Elsevier

World Neurosurgery

Volume 86, February 2016, Pages 484-489
World Neurosurgery

Technical Note
Repetitive Plantar Flexion Test as an Adjunct Tool for the Diagnosis of Common Peroneal Nerve Entrapment Neuropathy

https://doi.org/10.1016/j.wneu.2015.09.080Get rights and content

Objective

The diagnosis of common peroneal nerve entrapment neuropathy (CPNEN) is based on clinical symptoms and nerve conduction studies. However, nerve conduction studies may not detect abnormalities. Under the hypothesis that repetitive plantar flexion that loads the peroneal nerve (PN) at the entrapment point without lumbar loading would be a useful CPNEN provocation test, we evaluated the repetitive plantar flexion (RPF) test as an adjunct diagnostic tool for CPNEN. The study design was a retrospective analysis of prospectively collected data.

Methods

Our study population consisted of 18 consecutive patients whose ipsilateral CPNEN improved significantly after PN neurolysis. Using repetitive ankle plantar flexion as a CPNEN provocation test, results were recorded as positive when it elicited numbness and/or pain in the affected area of the PN.

Results

The RPF test induced symptoms on all affected sides in the course of 57.4 seconds (range, 14–120 seconds). In 3 patients it induced numbness in the affected area of the PN in the normal leg. Receiver operating characteristic analysis showed that the diagnostic sensitivity and accuracy of the test were 94.4% each. The suggested cutoff point was 110 seconds and the area under the receiver operating characteristic curve was 0.97 (95% confidence interval 0.93–1.02). The positive and the negative predictive values were 89.5% and 94.1%, respectively.

Conclusions

Our simple RPF test elicited the symptoms of CPNEN and our provocation test helped to identify dynamic PN entrapment neuropathy as the origin of intermittent claudication.

Section snippets

Study Population

All patients gave prior written informed consent for participation in this retrospective analysis of prospectively collected data. They were consecutive patients whose CPNEN was improved by PN neurolysis. The diagnosis of ipsilateral CPNEN was based on symptoms, such as numbness and/or pain from the lower leg to the dorsum of the foot, which appeared upon walking or standing and produced intermittent claudication. The Tinel sign of the PN around the neck of the fibula was positive in all

Participants

Between September 2013 and January 2015, we surgically treated 39 consecutive patients with CPNEN (Table 1). From our study we excluded 17 patients; 9 had bilateral CPNEN, 4 presented with dementia or psychological problems, 1 had Parkinson disease, and 3 manifested severe arteriosclerosis obliterans. The exclusion of 2 additional patients with unsatisfactory surgical outcomes was based on the assumption that the original diagnosis of CPNEN was incorrect. As we also excluded 2 patients who

Discussion

PN neuropathy is the most common peripheral neuropathy of the lower extremities and the most frequent cause of numbness and pain in the lower limbs. CPNEN surgery yielded good results.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 The causes of PN neuropathy are multiple; it can be the result of previous orthopedic procedures and leg trauma. According to Dellon et al6 most large case series included a sizeable number of patients in whom no particular cause for their common peroneal neuropathy could be

Conclusions

Our simple RPF test elicited symptoms in patients with CPNEN. We suggest that our provocation test as an adjunct diagnostic tool for CPNEN as the origin of intermittent claudication.

Acknowledgments

We are grateful to Toshinori Yusa for her contribution to the electrophysiologic studies.

References (18)

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