Evaluation of Etiologic Factors and Electrophysiologic Findings in Patients with Peroneal Neuropathy

Abstract

Objective:Peroneal neuropathy is the most common entrapment mononeuropathy in the lower extremity. The common site of injury is around the fibular head where the nerve becomes superficial. Compressive pathologies are the most frequently seen etiologies. The treatment plan is designed according to the etiology. Electrophysiologic investigations are accepted as the gold standard for the diagnosis of peroneal neuropathy. In this study, we aimed to evaluate the etiologic factors and electrodiagnostic findings in peroneal neuropathy.Method:We retrospectively analyzed the etiological and electrodiagnostic test findings of patients with clinical features compatible with peroneal neuropathy, who presented to the Electromyography Laboratory of İstanbul Medipol University Hospital between January 2016 and December 2019. Patients with polyneuropathy or a disease that may cause polyneuropathy such as diabetes mellitus, those with lumbosacral radiculopathy or plexopathy, and those with neurodegenerative diseases were excluded.Results:A total of 30 patients with clinical features compatible with peroneal neuropathy (19 males, 11 females, median age 30 years; range 21 to 66) were enrolled in the study. Four (13.3%) patients had a comorbid disease. The median duration (minimum-maximum) of the symptoms was 20.5 (2-140) weeks. The affected side of the peroneal nerve was 43.3% right, 43.3% left, and 13.3% bilateral. The common cause of peroneal nerve injuries was due to compression (40%). Potential causes of compression in five out of 12 cases were iatrogenic. Weight loss was found in 10% of patients and one patient (3.3%) had a history of a recurrent ganglion cyst. Approximately 23% of lesions were due to traction injury and 23% of cases were idiopathic. According to electrophysiologic investigations, 16 cases were predominantly demyelinating without axonal injury. The axonal injury was detected in the remaining 14 cases (%46.6) and half of the cases with axonal injury were accompanied by demyelinating injury. Six cases had mild, 3 cases had severe, and 5 cases had a total axonal injury.Conclusion:Compression is the most commonly seen etiological factor in peroneal neuropathy. Electrophysiologic investigations play a significant role in the differential diagnosis, prognosis, management plan, and follow-up of recovery. Further detailed studies are needed to clarify the relationship between electrophysiologic findings and prognosis to form an algorithm for the treatment and follow-up.

Keywords

• electrodiagnosis
• entrapment neuropathy
• peroneal nerve