Peroneal Mononeuropathy Workup

  • Author: Pinky Agarwal, MD; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Aug 3, 2010
 

Imaging Studies

The following imaging studies are useful in peroneal mononeuropathy.

  • MRI of the lower thigh or popliteal fossa may be indicated if a mass lesion is suspected. Peripheral nerve nodular mass lesions and inflammatory pseudotumors of the peripheral nerves may be detected and confirmed by pathological excision.[21]
  • MRI can also detect variations in the posterior and distal extents of the biceps femoris muscle, which can produce a tunnel in which the common peroneal nerve travels causing peroneal nerve compression.[22]
  • Color duplex ultrasonography and angiography can reveal a popliteal artery pseudoaneurysm in the popliteal fossa.[23]
  • High resolution sonography of the common peroneal nerve may identify structural lesions of the peroneal nerve such as intraneural ganglion[24] and inflammatory changes in vasculitic neuropathy[25] .
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Other Tests

Nerve conduction studies and needle EMG aid in defining the location and type of lesion.

  • Nerve conductions should show isolated peroneal nerve abnormalities. If the lesion is at the knee, then conduction block or, less commonly, conduction velocity slowing over that segment of the nerve should be documented. When axonal loss occurs in direct nerve trauma or with long-standing compression, a small compound muscle action potential may be noted. If other mononeuropathies with conduction blocks are found, then consideration should be made for an underlying vasculitis causing mononeuritis multiplex or possibly for hereditary neuropathy with liability to pressure palsy. If more diffuse nerve abnormalities are noted, then a generalized neuropathy should be considered, especially chronic demyelinating polyneuropathy.
  • EMG is useful to localize the lesion. It can be helpful in determining which nerve is involved primarily—the common peroneal nerve at the knee or one of its two branches, the superficial or deep peroneal nerve. The tibialis anterior or extensor hallucis longus muscles (ie, innervated by the deep peroneal) and the peroneus longus or brevis muscles (ie, innervated by the superficial peroneal) are useful to study for this purpose.
  • EMG also is helpful in determining if the foot drop is due to an L5 radiculopathy or a sciatic lesion. In an L5 radiculopathy, the tibialis posterior, which is a foot inverter, and the lumbosacral paraspinous muscles are involved.
  • Involvement of the peroneal division of the sciatic nerve in the thigh or hip area is more difficult to determine clinically. In the thigh, the peroneal division of the sciatic nerve innervates the short head of the biceps femoris muscle, a knee flexor. As isolating this muscle clinically is difficult, EMG may be necessary to determine involvement.
  • If lesions in the thigh are suspected on EMG, then MRI of the thigh (evaluating for cysts or tumors) is indicated.
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Histologic Findings

Peroneal neuropathy from intraneural ganglia of the peroneal nerve may have various patterns: outer (epifascicular) epineurial, inner (interfascicular) epineurial, and combined outer and inner epineurial.[26]

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Contributor Information and Disclosures
Author

Pinky Agarwal, MD  Clinical Assistant Professor, Department of Neurology, University of Washington; Attending Neurologist, Booth Gardner Parkinson's Care Center, Kirkland, WA

Pinky Agarwal, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, Association of Clinical Research Professionals, and Movement Disorders Society

Disclosure: Nothing to disclose.

Coauthor(s)

Alida Griffith, MD  Movement Disorders Neurologist, Booth Gardner Parkinson's Care Center

Disclosure: TEVA Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Specialty Editor Board

Aashit K Shah, MD  Associate Professor of Neurology, Wayne State University; Program Director, Clinical Neurophysiology Fellowship, Department of Neurology, Detroit Medical Center

Aashit K Shah, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, and American Epilepsy Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Glenn Lopate, MD  Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Director of Neurology Clinic, St Louis ConnectCare; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD  Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology

Disclosure: Nothing to disclose.

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Peroneal sensory distribution: The striped area is the superficial peroneal sensory distribution. The green solid area represents the deep peroneal sensory distribution. All 3 areas shaded would be numb in a patient with a common peroneal nerve lesion.
 
 
 
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