142 Common Peroneal Nerve Decompression for Slimmers Palsy: A Case Series With Intraoperative Stimulation

Abstract

INTRODUCTION: Slimmer’s palsy refers to common peroneal nerve (CPN) entrapment neuropathy associated with rapid or significant weight loss. Indications and outcomes for CPN decompression in this population remain unclear. While there are reports documenting functional improvement after surgical decompression, there are also case series demonstrating recovery with non-operative management, including diet modification, nutritional supplementation, and rehabilitation. METHODS: Retrospective chart review was performed to identify patients (age >18) who underwent CPN decompression between 2012-2021 with documented history of weight loss >5 kg. Demographics, weight loss, operative details, electromyography findings, onset/degree of weakness by manual muscle testing (MMT), and extent of improvement were collected. Pre- and post-decompression conduction thresholds were measured intraoperatively. Descriptive statistics were performed, including paired t-tests for pre- and post-operative MMT scores and pre- and post-decompression conduction thresholds. RESULTS: Five total patients were identified. Median age was 39 years. Most were male (3/5), White (5/5), privately insured (3/5), current/former smokers (3/5), and normal weight (3/5). Mean weight loss was 27 kg (range: 5-45). Reasons for weight loss included intentional, chemotherapy-related, bariatric surgery, and one case of unexplained weight loss. Mean MMT score at time of evaluation was 2.0 + 0.45 for tibialis anterior (TA), 2.0 + 0.55 for extensor hallucis longus (EHL) and 2.2 + 0.58 for peroneus longus (PL). Time to surgery ranged from 4-6 months. Mean postoperative MMT scores were significantly improved in TA (4.6 + 0.24, p = 0.007), EHL (4.6 + 0.24, p = 0.007) and PL (4.6 + 0.24, p = 0.02) compared to baseline. Mean conduction thresholds (5.75 + 1.89) were lower after decompression (1.2 + 0.31), although not statistically significant in this sample (p = 0.12). CONCLUSIONS: In this small series, CPN decompression restored function for patients with Slimmer’s palsy. Nerve conduction block was observed intraoperatively in most cases, perhaps supporting a compressive etiology for this condition.