2.5),respectively.Interobserver agreement was good and the Kappa value was 0.69 (P ＜ 0.05).The SNR of the common peroneal nerves on DW-MRN with anteriorposterior,right-left,three directional and six directional MPGs were 3.05 (2.30-4.20),3.05 (2.26-4.34),2.72 (1.84-13.80) and 2.68 (1.87-3.67),respectively.CNR were 0.51 (0.39-0.62),0.51 (0.39-0.63),0.46(0.30-0.86) and 0.46(0.30-0.57),respectively.The scores of the common peroneal nerve image quality were 3.5 (2.0-4.0),4.0 (2.0-4.0),2.0 (1.0-3.0) and 2.0 (1.0-2.5),respectively.Interobserver agreement was good and the Kappa value was 0.70(P ＜0.05).For SNR,CNR and nerve image quality of the tibial nerves and the common peroneal nerves,there were significant differences among different MPGs (x2 =215.01,215.01,60.49 and 182.82,182.82,60.22,respectively,P ＜ 0.05).SNR,CNR and nerve image quality of the tibial nerves and the common peroneal nerves on DW-MRN with unidirectional MPGs were better than those with three-directional and sixdirectional MPGs (Z =-6.90-4.03,P ＜ 0.05).The SNR and CNR of the tibial nerves on DW-MRN with right-left direction were better than those with anterior-posterior unidirectional MPGs (Z =-3.53,-3.41,P ＜ 0.05),but there was no significant difference of image quality between right-left and anteriorposterior directional MPGs (Z =-0.58,P ＞ 0.05).DW-MRN of the tibial nerves with three-directional MPGs was better than that with six-directional MPGs (Z =-3.00,-2.80,-3.92,P ＜ 0.05).There were no significant differences between right-left and anterior-posterior unidirectional MPGs,or between three-directional and six-directional MPGs of common peroneal nerves (Z =-1.94--0.31,P ＞ 0.05).Conclusions DW-MRN has capability to provide three-dimensional visualization of the tibial and common peroneal nerves,and the image quality with unidirectional MPGs is better than that with three or six directional MPGs.

Seven cases of common peroneal nerve injury causes and diagnosis of neural electrophysiology / 中国基层医药

Objective To explore the specific causes of common peroneal nerve injury, characteristics of such injured nerve's electrophysiological performance and its diagnostic value.Methods The clinical and neurophys-iological examination data of 7 patients with common peroneal nerve injury were retrospectively analyzed.Results The patients of common peroneal nerve injury cause for long time squatting down.Compared with the healthy side, potential amplitude of the deep peroneal nerve or the superficial proneal nerve of the injured side changes more obviously.On the average the amplitude fell by about 50% with the largest drop by 88%.EMC indicated that the muscle controlled by injured nerve has spontaneous potential,reduced recruitment and so on.Conclusion Long time squatting down was relatively rare cause for common peroneal nerve injury.Neural physiological detection could provide more specific positioning diagnosis and differential diagnosis for common peroneal nerve injury,had better clinical application value.