Use of aerobic treadmill exercises on nerve regeneration after sciatic nerve injury in spontaneously hypertensive rats

Purpose: Various postoperative protocols have been proposed to improve outcomes and accelerate nerve regeneration. Recently, the use of physical exercise in a post-surgical neurorraphy procedure has shown good results when started early. We experimentally investigated the hypothesis that post-operative exercise speeds up results and improves clinical and morphologic parameters. Methods: Isogenic rats were randomly divided into four groups: 1 SHAM; 2 SHAM submitted to the exercise protocol (EP); 3 Grafting of the sciatic nerve; and 4 Grafting of the sciatic nerve associated with the EP. The EP was based on aerobic activities with a treadmill, with a progressive increase in time and intensity during 6 weeks. The results were evaluated by the sciatic functional index (SFI), morphometric and morphologic analysis of nerve distal to the lesion, and the number of spinal cord motor neurons, positive to the marker Fluoro-Gold (FG), captured retrogradely through neurorraphy. Results: Functional analysis (SFI) did not show a statistical difference between the group grafted with (­50.94) and without exercise (-65.79) after 90 days. The motoneurons count (Spinal cord histology) also showed no diference between these groups (834.5 × 833 respectively). Although functionally there is no difference between these groups, morphometric study showed a greater density (53.62) and larger fibers (7.762) in GRAFT group. When comparing both operated groups with both SHAM groups, all values were much lower. Conclusions: The experimental model that this aerobic treadmill exercises protocol did not modify nerve regeneration after sciatic nerve injury and repair with nerve graft.

Foot drop - an uncommon presentation of FOLFOX toxicity

A quimioterapia com FOLFOX (oxaliplatina, leucovorina e 5-fluorouracilo) é frequentemente utilizada em doentes com cancro colorretal. Os sais de platina são conhecidos por serem uma classe de quimioterápicos que comumente induzem neurotoxicidade periférica. Na toxicidade induzida pela oxaliplatina, os sintomas sensitivos são os mais frequentes. Neste artigo, apresentamos dois casos clínicos de pacientes com adenocarcinoma de cólon, ambos submetidos à quimioterapia com FOLFOX4, e que desenvolveram neurotoxicidade incomum, apresentando pé pendente após o terceiro ciclo de tratamento. Esta manifestação clínica pode ser explicada por dano axonal nos neurônios motores periféricos do nervo peroneal comum (fibular), que fornece inervação motora aos músculos do pé. A paralisia do nervo fibular causa fraqueza súbita nos músculos do pé, que parece ser temporária. Ambos os doentes recuperaram completamente do evento sem necessidade de ajustes no tratamento, nem introdução de medicamentos diferentes. A apresentação de pé pendente como toxicidade da quimioterapia ainda é pouco compreendida. Os casos relatados mostram o pé pendente como uma manifestação grave e incomum de neuropatia induzida por FOLFOX, que pode ser transitória, e não requer necessariamente intervenção específica.

Chemotherapy based on FOLFOX (oxaliplatin, leucovorin, and 5-fluorouracil) regimen is frequently used in colorectal cancer patients. Oxaliplatin and other platinum agents are known to be a class of chemotherapy drugs that commonly induce peripheral neurotoxicity. The most frequent oxaliplatin related neurotoxicity is sensitive symptoms. Here, we present two cases of patients with colon adenocarcinoma, both undergoing chemotherapy with FOLFOX4, who developed uncommon neurotoxicity, presenting with foot drop after the third treatment cycle. Foot drop may be explained by axonal damage of peripheral motor neurons of the common peroneal (fibular) nerve, which provides motor innervation to the foot muscles. Peroneal nerve palsy causes sudden weakness in the muscles of the foot that seems to be temporary. Both patients completely recovered from the event. There was no need for treatment adjustments, neither introduction of different drugs. Foot drop as chemotherapy toxicity is still poorly understood. The reported cases show foot drop as a severe and uncommon manifestation of FOLFOX-induced neuropathy, that might be transitory, and does not necessarily requires specific intervention.

Relationship between fabella and posterolateral knee pain and common peroneal nerve injury / 中国骨伤

OBJECTIVE@#To analyze the incidence and characteristics of fabella in the Chinese population and its correlation with pain in the posterolateral region of the knee joint and common peroneal nerve palsy.@*METHODS@#Total 732 patients including 405 males(450 knees) and 327 females(383 knees) who underwent unilateral or bilateral knee MR imaging from September 2015 to July 2019 were retrospectively evaluated. The basic information of all patients was extracted from the hospital's his system. The patient's medical records were checked by telephone follow-up or his system, and the number of patients with posterolateral knee pain and common peroneal nerve paralysis were recorded.@*RESULTS@#The overall prevalence of fabella was 48.38%, 23.53% in men and 24.85% in women, there was no significant difference between them (@*CONCLUSION@#The prevalence of fabella us in Chinese population is 48.38%. There is no relationship between the incidence of gastrocnemius and gender, but the incidence of fabella is positively correlated with age, pain in the posterolateral region of the knee joint and the occurrence of common peroneal nerve symptoms.

Eficacia del bloqueo poplíteo por vía lateral / Effectiveness of the blockade popliteal for via lateral

Introducción: Los bloqueos nerviosos periféricos son un componente aceptado en la práctica médica desde el área quirúrgica, el control del dolor crónico y el posoperatorio. Objetivo: Evaluar la eficacia del bloqueo poplíteo por vía lateral en los pacientes intervenidos por afecciones en el pie y tobillo. Métodos: Se realizó un estudio analítico transversal en los pacientes intervenidos por afecciones en el pie y tobillo en el período de septiembre 2015 a septiembre 2018. Se constituyó el universo con 431 pacientes y la muestra por 209. Resultados: Más de las tres cuartas partes de los pacientes intervenidos por afecciones del pie y del tobillo a los que se les aplica el bloqueo se encuentran por encima de la quinta década de la vida. La mayor parte de ellos corresponden al rango de 51 Kg a los 70 Kg, con cuatro a seis cm de profundidad de la aguja para la localización del nervio basado en la ecuación de la recta. Es 19 veces más probable en ellos la ausencia de dolor en las primeras seis horas del posoperatorio después del bloqueo y más probable el éxito de la técnica propuesta con la determinación de la profundidad en cm de la aguja basado en la ecuación de la recta, con odds ratio de 31. Conclusiones: Se evaluó de eficaz el bloqueo poplíteo por vía lateral en la mayor parte de pacientes intervenidos por afecciones en el pie y tobillo(AU)

Background: the blockades nervous peripherals are a component accepted in the medical practice, from the surgical area, control of the chronic pain and postoperatory. Objective: to evaluate the effectiveness of the blockade popliteal for via lateral in the patients intervened by affections in the foot and ankle. Methods: it was carried out a study transversal analytic of patients intervened by affections in the foot and ankle in the period from September 2015 to September 2018. The universe was constituted with 431 patients and the sample by 209. Results: more than the fourth three parts of the patients intervened by affections of the foot and of the ankle to those that are applied the blockade popliteal for via lateral they are above the fifth decade of the life. Most of the patients belong together to the range from 51 to the 70 Kgs with four to six cm of depth based on the equation of the straight line. It is more probable 19 times in the patients the pain absence in the first six hours of the post operatory after the blockade and more probable the success of the technique proposal with the determination of the depth in cm of the needle based before on the equation of the straight line described with odds ratio of 31. Conclusions: the evaluation of the effectiveness of the blockade popliteal for via lateral increases the anesthesiologist's therapeutic arsenal and it redounds in benefits for the patient during the perioperatorio, the application of this technique in appropriate clinical situations adds alternative valuable to the anesthetic attendance(AU)

Unilateral Deep Peroneal Neuropathy during Cyclosporine Therapy

No abstract available.

Foot drop: an iatrogenic complication of spinal anesthesia / Pé caído: uma complicação iatrogênica da anestesia espinhal

Abstract Background and objectives Foot drop in postoperative period is very rare after spinal anesthesia. Early clinical assessment and diagnostic interventions is of prime importance to establish the etiology and to start appropriate management. Close follow-up is warranted in early postoperative period in cases when patient complain paresthesia or pain during needle insertion or drug injection. Case report A 22-year-old male was undergone lower limb orthopedic surgery in spinal anesthesia. During shifting from postoperative ward footdrop was suspected during routine assessment of regression of spinal level. Immediately the patient was referred to a neurologist and magnetic resonance imaging was done, which was inconclusive. Conservative management was started and nerve conduction study was done on the 4th postoperative day that confirmed pure motor neuropathy of right peroneal nerve. Patient was discharged with ankle splint and physiotherapy after slight improvement in motor power (2/5). Conclusions Foot drop is very rare after spinal anesthesia. Any suspected patient must undergo emergent neurological consultation and magnetic resonance imaging to exclude major finding and need for early surgical intervention.

Resumo Justificativa e objetivos Pé caído no período pós-operatório é muito raro após a anestesia espinhal. Avaliação clínica e intervenções diagnósticas precoces são de primordial importância para estabelecer a etiologia e iniciar o tratamento adequado. Um acompanhamento atento é justificado no pós-operatório imediato nos casos em que o paciente se queixa de parestesia ou dor durante a inserção da agulha ou da injeção de fármacos. Relato de caso Paciente do sexo masculino, 22 anos, submetido a cirurgia ortopédica de membros inferiores sob anestesia espinhal. Durante a transferência para a sala de recuperação pós-operatória, houve suspeita de pé caído durante a avaliação rotineira da regressão do nível espinhal. O paciente foi imediatamente enviado ao neurologista e uma ressonância magnética foi feita, mas não foi conclusiva. O manejo conservador foi iniciado e o estudo de condução nervosa foi feito no 4° dia de pós-operatório, o que confirmou a neuropatia motora pura do nervo fibular direito. O paciente foi dispensado com imobilizador de tornozelo e fisioterapia após ligeira melhoria da força motora (2/5). Conclusões Pé caído é muito raro após a anestesia espinhal. Qualquer paciente suspeito deve ser submetido à consulta neurológica de emergência e ressonância magnética para excluir o principal achado e a necessidade de intervenção cirúrgica precoce.

Ostectomía del peroné en el genu varo doloroso de rodilla. Resultados preliminares al año de operado / Fibula ostectomy in painful genu varum of the knee. Preliminary results after a year of the surgery

Introducción: la artrosis de rodilla puede llegar a ser una patología muy invalidante por sus síntomas, caracterizados por dolor, inseguridad y pérdida funcional. Es una patología degenerativa que ha aumentado su prevalencia en las últimas décadas, muy ligada al envejecimiento poblacional. Objetivo: validar la técnica de la ostectomía del peroné en el genu varo doloroso como nueva opción de tratamiento. Materiales y Métodos: se realizó un estudio, prospectivo y lineal en el Hospital Militar "Dr. Mario Muñoz Monroy" de Matanzas, desde abril del 2016 hasta agosto del 2017. Se aplicó la nueva técnica del Dr. Ying-Ze Zhang, del Departamento de Cirugía Ortopédica del Tercer Hospital de la Universidad Médica de Hebei en Shijiazhuang, China. En la actualidad ya existe una casuística de 75 pacientes, con 84 rodillas operadas de los cuales se presentan los resultados de los primeros 11 pacientes, posterior al año de operado. Resultados: el promedio de edad fue de 64,3 años, (45 años el menor y 84 años el mayor); de los cuales 8 eran hombres y 3 mujeres. Se aplicó la escala visual analógica para el dolor pre y post-operatorio en cuanto a la marcha y al subir escalones; estando todos los pacientes al caminar, por encima de 6 y al subir escaleras por encima de 7. Después de un año de operados 10 pacientes se encontraban evaluados al caminar entre 0 y 3 puntos, y al subir escalones 9 en igual puntuación; 1 en 5, y solamente 1 paciente mantuvo igual puntuación antes de operarse. Valorando estas puntuaciones se evaluaron 9 pacientes de bien, 2 de regular, y se presentaron 3 complicaciones. Conclusiones: al año de seguimiento ocurre gran mejoría del dolor, mejorando la seguridad del paciente durante la marcha (AU).

Introduction: the fibular osteoarthritis could be a very invalidating disease due to its symptoms, characterized by pain, insecurity and functional loss. It is a degenerative disease whose prevalence has increased during the last decades, tightly linked to population ageing. Objective: to validate the technique of fibular ostectomy in the painful genu varum as a new treatment option. Materials and Methods: a prospective, lineal study was carried out in the Military Hospital "Dr. Mario Muñoz Monroy", of Matanzas, from April 2016 to August 2017. It was used the new technique of Dr. Ying-Ze Zhang, from the Department of Orthopedic Surgery of the Third Hospital of Hebei Medical University in Shijiazhuang, China. Currently there is a series of cases of 75 patients, with 84 operated knees; the results of the first 11 operated patients, are presented here after a year of the surgery. Results: the average age was 64.3 years, 45 years the youngest and 84 years the eldest; from them, 8 were men and 3 women. The analogical visual scale for the pre and post-surgical pain was applied during the gait and when going upstairs. During the gait all the patients were above 6, and when climbing upstairs above 7. After a year from the operation 10 patients got an evaluation between 0 and 3 points during the gait, and 9 got the same score when climbing steps; one got 5, and only 1 patient kept the same score than before the operation. Taking into account these scores, 9 patients were evaluated as good, 2 regular, and there were 3 complications. Conclusions: after a one-year follow-up, the pain greatly improves, improving patients' security during the gait (AU).

Anatomical Variants of “Short Head of Biceps Femoris Muscle” Associated with Common Peroneal Neuropathy in Korean Populations : An MRI Based Study

OBJECTIVE: In Asians, kneeling and squatting are the postures that are most often induce common peroneal neuropathy. However, we could not identify a compatible compression site of the common peroneal nerve (CPN) during hyper-flexion of knees. To evaluate the course of the CPN at the popliteal area related with compressive neuropathy using magnetic resonance imaging (MRI) scans of healthy Koreans.METHODS: 1.5-Tesla knee MRI scans were obtained from enrolled patients and were retrospectively reviewed. The normal populations were divided into two groups according to the anatomical course of the CPN. Type I included subjects with the CPN situated superficial to the lateral gastocnemius muscle (LGCM). Type II included subjects with the CPN between the short head of biceps femoris muscle (SHBFM) and the LGCM. We calculated the thickness of the SHBFM and posterior elongation of this muscle, and the LGCM at the level of femoral condyles. In type II, the length of popliteal tunnel where the CPN passes was measured.RESULTS: The 93 normal subjects were included in this study. The CPN passed through the “popliteal tunnel” formed between the SHBFM and the LGCM in 36 subjects (38.7% type II). The thicknesses of SHBFM and posterior portions of this muscle were statistically significantly increased in type II subjects. The LGCM thickness was comparable in both groups. In 78.8% of the “popliteal tunnel”, a length of 21 mm to < 40 mm was measured.CONCLUSION: In Korean population, the course of the CPN through the “popliteal tunnel” was about 40%, which is higher than the Western results. This anatomical characteristic may be helpful for understanding the mechanism of the CPNe by posture.

Anatomical Variants of “Short Head of Biceps Femoris Muscle” Associated with Common Peroneal Neuropathy in Korean Populations : An MRI Based Study

OBJECTIVE: In Asians, kneeling and squatting are the postures that are most often induce common peroneal neuropathy. However, we could not identify a compatible compression site of the common peroneal nerve (CPN) during hyper-flexion of knees. To evaluate the course of the CPN at the popliteal area related with compressive neuropathy using magnetic resonance imaging (MRI) scans of healthy Koreans. METHODS: 1.5-Tesla knee MRI scans were obtained from enrolled patients and were retrospectively reviewed. The normal populations were divided into two groups according to the anatomical course of the CPN. Type I included subjects with the CPN situated superficial to the lateral gastocnemius muscle (LGCM). Type II included subjects with the CPN between the short head of biceps femoris muscle (SHBFM) and the LGCM. We calculated the thickness of the SHBFM and posterior elongation of this muscle, and the LGCM at the level of femoral condyles. In type II, the length of popliteal tunnel where the CPN passes was measured. RESULTS: The 93 normal subjects were included in this study. The CPN passed through the “popliteal tunnel” formed between the SHBFM and the LGCM in 36 subjects (38.7% type II). The thicknesses of SHBFM and posterior portions of this muscle were statistically significantly increased in type II subjects. The LGCM thickness was comparable in both groups. In 78.8% of the “popliteal tunnel”, a length of 21 mm to < 40 mm was measured. CONCLUSION: In Korean population, the course of the CPN through the “popliteal tunnel” was about 40%, which is higher than the Western results. This anatomical characteristic may be helpful for understanding the mechanism of the CPNe by posture.

Common Peroneal Neuropathy With Anterior Tibial Artery Occlusion: A Case Report

Peroneal neuropathy is a common mononeuropathy of the lower limb. Some studies have reported cases of peroneal neuropathy after vascular surgery or intervention. However, no cases of peroneal neuropathy with occlusion of a single peripheral artery have been previously reported. A 73-year-old man was referred with a 3-week history of left-sided foot drop. He had a history of valvular heart disease and arrhythmia, and had previously been treated with percutaneous coronary intervention. Computed tomography angiogram of the lower extremity showed proximal occlusion of the left anterior tibial artery. An electrodiagnostic study confirmed left common peroneal neuropathy. After diagnosis, anticoagulation therapy was started and he received physical therapy.

Use of superficial peroneal nerve graft for treating peripheral nerve injuries / Emprego do enxerto do nervo fibular superficial para tratamento de lesões de nervos periféricos

To evaluate the clinical results from treating chronic peripheral nerve injuries using the superficial peroneal nerve as a graft donor source. METHODS: This was a study on eleven patients with peripheral nerve injuries in the upper limbs that were treated with grafts from the sensitive branch of the superficial peroneal nerve. The mean time interval between the dates of the injury and surgery was 93 days. The ulnar nerve was injured in eight cases and the median nerve in six. There were three cases of injury to both nerves. In the surgery, a longitudinal incision was made on the anterolateral face of the ankle, thus viewing the superficial peroneal nerve, which was located anteriorly to the extensor digitorum longus muscle. Proximally, the deep fascia between the extensor digitorum longus and the peroneal longus muscles was dissected. Next, the motor branch of the short peroneal muscle (one of the branches of the superficial peroneal nerve) was identified. The proximal limit of the sensitive branch was found at this point. RESULTS: The average space between the nerve stumps was 3.8 cm. The average length of the grafts was 16.44 cm. The number of segments used was two to four cables. In evaluating the recovery of sensitivity, 27.2% evolved to S2+, 54.5% to S3 and 18.1% to S3+. Regarding motor recovery, 72.7% presented grade 4 and 27.2% grade 3. There was no motor deficit in the donor area. A sensitive deficit in the lateral dorsal region of the ankle and the dorsal region of the foot was observed. None of the patients presented complaints in relation to walking. CONCLUSIONS: Use of the superficial peroneal nerve as a graft source for treating peripheral nerve injuries is safe and provides good clinical results similar to those from other nerve graft sources.

Avaliar resultados clínicos do tratamento das lesões crônicas de nervos periféricos com o nervo fibular superficial como fonte doadora de enxerto. MÉTODOS: Estudo de 11 pacientes com lesões de nervos periféricos nos membros superiores tratados com enxerto do ramo sensitivo do nervo fibular superficial, com intervalo médio de 93 dias entre a data de registro da lesão e a cirurgia. Foram observadas lesões do nervo ulnar em oito pacientes e do nervo mediano em seis. Em três ambos os nervos foram lesados. Na cirurgia faz-se incisão longitudinal na face anterolateral no tornozelo, visualiza-se o nervo fibular superficial, situado anteriormente ao músculo extensor longo dos artelhos. Proximalmente disseca-se a fáscia profunda entre os músculos extensor longo dos artelhos e o fibular longo. A seguir, identifica-se o ramo motor do músculo fibular curto, um dos ramos do nervo fibular superficial. O limite proximal do ramo sensitivo encontra-se nesse ponto. RESULTADOS: A média do espaço entre os cotos nervosos foi de 3,8 cm, comprimento médio dos enxertos de 16,44 cm, número de segmentos usados de dois a quatro cabos. Na avaliação da recuperação da sensibilidade, 27,2% evoluíram para S2+, 54,5% para S3 e 18,1% para S3+. Quanto à recuperação motora, 72,7% apresentavam grau 4 e 27,2%, grau 3. Não houve déficit motor da área doadora, observou-se déficit sensitivo na região dorso lateral do tornozelo e dorsal do pé. Nenhum paciente apresentou queixas à deambulação. CONCLUSÕES: O uso do nervo fibular superficial no tratamento das lesões de nervos periféricos como fonte de enxerto é seguro e proporciona resultados clínicos semelhantes a outras fontes de enxerto de nervos.

Diagnostic Cutoff Value for Ultrasonography of the Common Fibular Neuropathy at the Fibular Head

OBJECTIVE: To establish the diagnostic cutoff value of ultrasonographic measurement for common fibular neuropathy (CFN) at the fibular head (FH). METHODS: Twenty patients with electrodiagnostically diagnosed CFN at the FH and 30 healthy controls were included in the study. The cross-sectional area (CSA) of sciatic nerve at mid-thigh level, common fibular nerve at popliteal fossa (PF), and common fibular (CF) nerve at FH were measured. Additionally, the difference of CF nerve CSA at the FH between symptomatic side and asymptomatic side (ΔSx–Asx), the ratio of CF nerve CSA at FH to at PF (FH/PF), and the ratio of CF nerve CSA at the FH symptomatic side to asymptomatic side (Ratio Sx–Asx) were calculated. RESULTS: CSA at the FH, FH/PF, ΔSx–Asx, and Ratio Sx–Asx showed significant differences between the patient and control groups. The cutoff value for diagnosing CFN at the FH was 11.7 mm² for the CSA at the FH (sensitivity 85.0%, specificity 90.0%), 1.70 mm² for the ΔSx–Asx (sensitivity 83.3%, specificity 97.0%), 1.11 for the FH/PF (sensitivity 47.1%, specificity 93.3%), and 1.24 for the Ratio Sx–Asx (sensitivity 72.2%, specificity 96.7%). CONCLUSION: The ultrasonographic measurement and cutoff value could be a valuable reference in diagnosing CFN at the FH and improving diagnostic reliability and efficacy.

Anatomical aspects of the nerves of the leg and foot of the giant anteater (Myrmecophaga tridactyla, Linnaeus, 1758) / Aspectos anatômicos dos nervos da perna e pé do tamanduá-bandeira (Myrmecophaga tridactyla, Linnaeus, 1758)

Although distal stifle joint nerve distribution has been well established in domestic animals, this approach is scarcely reported in wild animals. Therefore, the aim of this study was to describe the nerves of the leg and foot of Myrmecophaga tridactyla with emphasis on their ramification, distribution, topography and territory of innervation. For this purpose, six adult cadavers fixed and preserved in 10% formalin solution were used. The nerves of the leg and foot of the M. tridactyla were the saphenous nerve (femoral nerve branch), fibular and tibial nerves and lateral sural cutaneous nerve (branches of the sciatic nerve) and caudal sural cutaneous nerve (tibial nerve branch). The saphenous nerve branches to the skin, the craniomedial surface of the leg, the medial surface of the tarsal and metatarsal regions and the dorsomedial surface of the digits I and II (100% of cases), III (50% of cases) and IV (25% of cases). The lateral sural cutaneous nerve innervates the skin of the craniolateral region of the knee and leg. The fibular nerve innervates the flexor and extensor muscles of the tarsal region of the digits and skin of the craniolateral surface of the leg and dorsolateral surface of the foot. The tibial nerve innervates the extensor muscles of the tarsal joint and flexor, adductor and abductor muscles of the digits and the skin of the plantar surface. The caudal sural cutaneous nerve innervates the skin of the caudal surface of the leg. The nerves responsible for the leg and foot innervation were the same as reported in domestic and wild animals, but with some differences, such as the more distal division of the common fibular nerve, the absence of dorsal metatarsal branches of the deep fibular nerve and a greater involvement of the saphenous nerve in the digital innervation with branches to the digits III and IV, in addition to digits I and II...

Apesar de bem estabelecida nos animais domésticos, a abordagem da distribuição nervosa distal do joelho é rara em animais selvagens. Portanto, o objetivo deste estudo foi descrever os nervos da perna e pé do Myrmecophaga tridactyla, com ênfase na sua ramificação, distribuição, topografia e território de inervação. Para tanto, foram utilizados seis cadáveres adultos, fixados e conservados em solução de formalina a 10%. A dissecação envolveu desde a formação dos nervos femoral e isquiático pelos ramos ventrais dos nervos espinhais lombares e sacrais até sua distribuição nos territórios propostos. Os nervos responsáveis pela inervação da perna e pé do M. tridactyla foram o N. safeno (ramo do N. femoral), os nervos fibular comum e tibial e o N. cutâneo lateral da sura (derivados do N. isquiático) e o N. cutâneo caudal da sura (ramo do N. tibial). O nervo safeno emite ramos cutâneos para a superfície craniomedial da perna, medial do tarso e metatarso e dorsomedial dos dedos I e II (100% dos casos), III (50% dos casos) e IV (25% dos casos). O nervo cutâneo lateral da sura inerva a região cutânea craniolateral do joelho e perna. O nervo fibular inerva os músculos flexores do tarso e extensores dos dedos e a região cutânea craniolateral da perna e dorsolateral do pé. O nervo tibial inerva os músculos extensores do tarso e flexores, adutores e abdutores dos dedos e região cutânea plantar. O nervo cutâneo caudal da sura inerva a pele da face caudal da perna. Pode-se concluir que os nervos responsáveis pela inervação da perna e pé foram os mesmos relatados em animais domésticos e selvagens, porém com algumas diferenças, como a divisão mais distal do nervo fibular comum, ausência de ramos metatarsianos dorsais do N. fibular profundo e uma maior participação do nervo safeno na inervação digital, contribuindo com ramos inclusive para os dedos III e IV, além dos dedos I e II...

Association between the use of gel pads under patients' knees and the incidence of peroneal neuropathy following liver transplantation

<p><b>INTRODUCTION</b>There have been intermittent reports of peroneal neuropathy (PN) occurring after liver transplantation. Although PN may not be viewed as a serious complication by liver transplant (LT) recipients who require the transplant for survival, PN can significantly reduce quality of life. The incidence of PN appears to have increased after the use of gel pads was introduced. These gel pads, which are placed under patients' knees during surgery, are used to reduce lower back strain and prevent contact between the peroneal nerve at the fibular head and the hard surface of the operating table. The aim of the present study was to investigate the association, if any, between the use of gel pads and the incidence of PN.</p><p><b>METHODS</b>The medical records of 261 adult LT recipients were retrospectively reviewed. The recipients were divided into gel pad (n = 167) and non-gel pad (n = 94) groups. The incidence and possible risk factors of PN were compared between the two groups.</p><p><b>RESULTS</b>The overall incidence of PN was 8.0% (21/261). The occurrence of PN was significantly higher in the gel pad group than in the non-gel pad group (10.8% vs. 3.2%; p < 0.05). Other possible risk factors were comparable between the two patient groups.</p><p><b>CONCLUSION</b>As the use of gel pads may increase the incidence of PN, we recommend against the use of gel pads under the knees of LT recipients.</p>

Common peroneal injury mistaken neuraxial analgesia complication after vaginal delivery: A case report

Common peroneal neuropathy during normal delivery is associated with instrumentation and prolonged time spent in a certain position. We report a case of unilateral common peroneal neuropathy in a vaginal delivery patient under labor analgesia with the combined spinal-epidural technique. A 29-year-old woman complained of weakness and numbness of the left foot two days after vaginal delivery. Neurologic examination and electrodiagnostic testing confirmed left common peroneal neuropathy. The patient was referred for rehabilitation, which substantially improved her mobility and function, and prevented secondary damage. The patient had not fully recovered at three months after the delivery. The possible etiology of the postpartum common peroneal neuropathy was most likely prolonged and excessive pressure around the knee by assistants. Excessive compression during delivery should be minimized or avoided. Patient education and awareness among the labor and delivery team will prevent this complication. Neurologic complications related to epidural analgesia should also be ruled out in these patients.

Schwannoma of Common Peroneal Nerve Presenting as a Foot Drop / 대한임상신경생리학회지

Foot drop is usually derived from peroneal nerve injury. Traumatic causes of peroneal nerve injury are more common than insidious causes including metabolic syndromes and mass lesions. We present a case with common peroneal neuropathy due to schwannoma, which is extremely rare. Complete excision of the mass lead to a gradual improvement of the symptoms. Schwannoma should be considered as a cause of common peroneal neuropathy.

Tumor de células gigantes del peroné y parálisis del nervio peroneo común / Tumeur à cellules géantes du péroné et paralyse du nerf péronier commun / Giant-cell tumor of the fibula and common peroneal nerve palsy

Los tumores del peroné comprenden solamente el 2,5 por ciento de los tumores primarios de los huesos y solo un tercio de ellos son benignos. El tumor de células gigantes es una lesión benigna, pero puede tener un comportamiento localmente agresivo. Se presenta el caso con el propósito de destacar el tratamiento quirúrgico utilizado con éxito ante un tumor de este tipo. Se trata de un paciente de 30 años de edad con diagnóstico imagenológico e histológico de un tumor de células gigantes del extremo proximal del peroné que produjo una parálisis compresiva del nervio peroneo común. Se realizó una resección en bloque del extremo proximal del peroné y una liberación del nervio peroneo. El tumor era de gran tamaño y aunque no existía infiltración de los tejidos blandos vecinos ya había ruptura de la cortical, por lo que se clasificó como un grado III. Después de dos meses de rehabilitación la movilidad y estabilidad de la rodilla eran normales. El paciente recuperó la función nerviosa a los cinco meses de la operación. Después de 15 meses no había signos clínicos ni imagenológicos de recidiva del tumor. La condición de grado III y la localización del tumor, fueron los dos aspectos tomados en cuenta para la elección de la resección en bloque como tratamiento en este caso, técnica quirúrgica que permiti'o la extracción del tumor sin crear tensiones por tracción excesiva sobre el nervio peroneo común. El paciente está totalmente reintegrado a su vida laboral y personal(AU)

Tumors of the fibula constitute a mere 2.5 percent of the primary tumors of bone, and only one third of them are benign. Giant-cell tumors are a benign lesion, but their behavior may be locally aggressive. This case presentation is aimed at describing the successful treatment of a giant-cell tumor. A 30-year-old male patient with an imaging and histological diagnosis of a giant-cell tumor of the proximal end of the fibula presents with compressive common peroneal nerve palsy. En bloc resection of the proximal end of the fibula and release of the peroneal nerve were performed. The tumor was large. Though there was no infiltration into the neighboring soft tissues, cortical rupture had already occurred. Thus, the tumor was classified as grade III. After two months of rehabilitation, mobility and stability of the knee were normal. Nerve function was recovered 5 months after surgery. At 15 months there were no clinical or imaging signs of tumor recurrence. Grade III classification and location were the two criteria leading to the choice of en bloc resection. This surgical technique enables extraction of the tumor without excessive traction tension on the common peroneal nerve. The patient has fully reintegrated to his work and personal life(AU)

Les tumeurs du péroné ne comprennent que 2,5 pourcent des tumeurs primaires des os, et un tiers d'entre elles sont bénignes. La tumeur à cellules géantes est une lésion bénigne, mais peut avoir un comportement local agressif. Un cas est présenté dans le but de mettre en relief le traitement chirurgical utilisé avec succès vis-à-vis une tumeur de ce type. Il s'agit d'un patient âgé de 30 ans, diagnostiqué par imagerie et histologie d'une tumeur à cellules géantes au côté proximal du péroné résultant en une paralysie par compression du nerf péronier commun. Une résection en bloc du côté proximal du péroné et une libération du nerf péronier sont effectuées. La tumeur est de grande taille, et quoiqu'il n'y a pas d'infiltration des tissus mous en proximité, il y a un rupture de la corticale, c'est pourquoi elle est classée grade III. Après deux mois de rééducation, la mobilité et la stabilité du genou deviennent normales. Le patient récupère la fonction nerveuse en 5 mois. Après 15 mois, il n'y a aucun signe clinique ou radiologique indiquant récidive de la tumeur. C'est la classification en grade III et la localisation de la tumeur qui ont décidé le choix de la résection en bloc comme technique chirurgicale permettant d'enlever la tumeur sans créer des tensions par traction excessive sur le nerf péronier commun. Le patient s'est complètement réintégré à sa vie quotidienne(AU)

Disability appraisal for common peroneal nerve injury in traffic accidents: 8 cases analysis / 法医学杂志

OBJECTIVE@#To investigate the characteristics of forensic clinical identification on common peroneal nerve injury in traffic accident.@*METHODS@#Eight cases of common peroneal nerve injury in traffic accidents were analyzed, including general condition of the wounded, the way of injury, the imaging results, the EMG results, and the degree of injury, etc.@*RESULTS@#In 8 cases, 2 cases of complete common peroneal nerve injury were determined to grade 9 (disability degree) and 6 cases of partial common peroneal nerve injury were determined to grade 10 (disability degree).@*CONCLUSION@#By comparison, the disability degree of complete common peroneal nerve injury is higher than that of partial common peroneal nerve injury. The forensic clinical identification of common peroneal nerve should be made with synthetical consideration of medical history, symptoms, and auxiliary examinations.

Common Peroneal Nerve Palsy by the Use of Intermittent Pneumatic Compression Device after Hartmann's Operation

Intermittent pneumatic compression device is a standard component for prevention of deep venous thrombosis in immobile patients. This method has been known to be safe with very low rate of complications compared to medical thromboprophylaxis. Therefore, this modality has been used widely in patients who underwent a general surgery. We report a patient who developed common peroneal nerve palsy during the use of intermittent pneumatic compression device after Hartmann's operation.