Compressive Superficial Peroneal Neuropathy

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Compressive Superficial Peroneal Neuropathy

Authors, Editors, Case Information Author: Kevin Burnham, MD Affiliation: UC Davis Health Co Author(s): Marcia Faustin MD FAAFP Brandon Hassid MD Editor: William Berrigan, MD Clinical Vignette: A young adult man with known history of bilateral anterior and lateral compartment fasciotomies 12 years prior presented with insidious onset of right greater than left exertional loss of sensation on the dorsolateral/lateral aspect of the ankle and foot. Type of Probe Used: Linear transducer, 15 MHz Unlabeled Long Axis View of Superficial Peroneal Nerve at the Surgical Scar Unlabeled Long Axis View of Superficial Peroneal Nerve in the region of the surgical scar Labeled Long Axis View of Superficial Peroneal Nerve at the Surgical Scar Labeled Long Axis View of Superficial Peroneal Nerve at the Surgical Scar showing focal notching of the nerve at the site of compression Unlabeled Short Axis View of Superficial Peroneal Nerve at the Surgical Scar Unlabeled Short Axis View of Superficial Peroneal Nerve at the Surgical Scar Labeled Short Axis View of Superficial Peroneal Nerve at the Surgical Scar Labeled Short Axis View of Superficial Peroneal Nerve at the Surgical Scar PL: peroneus longus; PB: peroneus brevis; EDL: extensor digitorum longus; TA: tibialis anterior Unlabeled Short Axis View of Superficial Peroneal Nerve Measurement at the Surgical Scar Unlabeled Short Axis View of Superficial Peroneal Nerve Measurement at the Surgical Scar, with an area of approximately 9 mm^2. Labeled Short Axis View of Superficial Peroneal Nerve Measurement Labeled Short Axis View of Superficial Peroneal Nerve Measurement at the Surgical Scar, with an area of approximately 9 mm^2. PL: peroneus longus; PB: peroneus brevis; EDL: extensor digitorum longus; TA: tibialis anterior; CSA: cross-sectional area Unlabeled Short Axis View of Superficial Peroneal Nerve Measurement Proximal to the Surgical Scar Unlabeled Short Axis View of Superficial Peroneal Nerve Measurement Proximal to the Surgical Scar, with an area of approximately 2.5 mm^2. Labeled Short Axis View of Superficial Peroneal Nerve Measurement Proximal to the Surgical Scar Labeled Short Axis View of Superficial Peroneal Nerve Measurement Proximal to the Surgical Scar, with an area of approximately 2.5 mm^2. PL: peroneus longus; PB: peroneus brevis; EDL: extensor digitorum longus; TA: tibialis anterior; CSA: cross-sectional area Unlabeled Short Axis View of Superficial Peroneal Nerve Measurement Distal to the Surgical Scar Unlabeled Short Axis View of Superficial Peroneal Nerve Measurement Distal to the Surgical Scar, with an area of approximately 1.6 mm^2. Labeled Short Axis View of Superficial Peroneal Nerve Measurement Distal to the Surgical Scar Labeled Short Axis View of Superficial Peroneal Nerve Measurement Distal to the Surgical Scar, with an area of approximately 1.6 mm^2. PL: peroneus longus; PB: peroneus brevis; EDL: extensor digitorum longus; TA: tibialis anterior; CSA: cross-sectional area Interpretation Image Interpretation: Focal hypoechoic enlargement of the superficial peroneal nerve in the region of the surgical scar (middle 1/3rd of the lateral calf). Long axis width approximately 2mm; short axis width approximately 5mm; cross-sectional area of the nerve was approximately 9 mm^2 at its maximum dimension. Just proximal to this area, the nerve was approximately 2.5 mm^2; just distal, it was approximately 1.6 mm^2. Teaching Pearl: Ultrasound signs of peripheral nerve compression include focal notching, enlargement proximal to the compression site, hypoechogenicity, fascicular enlargement, irregularity, or loss of normal architecture. For superficial peroneal neuropathy, one should scan the length of the nerve through the fascial exit point and any surgical scar or suspected compression site in short and long axis. When measuring cross-sectional area, one should obtain a true short-axis image perpendicular to the nerve and measure inside the hyperechoic epineurial rim for consistency. Side-to-side comparison and measurements at the site of concern, proximal, and distal help further diagnostic confidence. References: 1. Nwawka OK, Lee S, Miller TT. Sonographic evaluation of superficial peroneal nerve abnormalities. AJR Am J Roentgenol. 2018;211(4):872-879. doi:10.2214/AJR.17.19322 2. Schwabl C, Schmidle G, Kaiser P, Drakonaki E, Taljanovic MS, Klauser AS. Nerve entrapment syndromes: detection by ultrasound. Ultrasonography. 2023;42(3):376-387. doi:10.14366/usg.22186 3. Bae DW, An JY. Cross-sectional area reference values for high-resolution ultrasonography of the lower extremity nerves in healthy Korean adults. Medicine (Baltimore). 2022;101(26):e29842. doi:10.1097/MD.0000000000029842
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Authors, Editors, Case Information

Unlabeled Long Axis View of Superficial Peroneal Nerve at the Surgical Scar

Labeled Long Axis View of Superficial Peroneal Nerve at the Surgical Scar

Unlabeled Short Axis View of Superficial Peroneal Nerve at the Surgical Scar

Labeled Short Axis View of Superficial Peroneal Nerve at the Surgical Scar

Unlabeled Short Axis View of Superficial Peroneal Nerve Measurement at the Surgical Scar

Labeled Short Axis View of Superficial Peroneal Nerve Measurement

Unlabeled Short Axis View of Superficial Peroneal Nerve Measurement Proximal to the Surgical Scar

Labeled Short Axis View of Superficial Peroneal Nerve Measurement Proximal to the Surgical Scar

Unlabeled Short Axis View of Superficial Peroneal Nerve Measurement Distal to the Surgical Scar

Labeled Short Axis View of Superficial Peroneal Nerve Measurement Distal to the Surgical Scar

Interpretation

UPCOMING EVENTS

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