Common Peroneal Nerve

Knee proprioception and SEPs to stimulation of the common peroneal nerve (CPN) were studied by Veleriani et al. in patients with ACL injury before and after ACL reconstruction [21]. Before surgery, all patients showed decreased knee position sense and lack of cortical P27 potential on the injured side. Arthroscopic reconstruction of the ligament was performed but knee proprioception and somatosensory central conduction did not recover to normal level. However, the loss of knee mechanoreceptors may possibly be restored by modifications of the CNS, which are not compensated by other nervous structures. 

In a 49-year-old man hyperthermic isolated limb perfusion with TNF alfa and melphalan was performed for an unresectable desmoid tumor with calf extension. Local toxicity resulted in extensive edema and common peroneal nerve impairment, including paresis, which was still severe 10 months later. 

Drouet A, Le Moigne F, Have L, Blondet R, Jacquin O, Chauvin F. Common peroneal nerve palsy following TNF-based isolated limb perfusion for irresect-able extremity desmoid tumor. Orthop Traumatol Surg Res 2009 95(8) 639-44. 

Nervous system Peripheral nerve damage has been reported in 1-48% of patients, including a 49-year-old man in whom hyperthermic isolated limb perfusion was performed with TNF-alpha and melphalan for an irresectable desmoid tumor and caused extensive local edema and a common peroneal nerve palsy, which was still severe 10 months later [87 ]. In such cases emergency compartmental pressure measurement may guide the need for fasciotomy... 

A. R. M. Rqi and R. B. M. Bowden, Effects of high peak pulsed electromagnetic field on the degeneration and regeneration of the common peroneal nerve fat rats,/. Bane Joint Stag. 65 478 (1983). 

Fig. 14.10a-d. Anatomy of the peroneal nerve, a Schematic drawing of a lateral view of the knee illustrates the course of the common peroneal nerve (curved arrows) which branches from the sciatic nerve (black arrow) at the apex of the popliteal fossa and descends posterior to the biceps femoris muscle (Bf) and tendon (asterisk) to turn anteriorly around the fibular head. The nerve then continues down between the lateral side of the neck of the fibula and the peroneus longus muscle (PI). Here the peroneal nerve divides into its two terminal branches, the superficial peroneal nerve (white arrowhead) and the deep peroneal nerve (white arrow), md sends a recurrent articular branch (open arrowhead).b-d Transverse Tl-weighted MR images obtained at the levels indicated in a (horizontal bars) reveal the normal position of the common peroneal nerve (curved arrow) relative to the biceps tendon, the crural fascia (open arrowhead) fibular head (FH). Note the relationships of the main trunk and the superficial (white arrowhead) and deep (white arrow) peroneal nerves with the fibular and neck (FN). Black arrow, tibial nerve... 

In the posterior external zone, the structures that are amenable to US examination include the muscles and tendons of the biceps femoris and the lateral head of the gastrocnemius, the common peroneal nerve... 

Fig. 14.87a-c. Fusiform neuroma of the common peroneal nerve in the popliteal fossa. The patient reported sudden onset of nerve deficit a knee sprain, a Longitudinal and b transverse 12-5 MHz US images with c fat-suppresse T2 -weighted MR imaging correlation demonstrate a fusiform hypoechoic swelling of the common peroneal nerve (arrowheads) as a result of a stretching injury in the popliteal fossa. Observe the position of the nerve between the biceps femoris (Bf) and the lateral head of the gastrocnemius (LHG)... 

Fig. 14.88a-c. Complete tear of the common peroneal nerve in a patient with previous knee dislocation, a Long-axis 12-5 MHz US image over the peroneal nerve in the popliteal fossa. The nerve has a wavy course and is characterized by abnormal thickened (arrowheads) and thinned (arrows) segments related to the interruption and laceration of the fascicles, b Transverse oblique 12-5 MHz US image over the lateral knee with c lateral radiographic correlation demonstrates abnormal hypoechoic tissue related to the avulsion of the biceps femoris tendon (arrows) from its insertion (open arrowhead) into the fibular head (FHj.Note the close relationship of the ruptured biceps with the torn nerve (white arrowheads). On the radiograph, a small fleck of bone (curved arrow) appears retracted proximally with the torn biceps tendon... 

O Reilly MAR, O Reilly PMR, Bell) (2003) Sonographic appearances of medial retinacular complex injury in transient patellar dislocation. Clin Radiol 58 636-641 Parkes A (1961) Intraneural ganglion of the lateral popliteal nerve. J Bone Joint Surg Br 43 784-790 Pedrazzini M, Pogliacomi F, Cusmano F et al (2002) Bilateral ganglion cyst of the common peroneal nerve. Eur Radiol 12 2802-2806... 

The anterior ankle is traversed by the deep peroneal nerve and the anterior tibial artery. The deep peroneal nerve is the larger of the two terminal divisions of the common peroneal nerve. It enters the anterior ankle crossing the interosseous membrane together with the anterior tibial artery and veins, usually lateral to the extensor hallucis longus tendons (Fig. 16.9). The anterior tibial artery, the smaller of the terminal branches of the popliteal artery, ends at the ankle joint, midway between the malleoli where it becomes the dorsalis pedis artery. It contributes to the blood supply of the ankle. 

Deep Peroneal Nerve, Common Peroneal Nerve, Sciatic Nerve, Dorsal Division Sacral Plexus, L5, SI. 

More proximal nerve lesions of common peroneal nerve, sciatic nerve, sacral plexus, or L5, SI nerve roots. 

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