Accessory Deep Peroneal Nerve Research Articles

Prevalence of Accessory Deep Peroneal Nerve in Sample of Bosnia and Herzegovina Subjects: an Electrophysiological Study.

Background:The accessory deep peroneal nerve (ADPN) is as an anomalous nerve derived from the superficial peroneal nerve or its branch and supplies motor innervations for extensor digitorum brevis (EDB) and sensory innervations for the lateral part of the ankle and foot regions. It is the most common anomalous innervation present in the lower limb.Objective:The aim of this study was to determine the prevalence of ADPN electrophysiologically in a sample of Bosnia and Herzegovina subjects who referred to an electromyography lab.Methods:This cross-sectional descriptive study included 316 lower limbs from 171 subjects referred for electrodiagnostic studies to Electromyography Lab, Department of Neurology, University Clinical Center Tuzla (Bosnia and Herzegovina) (102 females/60% and 69/40%) males). Motor nerve conduction studies for the peroneal nerve and ADPN were done. Compound muscle action potential (CMAP) and nerve conduction velocity (NCV) of deep peroneal nerve (DPN) were measured by using EMG machine by stimulating DPN at knee, ankle and lateral malleolus areas accordingly, with recording from extensor digitorum brevis (EDB) muscle.Results:ADPN was found in 46 (14.5%) of 316 legs. ADPN was found in 18 (39.1%) right lower limbs and 28 (60.9%) left lower limbs. Ten subjects (5.8%) had bilateral ADPN. There was no statistically significant difference between the occurrence of ADPN in women versus men (p=0.757), as well as in right versus left legs (p=0.237).Conclusion:This study demonstrated that ADPN prevalence, in a sample of Bosnia and Herzegovina subjects who referred to an electromyography lab is 14.5%. Recognition of ADPN is very important for proper interpretation of lower limbs electrophysiological data.

Prevalence of Accessory Deep Peroneal Nerve in Sample of Bosnia and Herzegovina Subjects: an Electrophysiological Study

Prevalence of Accessory Deep Peroneal Nerve in Sample of Bosnia and Herzegovina Subjects: an Electrophysiological Study

Electrophysiological study of accessory deep peroneal nerve in a sample of Egyptian subjects

IntroductionAccessory deep peroneal nerve (ADPN) is the most common anomalous innervation present in the lower limb.AimThe aim of this study was to determine the prevalence of ADPN electrophysiologically in a sample of healthy Egyptian individuals.Subjects and methodsThis cross-sectional study included 200 lower limbs from 100 [56 (56%) women and 44 (44%) men] Egyptian apparently healthy volunteers. Motor nerve conduction studies for the peroneal nerve and ADPN were done.ResultsADPN was found in 20 (10%) lower limbs of 17 (17%) subjects. There was no statistically significant difference between the occurrence of ADPN in women versus men (P=0.797). ADPN was found in 11 (55%) right lower limbs and in nine (45%) left lower limbs. There was no statistically significant difference between the occurrence of ADPN in right lower limbs versus left lower limbs among subjects with ADPN (P=0.637). It was present bilaterally in three (17.65%) subjects. There was no statistically significant difference between the occurrence of bilateral ADPN in women versus men (P=0.761). Among the 14 (82.35%) subjects with unilateral ADPN, it was present in the right side in eight (57.14%) subjects. There was no statistically significant difference between the occurrence of unilateral ADPN in the right side versus left side (P=0.579).ConclusionThis study demonstrated that ADPN prevalence in the referred Egyptian sample through electrodiagnostic studies of lower limbs was 17%, with no sex nor side difference. Recognition of ADPN is essential for proper interpretation of lower limbs electrophysiological data.

Prevalence of the accessory deep peroneal nerve: A cadaveric study and meta-analysis

ObjectivesThe accessory deep peroneal nerve (ADPN) is a common anatomical variant arising from the superficial peroneal nerve (SPN) and, when present, is often responsible for partial or complete innervation of the extensor digitorum brevis muscle (EDBM). The nerve lies posterior to the peroneus brevis muscle, traveling posterior to the lateral malleolus to terminate in the ankle by giving off sensory branches to the ankle and joints. Although the EDBM is usually supplied by the deep peroneal nerve (DPN), in the presence of an ADPN, electrodiagnostic procedures may be complicated. Due to the lack of detailed anatomical knowledge on the topography of the ADPN, its presence posterior to the lateral malleolus can be iatrogenically injured during surgical procedures on the ankle using a lateral approach. Therefore, this meta-analysis aimed to provide a comprehensive, evidence-based assessment of the anatomical characteristics of the ADPN, supplemented with data from our own cadaveric dissection. Patients and methodsA comprehensive search of all major electronic databases, including Pubmed, Embase, Scopus, Web of Science, ScienceDirect, SciELO, and BIOSIS was performed. All articles with data on prevalence, symmetry and innervation of the EDBM by the ADPN were included. The anatomical data was then extracted and pooled into a meta-analysis using MetaXL 2.0. In addition, we dissected 21 cadavers (n=42 lower limbs) bilaterally to find the ADPN. ResultsA total of 19 studies (n=6070 lower limbs) were included in the meta-analysis. The pooled prevalence of the ADPN was 18.8% (95%CI:14.2–24.0) with a 39.3% prevalence rate for cadaveric studies. The ADPN was present more commonly unilaterally (67.0%) and when it was present, provided branches to the EDBM in 79.5% of cases. In our cadaveric study, the ADPN was identified in 5 of the 42 lower limbs dissected (11.9%); on the right side in 3 lower limbs and on the left side in 2 lower limbs. ConclusionsThe ADPN is a clinically important nerve and has been inculpated in unexplained cases of chronic ankle pain and EDBM atrophy. The variability in detection of the ADPN using electrophysiological techniques can lead to misdiagnoses of peroneal nerve lesions and increase the risk for iatrogenic injury to the ADPN, especially in laterally approaching ankle procedures and sural nerve biopsies.

Prevalence of accessory deep peroneal nerve in referred patients to an electrodiagnostic medicine clinic

BackgroundAccessory Deep Peroneal Nerve (ADPN) is an anatomic variation that can potentially cause disturbance in electrodiagnostic studies. This anomaly could be detected by nerve conduction studies. There are no recent updates about prevalence of this anatomic variation. Electrodiagnostic medicine clinic is the best environment for detecting presence and prevalence of this nerve, so present study enrolled.Materials & MethodsIn this cross sectional descriptive study that take place from March 2009 to July 2010, 230 cases comprising 460 legs referred for electrodiagnostic studies of upper limbs problems participated in the study. Compound muscle action potential (CMAP) and Nerve conduction Velocity (NCV) of Deep Peroneal Nerve (DPN) were measured by using EMG machine by stimulating DPN at knee, ankle and lateral malleolous areas accordingly, with recording from extensor digitorum brevis muscle. Results were analyzed and conclusion made.ResultsThe study population included 120 females (52%) and 110 (47%) males with mean age of 42.1 ± 13.5 years. ADPN was detected in 28 patients (12%). Among them,10(17.9%) had bilateral ADPN and in remained 18 cases (82.1%) APN was unilateral. In 8 patients there was no recorded CMAP from EDB by proximal and distal stimulation implying EDB agenesis. Gender distribution was similar which means half of the cases (14 patients) belonged to each gender.ConclusionThe prevalence of ADPN in this study was 12.2%, (17.9% bilateral and 82.1% unilateral).

21. Prevalence of accessory deep peroneal nerve in referred patients to an electrodiagnostic medicine clinic

21. Prevalence of accessory deep peroneal nerve in referred patients to an electrodiagnostic medicine clinic

Study of accessory deep peroneal nerve motor conduction in a population of healthy subjects

The short extensor muscle of the toes (extensor digitorum brevis) is innervated by the deep peroneal nerve (DPN) but can also receive innervation from an accessory deep peroneal nerve (ADPN), a branch of the superficial peroneal nerve (SPN). We conducted a systematic electrophysiological study of the DPN and ADPN in 200 healthy subjects (400 legs). We found the presence of an ADPN in 13.5% of the subjects (8.5% of the legs). On average, ADPN amplitudes and motor potential areas were one-fifth of those for the corresponding DPN. Without this systematic search, most of the ADPN would not have been detected. Comparative study of electrophysiological parameters in patients with and without ADPN showed a significantly higher (P<0.0001) DPN motor potential area ratio (distal/proximal ratio) in subjects without an ADPN. Even though electrophysiological identification of the ADPN is generally not easy (in simple DPN motor conduction studies), the nerve can sometimes be clinically symptomatic (ankle pain). Evaluation of the DPN motor potential area ratio (distal/proximal ratio) heightens the detection of ADPN.

Anatomic variations of superficial peroneal nerve: clinical implications of a cadaver study.

Superficial peroneal nerve and its branches are frequently at risk for iatrogenic damage. Although different studies on anatomical variations of superficial peroneal nerve are available in the medical literature, such reports are rare from India. Hence the present study was undertaken on Indian population. A total of 60 specimens of inferior extremities from 30 properly embalmed and formalin fixed cadavers were dissected and examined for the location and course of the superficial peroneal nerve including number, level, course and distributions of branches. The superficial peroneal nerve in 28.3% specimens was located in the anterior compartment of the leg. In 8.3% specimens the superficial peroneal nerve branched before piercing between the peroneus longus and extensor digitorum longus muscle whereas in 11.7% specimens it branched after piercing the aforementioned muscles and before piercing the deep fascia. In 41 out of 60 specimens the sensory division of superficial peroneal nerve branched into the medial dorsal cutaneous nerve and intermediate dorsal cutaneous nerve distal to its emergence from the deep fascia and proximal to its relation to the extensor retinaculum. In 20 out of 60 specimens the accessory deep peroneal nerve, an additional branch from the sensory division of superficial peroneal nerve, through its course in the anterior compartment of the leg passed deep to the extensor retinaculum and supplied the ankle and the dorsum of foot. Hopefully the present study will help in minimizing iatrogenic damage to the superficial peroneal nerve and its branches while performing arthroscopy, local anesthetic block, surgical approach to the fibula, open reduction and internal fixation of lateral malleolar fractures, application of external fixators, elevation of a fasciocutaneous or fibular flaps for grafting, surgical decompression of neurovascular structures, or miscellaneous surgery on leg, foot and ankle.

Atypical deep peroneal neuropathy in the setting of an accessory deep peroneal nerve

We report a case of deep peroneal neuropathy resulting in foot drop with preserved toe extension. These unexpected findings were the result of the presence of an accessory deep peroneal nerve that provided total innervation of the extensor digitorum brevis. We review the literature on total innervation of the extensor digitorum brevis by the accessory deep peroneal nerve with and without an associated deep peroneal nerve lesion. Muscle Nerve 40: 313-315, 2009.

The consistent presence of the human accessory deep peroneal nerve.

Twenty-four human legs were dissected macroscopically to study the morphological details of the accessory deep peroneal nerve. This nerve arose from the superficial peroneal nerve and descended in the lateral compartment of the leg, deep to peroneus longus along the posterior border of peroneus brevis. Approaching the ankle joint, this nerve passed through the peroneal tunnels to wind around the lateral malleolus; it then crossed beneath the peroneus brevis tendon anteriorly to reach the dorsum of the foot. The accessory deep peroneal nerve was found in every case examined and constantly gave off muscular branches to peroneus brevis and sensory branches to the ankle region. In addition, this nerve occasionally had muscular branches to peroneus longus and extensor digitorum brevis, and sensory branches to the fibula and the foot. The anomalous muscles around the lateral malleolus were also innervated by this nerve. Neither cutaneous branches nor communicating branches with other nerves were found. The present study reveals that the accessory deep peroneal nerve is consistently present and possesses a proper motor and sensory distribution in the lateral region of the leg and ankle. It is not an anomalous nerve as has previously been suggested.

The Accessory Deep Peroneal Nerve in Taiwanese:Detected by Electrodiagnostic Study

The Accessory Deep Peroneal Nerve in Taiwanese:Detected by Electrodiagnostic Study

AAEM minimonograph #2: important anomalous innervations of the extremities.

Anomalous innervations of the extremities are common and influence the interpretation of electrophysiologic studies in normal patients and those with peripheral nerve lesions. The following anomalous innervations are reviewed: median to ulnar nerve communication; ulnar to median nerve communication; variations in the innervation of intrinsic muscles of the hand; accessory deep peroneal nerve; and tibial to peroneal nerve communication. The electrophysiologic recognition of these anomalies and the manner in which they affect the interpretation of electrodiagnostic studies in various conditions is emphasized.

Nerf peronier accessoire. Etude electrophysiologique

The extensor digitorum brevis muscle is innervated by the deep peroneal nerve. In some cases it has an additional innervation by the accessory deep peroneal nerve, a branch of the superficial deep peroneal nerve. The motor nerve conduction study with detection on the extensor digitorum brevis allows to detect such an anatomical variation. It has been found in twelve cases out of 67 subjects. In two cases it was bilateral and in two other cases the extensor digitorum brevis muscle was innervated by the accessory deep peroneal nerve alone. That anatomical variation has to be known in order to avoid errors in interpretating the peroneal motor nerve conduction velocity.

Axonal conduction velocity and voluntary discharge properties of individual short toe extensor motor units in man.

1. The axonal conduction velocity and the voluntary discharge properties of 120 short toe extensor motor units were studied in man. 2. Electromyographic techniques were used which permitted the identification of individual motor unit potentials after proximal and distal electrical nerve stimulation and during maximum voluntary effort. 3. The necessary selectivity of the e.m.g. recordings was achieved in two circumstances. In some subjects, previous motor nerve lesions distal to the point of stimulation had led to collateral sprouting with larger motor unit potentials. In other subjects an accessory deep peroneal nerve was present, so that lidocaine block of the main motor nerve left a small number of innervated motor units. 4. The axonal conduction velocities of the individual motor units ranged from 30 to 54 m/sec with most motor units between 35 and 45 m/sec. 5. Motor units which voluntarily could be driven continuously at frequencies below 10/sec had axonal conduction velocities between 30 and 45 m/sec. 6. Motor units which on voluntary drive responded only in high frequency bursts had axonal conduction velocities between 40 and 54 m/sec. 7. Motor units with intermediate voluntary discharge properties had intermediate axonal conduction velocities. 8. Thus a relationship was established between voluntary discharge properties and axonal conduction velocity.

The accessory deep peroneal nerve.

The innervation of the right M. extensor digitorum brevis was investigated in 52 subjects with the aid of stimulation electromyography. In 13 cases (25%) a particular branch of the superficial branch of the peroneal nerve, the accessory deep peroneal nerve, could be identified. In 1 case it alone, and in 12 cases, together with the deep peroneal nerve, innervated the M. ext. dig. brevis. The significance of the awareness of this anomalous innervation is pointed out.

Hereditary aspects of accessory deep peroneal nerve.

Hereditary aspects in the anomalous innervation of the extensor digitorum brevis muscle by the accessory deep peroneal nerve, were investigated. Utilizing electrophysiological techniques, 22% of 100 healthy unrelated individuals demonstrated this variation in innervation of one or both extensor digitorum brevis muscles. The study of family members of five of these subjects with the variation showed that 78% of relatives also had this anomalous innervation. These data suggest that hereditary factors may be significant in the occurrence of this variation and a dominant mode of inheritance may be the case.

Atypical deep peroneal neuropathy in presence of accessory deep peroneal nerve.

The clinical and electrophysiological findings in two patients with a deep peroneal neuropathy occurring in the presence of significant innervation of the extensor digitorum brevis muscle by the accessory deep peroneal nerve are reported. This nerve is a branch of the superficial peroneal nerve which was not involved in either cases reported. An awareness of this anatomical variation of innervation of the extensor digitorum brevis muscle is important for the correct clinical and electromyographic evaluations of deep peroneal nerve lesions. The electromyographic findings in this situation are sufficiently characteristic to identify clearly this anatomical variant. From a clinical point of view, residual function in the lateral portion of the extensor digitorum brevis muscle, in the face of an otherwise complete deep peroneal palsy, should suggest this anatomical variation.

The innervation of the joints of the foot.

AbstractThe nerve supply of the ankle joint and of the joints of the foot was studied in dissections of fetal and adult feet and in serial sections of fetal feet stained with silver.The ankle joint was supplied by the tibial, sural, deep peroneal, and saphenous nerves, and by the accessory deep peroneal nerve when present.The tarsal joints were supplied on their plantar aspects by the medial or lateral plantar nerves, and on their dorsal aspects chiefly by the deep peroneal nerve. The joint between the lateral and intermediate cuneiform received branches from the intermediate dorsal cutaneous nerve also. The lateral dorsal cutaneous nerve and the accessory deep peroneal nerve when present provided additional branches to the subtalar and calcaneocuboid joints.The tarsometatarsal joints were supplied on their plantar aspects by the medial or lateral plantar nerves. Most of them were supplied on their dorsal aspects by the deep peroneal nerve, but the cuboid‐metatarsal joints received their supply from the intermediate dorsal cutaneous nerve. The intermetatarsal joints had a similar but sparser supply. The joint between the fourth and fifth metatarsal received branches from the intermediate dorsal cutaneous nerve.The plantar digital nerves provided the main supply to the metatarsophalangeal joints. The dorsal aspect of the first metatarsophalangeal joint was supplied by the deep peroneal and the medial dorsal cutaneous nerves, of the second metatarsophalangeal joint by the deep peroneal nerve, and of the fourth and fifth metatarsophalangeal joints by the lateral dorsal cutaneous nerve. The interphalangeal joints did not receive articular branches from the dorsal digital nerves, except in the case of the interphalangeal joint of the big toe, which was supplied by the deep peroneal and the medial dorsal cutaneous nerves.