Evaluating Etiologies and Outcomes in Common Peroneal Nerve Decompression
Kenan Tawaklna, MD, Ruby Taylor, MD, Ethan Blum, BS, Matthew De la Paz, BS and Susan E Mackinnon, MD, FRCS(C), FACS, Washington University School of Medicine, St. Louis, MO
Introduction:
Common peroneal neuropathy is a compressive neuropathy of the nerve as it crosses the fibular neck that can have significant sensorimotor symptoms in the lower extremity. Despite sharing a similar pathophysiology with carpal tunnel syndrome, common peroneal neuropathy remains underdiagnosed. Some of the barriers to diagnosis include: varying presentation, lack of consensus on diagnostic criteria, lack of clinical awareness, reliance on electrodiagnostic studies. The aims of this study are to: raise awareness of common peroneal neuropathy, evaluate the effectiveness of decompression, and identify factors that affect outcomes.
Materials and Methods:
A retrospective chart review was done for patients that underwent common peroneal nerve decompression by a single surgeon from 2011-2023 with minimum 6-month follow-up. Every patient underwent evaluation using Visual Analog Scale (VAS) survey as well as comprehensive sensorimotor exam. The following data was collected from chart review: presenting symptoms, comorbidities, pre- and post-operative pain scores, pre- and postoperative quality of life measures, results of electrodiagnostic studies. Descriptive statistics were used to compare patient demographics, presenting symptoms, and perioperative pain/quality of life (QoL) assessments. Two-sided tests were used to compare continuous variables. Chi-square analysis was used for categorical variables. Multivariate regression models were used to identify patient factors affecting outcomes.
Results:
231 patients were included in the study. 47% percent of patients presented without any motor symptoms. The most common presenting symptom was pain or paresthesia to the dorsum of the foot (67%) but could occur anywhere on the leg including lateral leg (45%), lateral ankle (33%), knee (31%), and fibular neck (29%). The most common etiology was iatrogenic (40%). 25% of all electrodiagnostic studies were normal and showed no evidence of neuropathy. CPN decompression outcomes showed a significant decrease in pain from 6 to 3.5 (p<0.0001) and increase in QoL 4.5 to 7 (p<0.0001). Patients presenting with foot drop saw a significant increase in MRC graded dorsiflexion function from 0.5 to 3.2 (p<0.0001). Patients that had a history of a fall (OR=10.6; CI: 1.9-60.3) or acute onset of symptoms (OR=4.1; CI: 1.2-12) were more likely to have an improved QoL. Patients with obesity (OR=0.26; 0.077-0.59) or traumatic etiology (OR=0.16; CI: 0.022-0.73) were less likely to have an improved QoL.
Conclusion:
Increased awareness of common peroneal neuropathy along with a comprehensive diagnostic approach that focuses on physical exam would allow earlier intervention using a simple operation that has the ability to restore critical function and improve quality of life.
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