Superficial Peroneal Neuropathy

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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: Young adult man with history of bilateral anterior and lateral compartment fasciotomies 12 years ago 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 Proximal unlabeled SAX view of superficial peroneal nerve cross sectional area Proximal unlabeled short axis view of superficial peroneal nerve cross sectional area Proximal labeled SAX view of superficial peroneal nerve cross sectional area Proximal labeled short axis view of superficial peroneal nerve cross sectional area, measured at 2.5 mm^2. PL: peroneus longus; PB: peroneus brevis; EDL: extensor digitorum longus; TA: tibialis anterior; CSA: cross-sectional area Distal unlabeled SAX view of superficial peroneal nerve cross sectional area Distal unlabeled SAX view of superficial peroneal nerve cross sectional area Distal labeled SAX view of superficial peroneal nerve cross sectional area Distal labeled short axis view of superficial peroneal nerve cross sectional area, measured at 1.6 mm^2. PL: peroneus longus; PB: peroneus brevis; EDL: extensor digitorum longus; TA: tibialis anterior; CSA: cross-sectional area Labeled SAX cross sectional area of superficial peroneal nerve Labeled short axis cross sectional area of superficial peroneal nerve, measured at 9 mm^2. PL: peroneus longus; PB: peroneus brevis; EDL: extensor digitorum longus; TA: tibialis anterior; CSA: cross-sectional area Unlabeled SAX cross sectional area of superficial peroneal nerve Unlabeled short axis cross sectional area of superficial peroneal nerve Labeled LAX of superficial peroneal nerve Labeled long axis view of superficial peroneal nerve Unlabeled SAX view of superficial peroneal nerve Unlabeled short axis view of superficial peroneal nerve Labeled SAX view of superficial peroneal nerve Labeled short axis view of superficial peroneal nerve PL: peroneus longus; PB: peroneus brevis; EDL: extensor digitorum longus; TA: tibialis anterior Unlabeled LAX view of superficial peroneal nerve Unlabeled long axis view of superficial peroneal nerve Interpretation Image Interpretation: Focal hypoechoic enlargement of the superficial peroneal nerve in the region of his surgical scar (middle 1/3rd of the lateral calf). Long axis width 2mm; short axis width 5mm; cross-sectional area of the nerve was 9 mm^2 at its maximum dimension. Just proximal to this area, the nerve was 2.5 mm^2; just distal, it was 1.6 mm^2. Teaching Pearl: Signs of nerve compression include focal notching of the nerve in long axis at the site of compression, nerve enlargement/swelling proximal to the site of entrapment, increased hypoechogenicity of the nerve, fascicular enlargement or irregularity, and/or loss of the fascicular architecture (Strakowski). When measuring nerve cross sectional area, ensure that you are in true short axis (perpendicular to the nerve) and measure at the inner border of the hyperechoic epineurium for consistency (Strakowski). This can be achieved by rotating back and forth until the smallest diameter is found. The normal reference range for cross sectional area of the superficial fibular nerve at the level of the distal calf has been described in two studies as 1 - 3.3 mm2 and 1 – 4 mm2 (Qrimli 2015, Bae 2022), though we are unable to identify literature describing reference ranges at the level of the ankle. Bae, Dae Woong MDa; An, Jae Young MD, PhDa,*. Cross-sectional area reference values for high-resolution ultrasonography of the lower extremity nerves in healthy Korean adults. Medicine 101(26):p e29842, July 1, 2022. \| DOI: 10.1097/MD.0000000000029842 https://pmc.ncbi.nlm.nih.gov/articles/PMC9239665/pdf/medi-101-e29842.pdf Qrimli M, Ebadi H, Breiner A, et al. Reference values for ultrasonograpy of peripheral nerves. Muscle Nerve. 2016;53(4):538-544. doi:10.1002/mus.24888 https://onlinelibrary.wiley.com/doi/full/10.1002/mus.24888?saml_referrer Strakowski MD JA. Ultrasound Evaluation of Peripheral Nerves and Focal Neuropathies, Second Edition: Correlation With Electrodiagnosis. 2nd ed. Demos Medical; 2020:630.
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Authors, Editors, Case Information

Proximal unlabeled SAX view of superficial peroneal nerve cross sectional area

Proximal labeled SAX view of superficial peroneal nerve cross sectional area

Distal unlabeled SAX view of superficial peroneal nerve cross sectional area

Distal labeled SAX view of superficial peroneal nerve cross sectional area

Labeled SAX cross sectional area of superficial peroneal nerve

Unlabeled SAX cross sectional area of superficial peroneal nerve

Labeled LAX of superficial peroneal nerve

Unlabeled SAX view of superficial peroneal nerve

Labeled SAX view of superficial peroneal nerve

Unlabeled LAX view of superficial peroneal nerve

Interpretation

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