Deep Peroneal Research Articles

A rare cause of deep peroneal nerve palsy due to compression of synovial cyst – Case report

INTRODUCTIONSynovial cyst is a rare cause of compression neuropathy and its differential diagnosis can be misleading. PRESENTATION OF CASEThis article presents clinical, radiological, and histological findings of deep peroneal nerve palsy due to compression of a synovial cyst in a 30-year-old patient admitted with sudden drop foot. DISCUSSIONFocal nerve entrapment in lower extremity due to synovial cystis a rare entity. Differential diagnosis is important. Surgical excision is the main treatment method with high success rate. CONCLUSIONSynovial cyst compression which can be treated easily with surgical excision should be considered in rapidly progressed drop foot.

A case of deep peroneal nerve entrapment neuropathy by the ganglion on the dorsum of foot

A case of deep peroneal nerve entrapment neuropathy by the ganglion on the dorsum of foot

Peroneal Nerve Compression in Figure Skaters

Compression of the peroneal nerve can cause sensory and motor deficits which can compromise the function of the foot. Neither common superficial nor deep peroneal nerve injuries, complicating figure skating, have been reported previously. We present three cases of peroneal nerve compression in figure skaters who underwent neurolysis for these peripheral nerve problems with excellent outcome. Peroneal nerve injury in figure skaters may be an underappreciated sports medicine problem.

Frequency-modulated electromagnetic neural stimulation (FREMS) as a treatment for symptomatic diabetic neuropathy: results from a double-blind, randomised, multicentre, long-term, placebo-controlled clinical trial

Aims/hypothesisThe aim was to evaluate the efficacy and safety of transcutaneous frequency-modulated electromagnetic neural stimulation (frequency rhythmic electrical modulation system, FREMS) as a treatment for symptomatic peripheral neuropathy in patients with diabetes mellitus.MethodsThis was a double-blind, randomised, multicentre, parallel-group study of three series, each of ten treatment sessions of FREMS or placebo administered within 3 weeks, 3 months apart, with an overall follow-up of about 51 weeks. The primary endpoint was the change in nerve conduction velocity (NCV) of deep peroneal, tibial and sural nerves. Secondary endpoints included the effects of treatment on pain, tactile, thermal and vibration sensations. Patients eligible to participate were aged 18–75 years with diabetes for ≥1 year, HbA1c <11.0% (97 mmol/mol), with symptomatic diabetic polyneuropathy at the lower extremities (i.e. abnormal amplitude, latency or NCV of either tibial, deep peroneal or sural nerve, but with an evocable potential and measurable NCV of the sural nerve), a Michigan Diabetes Neuropathy Score ≥7 and on a stable dose of medications for diabetic neuropathy in the month prior to enrolment. Data were collected in an outpatient setting. Participants were allocated to the FREMS or placebo arm (1:1 ratio) according to a sequence generated by a computer random number generator, without block or stratification factors. Investigators digitised patients’ date of birth and site number into an interactive voice recording system to obtain the assigned treatment. Participants, investigators conducting the trial, or people assessing the outcomes were blinded to group assignment.ResultsPatients (n = 110) with symptomatic neuropathy were randomised to FREMS (n = 54) or placebo (n = 56). In the intention-to-treat population (50 FREMS, 51 placebo), changes in NCV of the three examined nerves were not different between FREMS and placebo (deep peroneal [means ± SE]: 0.74 ± 0.71 vs 0.06 ± 1.38 m/s; tibial: 2.08 ± 0.84 vs 0.61 ± 0.43 m/s; and sural: 0.80 ± 1.08 vs −0.91 ± 1.13 m/s; FREMS vs placebo, respectively). FREMS induced a significant reduction in day and night pain as measured by a visual analogue scale immediately after each treatment session, although this beneficial effect was no longer measurable 3 months after treatment. Compared with the placebo group, in the FREMS group the cold sensation threshold was significantly improved, while non-significant differences were observed in the vibration and warm sensation thresholds. No relevant side effects were recorded during the study.Conclusions/interpretationFREMS proved to be a safe treatment for symptomatic diabetic neuropathy, with immediate, although transient, reduction in pain, and no effect on NCV.Trial registrationClinicalTrials.gov NCT01628627FundingThe clinical trial was sponsored by Lorenz Biotech (Medolla, Italy), lately Lorenz Lifetech (Ozzano dell’Emilia, Italy).Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-012-2795-7) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Limb salvage surgery for malignant tumors of the proximal tibia involving the fibula

Objective To investigate technique,effect,complications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula.Methods Between November 1998 and February 2010,32 patients with malignant tumors of the proximal tibia involving the fibula underwent limb salvage surgery in our institute.There were 21 males and 11 females,aged from 10 to 66 years (average,23.4years).There were 23 cases of osteosarcoma,5 cases of chondrosarcoma,1 case of malignant giant cell tumor,and 3 cases of soft tissue sarcoma.All patients received en bloc resection of tumor including proximal tibia and fibula.During operations,ligation of anterior tibial vessels was performed in 14 patients,anastomosis of posterior tibial vessels in 1 patient,both ligation of anterior tibial vessels and anastomosis or replacement of posterior tibial vessels in 5 patients.The common peroneal nerve was resected in 4 patients,and the deep peroneal nerve was resected in 5 patients.The reconstruction methods included prosthetic replacement in 24 patients,replacement with inactivated autograft-prosthesis composite in 5 patients,and replacement with inactivated autograft in 3 patients.The caput mediale musculi gastrocnemii flap was transferred to reconstruct soft tissue defect in 14 patients,while caput laterale musculi gastrocnemii flap was transferred in 1patient.Results All patients were followed up for 11 to 159 months (average,39.4 months).Local recurrence occurred in 6 patients (18.8％).The overall 5-year survival rate was 51.2％.Fourteen patients died of tumor metastasis,2 survived with tumor,and 16 patients survived without tumor.Variant complications occurred in 15 patients (46.9％).The complications included ischemia of the lower leg in 4 patients,peroneal nerve palsy in 12 patients (permanent palsy in 9 patients and temporary palsy in 3 patients),wound healing problem in 4 patients,deep infection in 1 patient,and periprosthetic fracture in 1 patient.The mean MSTS 93 score was 21.6 points (72％).Conculusion The indications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula should be restricted.Although complications are encountered frequently,most patients have acceptable postoperative function. Key words: Tibia; Fibula; Bone neoplasms; Extremities; Salvage therapy

Microsurgical repair of many places and polymorphous skin defects of hands

Objective To discuss the clinical effects of the many kinds of combined skin flaps of foot which used for repairing of many places and polymorphous skin defects of hands.Methods This study included 18 patients (15 male and 3 female) with a mean age of 32.6 years (range 15-56 years) between September 2003 and January 2012.The skin defect of hand were 2-3 places and the size of the defect ranged 1.5 cm × 2.0 cm-2.5 cm × 13.0 cm.All of them with bones and tendons exposure or defect.These 18 patients with many places and polymorphous skin defects of hands were treated with combined anterosuperior malleolusdorsalls pedis flaps (6 cases),three-leaf flap of dorsum of foot (2 cases),combined the first dorsal metatarsal artery island flap and toe back flap (5 cases)and combined toe back flaps (5 cases).Meanwhile,deep peroneal nerve was used to repair defect of digital nerve or dorsal digital nerve and long extensor tendon of toes was used to repair digital flexor tendon or digital extensor tendon.Results Eighteen patients with 32 flaps survived.In the follow-up of 4 months-2 years,the fingers and skin flaps were in good shape and normal color.The sensation of the hands of the patients with nerve repaired was restored to S2-S3 and the two-point discrimination was 8-10 mm.The motor function of the hands of the patients with tendons repaired was good,which can be competent to daily life and work.Conclusion Many kinds of combined skin flaps of foot were used to repair many places and polymorphous skin defects of hands. Key words: Hand; Foot; Surgical flap; Microsurgey

The feasibility of using high frequency ultrasound to assess nerve ending neuropathy in patients with diabetic foot

ObjectivesThe nerve ending problem is one of the major causes for diabetic feet. In this work, we explored the feasibilities of using high frequency ultrasound (US) in nerve ending problem evaluation for patients with diabetic foot. MethodsThe endings of the medial branch of deep peroneal nerves (mbDPN) were interrogated by US, and the nerve conduction characters were studied in a cohort of 19 clinically diagnosed diabetic feet patients and a control group of healthy volunteers. ResultsDistinct echoic appearances were consistently detected between the mbDPN nerves of diabetic feet patients and healthy volunteers. In healthy volunteers, hypoechoic bands were readily observed at the anatomical locations of mbDPNs. However, these hypoechoic bands of the mbDPNs were not clear in the diabetic feet patients, and the surfaces of the mbDPNs appeared obscure and irregular in these patients relative to those of healthy volunteers. In addition, the US echoes of mbDPN in patients with diabetic feet were more heterogeneous than those in healthy volunteers. The mean diameters of mbDPNs were 1.3±0.4mm in patients with diabetic foot and 0.8±0.2mm in the control group (P<0.05). Finally, results from the nerve conduction studies (NCS) showed abnormalities in patients with diabetic feet syndrome. ConclusionHigh frequency US can be a useful modality for evaluating nerve ending problems in diabetic feet patient; and the mbDPN enlargement, obscurity, surface irregularity and heterogeneity in echo can serve as the markers indicating nerve ending problems in the diabetic feet patients under ultrasound interrogation.

Lateral Tibial Plateau Fracture with a Displaced Posterolateral Fragment and Fibular Head Entrapment: A Case Report.

Fractures of the lateral tibial plateau often result from a direct lateral blow to the proximal part of the tibia or from a valgus force with impaction of the lateral femoral condyle into the lateral tibial plateau1. These fractures can often be reduced and fixed through a standard lateral approach. We describe an unusual case of a patient who sustained a lateral tibial plateau fracture with substantial depression of the lateral plateau and a large posterolateral fragment with resultant entrapment of the fibula. The pattern required a dual posterior and lateral approach for reduction and fixation. The patient was informed that data concerning this case would be submitted for publication, and he provided consent. A thirty-three-year-old previously healthy pedestrian was struck at high speed by an automobile; the bumper of the car hit the lateral aspect of the left knee. He sustained an isolated closed comminuted lateral tibial plateau fracture with approximately 3 cm of lateral joint depression and a large displaced posterolateral split in the coronal plane (Fig. 1). The apex of the posterolateral spike was 7 cm distal to the joint line. Computed tomography (CT) revealed that the fibular head was enclosed in the gap between the posterolateral fragment and the anterolateral comminution (Figs. 2-A and 2-B). On examination, the patient had an incomplete peroneal nerve palsy on the left (deep peroneal nerve involvement) but was otherwise neurovascularly intact. The peroneal palsy involved the deep branch (0 of 5 tibialis anterior and extensor hallucis longus muscle function) but spared the superficial branch (4 of 5 peroneal muscle function). Over the next twelve hours, the patient developed a compartment syndrome and required an emergency four-compartment fasciotomy and application of an external fixator spanning the knee joint. The muscles of all compartments were viable. The fasciotomy sites were …

Comment to: Drop foot, a rare complication following Müller’s phlebectomy, by Otters EFM, van Neer PAFA. Phlebology 2012;27:1-2.

A 43-year old woman had previously undergone bilateral surgical stripping of the great saphenous vein and the right small saphenous vein and subsequent sclerottherapy. She later presented with reticular visible asymptomatic varicose veins on the dorsolateral side of the right upper leg up to shortly below her knee. A phlebectomy was performed by local anesthesia (non-tumescent) with approximately 15 cm3 lidocaine 1%. Immediately after phlebectomy, the patient noticed weakness of the right foot, right foot drop, without neurological pain. The drop foot disappeared spontaneously after several hours without therapy. The sciatic nerve runs behind the femur from the buttock to the lower thigh where it divides into the common peroneal nerve (CPN) and tibial nerve. The CPN then descends along the lateral side of the popliteal fossa to the head of the fibula. It winds round the head of the fibula and divides into the superficial peroneal nerve and the deep peroneal nerve....

Stimulus Point Distribution in Deep or Superficial Peroneal Nerve for Treatment of Ankle Spasticity

To develop effective electrical stimulation treatment to reduce spasticity, we examined the optimal stimulus point of the common peroneal nerve. The locations of selective stimulus points for the deep peroneal nerve or superficial peroneal nerve fiber were examined in 25 healthy subjects in both legs (50 legs) using the ratio of the tibialis anterior (TA) to the peroneus longus (PL) M-wave amplitude (TA/PL ratio). In addition, we measured reciprocal Ia inhibition in ten healthy subjects. The amount of inhibition was determined from short-latency suppression of the soleus (Sol) H-reflex by conditioning stimuli to the deep or superficial peroneal nerve. The paired t-test was used for statistical analysis. The mean TA/PL ratio during deep peroneal nerve stimulation was significantly different from superficial peroneal nerve stimulation (p < 0.001). The mean stimulus point for the deep peroneal nerve was located 7 ± 5 mm distal and 3 ± 6 mm anterior from the distal edges of the head of fibula and was markedly different from the stimulus point for the superficial peroneal nerve (20 ± 7 mm distal and 12 ± 8 mm posterior). During deep peroneal nerve stimulation, the mean conditioned H-reflex was depressed to 83.8 ± 10.7% of the unconditioned value of the H-reflex. In contrast, during superficial peroneal nerve stimulation, the mean conditioned H-reflex increased to 105.3 ± 5.2%. These values were significantly different (p < 0.001). In the present study, we revealed a stimulus area of the deep peroneal nerve. Also, we observed the inhibitory effects of stimulation upon the deep peroneal nerve at individual stimulus point. Our results appear to indicate that localized stimulation of the deep peroneal nerve is more useful for the reduction of ankle spasticity.

G.P.94 Incidence and severity of peripheral neuropathy in children on vincristine – Do vitamin E levels change during treatment?

Abstract Chemotherapy induced peripheral neuropathy (PN) is a common dose limiting side effect associated with vincristine treatment. The painful sensori motor neuropathy seen in vincristine is similar to that in vitamin E deficiency. To determine the incidence, severity and type of PN associated with vincristine chemotherapy in children and to determine the levels of Vitamin E in the blood before and after starting vincristine. All children in the oncology unit of a tertiary paediatric hospital on vincristine were included. A detailed history,specifically tailored neurological examination and nerve conduction studies were performed and blood vitamin E levels were measured at baseline and at 3, 6 and 12 months from the time of chemotherapy. Thirty patients were enrolled over a period of 12 months. The mean age of the children was 6.2 years. 14/28(50%) children had pre B acute lymphoblastic leukemia. Peripheral neuropathy was evident in more than 90% patients. The most common subjective features of PN were weakness seen in 39% and pain in 30% at 3 months. The most common objective finding was loss of ankle reflex seen in 57% at 3 months and reduced ankle reflex in a further 21%. The subjective weakness disappeared and the pain reduced at 12 months while the objective signs persisted. The most common autonomic feature was constipation seen in 43% at 3 months. The most common nerve affected was the deep peroneal nerve with axonal involvement in 82% of the subjects tested. The vitamin E levels dropped significantly at 3, 6 and 12 months from baseline although they still remained within normal limits. More than 90% children on vincristine had evidence of neuropathy. It was mild sensorimotor axonal neuropathy that appeared within 3 months of treatment in most. The levels of vitamin E remained in the normal range though there was a significant drop at 3 months, followed by values lower than baseline at 6 and 12 months.

Evidence to support that adventitial cysts, analogous to intraneural ganglion cysts, are also joint‐connected

Cystic adventitial disease (CAD) is a rare condition in which cyst is found within a vessel, typically producing symptoms of vascular compromise. Most commonly located in the popliteal artery near the knee, it has been reported in arteries and veins throughout the body. Its pathogenesis has been poorly understood and various surgical approaches have been recommended. We extrapolated some recent information about a similar condition, intraneural ganglion cyst affecting the deep fibular (peroneal) nerve, to the prototype, CAD of the popliteal artery. In intraneural ganglion cysts affecting the deep fibular nerve we have shown that an articular (neural) branch is the conduit between the superior tibiofibular joint and the main parent nerve for which epineurial dissection of joint fluid can occur. We hypothesized that the same principles would apply to CAD and that an articular (vascular) branch would be the conduit from the knee joint leading to dissection to the main parent vessel. We reviewed five patients with CAD of the popliteal artery in whom MRIs were available: two treated by the primary author well familiar with the proposed articular theory, and three treated by others at our institution, less familiar with it. We then reviewed the literature critically to assess for additional evidence to support our articular (synovial) theory and an anatomic explanation. In the two cases treated by the primary author a joint connection was identified on high resolution MRI prospectively and intraoperatively through the middle genicular artery (MGA); postoperatively in these cases there was no recurrence. In the other three cases, a joint connection was not identified on imaging or at operation. Reinterpretation of these cases revealed a joint connection through the MGA in the one patient who had preoperative imaging and subclinical persistence/recurrence in the two patients who underwent postoperative MRIs done for other reasons. Our review of the literature and imaging studies revealed unrecognized joint connections in CAD to the knee and other joints as well as evidence that the MGA is the conduit in cases of CAD of the popliteal artery. We believe that adventitial cysts originate in neighboring joints and dissect within articular (vascular) branches. In our opinion, the unifying articular theory and the principles introduced for intraneural ganglion cysts apply equally to common and rare sites of adventitial cysts.

Injury to the Anterior Tibial System During Percutaneous Plating of a Proximal Tibial Fracture

Minimally invasive osteosynthesis of proximal tibial fractures has grown in popularity in recent years. This article describes a patient with a Schatzker type VI proximal tibial fracture (AO/OTA type 41.C3) and previous compartment syndrome treated with definitive fixation 8 weeks after initial injury with a precontoured proximal tibial plate and a distal targeting device. Brisk bleeding occurred during percutaneous insertion of a cortical screw at the midshaft of the tibia. Surgical exploration revealed sidewall tearing of the anterior tibial artery and vein, which were clipped at the screw insertion site. After the bleeding was controlled, the patient had a strong palpable posterior tibial pulse with no palpable dorsalis pedis pulse, and the foot remained well perfused. Function of the deep peroneal nerve was normal postoperatively. Previous concerns regarding the percutaneous treatment of proximal tibial fractures have focused on the risks of damage to the superficial peroneal nerve from distal screws. Based on cadaveric studies, percutaneously and laterally based screw placement in the distal tibial metaphysis threatens injury to the anterior tibial system. However, with alterations to the normal anatomy caused by severe trauma, previously described safe zones may be changed and neurovascular structures may be exposed to risk in locations that were previously thought safe.

Normal and sonographic anatomy of selected peripheral nerves. Part III: Peripheral nerves of the lower limb.

The ultrasonographic examination is currently increasingly used in imaging peripheral nerves, serving to supplement the physical examination, electromyography and magnetic resonance imaging. As in the case of other USG imaging studies, the examination of peripheral nerves is non-invasive and well-tolerated by patients. The typical ultrasonographic picture of peripheral nerves as well as the examination technique have been discussed in part I of this article series, following the example of the median nerve. Part II of the series presented the normal anatomy and the technique for examining the peripheral nerves of the upper limb. This part of the article series focuses on the anatomy and technique for examining twelve normal peripheral nerves of the lower extremity: the iliohypogastric and ilioinguinal nerves, the lateral cutaneous nerve of the thigh, the pudendal, sciatic, tibial, sural, medial plantar, lateral plantar, common peroneal, deep peroneal and superficial peroneal nerves. It includes diagrams showing the proper positioning of the sonographic probe, plus USG images of the successively discussed nerves and their surrounding structures. The ultrasonographic appearance of the peripheral nerves in the lower limb is identical to the nerves in the upper limb. However, when imaging the lower extremity, convex probes are more often utilized, to capture deeply-seated nerves. The examination technique, similarly to that used in visualizing the nerves of upper extremity, consists of locating the nerve at a characteristic anatomic reference point and tracking it using the “elevator technique”. All 3 parts of the article series should serve as an introduction to a discussion of peripheral nerve pathologies, which will be presented in subsequent issues of the “Journal of Ultrasonography”.

128. Single fiber electromyography with a concentric needle electrode and surface stimulus in the orbicularis oculi muscle

arthroscopy 3 months prior, using three standard ankle port sites, subsequently developed precisely delineated numbness and pain of the right ankle and foot. Physical examination showed heterogeneous sensory disturbance and hypersensitivity throughout the entire dorsum of the foot, as well as extensor digitorum brevis atrophy. Electrodiagnosis demonstrated neuropathy of the right saphenous, superficial fibular sensory, and distal deep fibular nerves. High frequency ultrasound was utilized for further localization and assessment. Ultrasonography demonstrated loss of the fasicular architecture and fusiform swelling of the affected nerves precisely at the port sites, but continuity was demonstrated with each nerve. Conclusion: This case demonstrates the utility of high frequency ultrasound in the assessment of traumatic neuropathies. Using this modality provided evidence of continuity (i.e., no neurotmesis) in the nerves that had absent sensory nerve action potentials. It also provided more precise localization of the injury than electrodiagnostic techniques alone. Additionally, this is the first reported case, to the authors’ knowledge, demonstrating ultrasonographic evidence of nerve disruption following a standard ankle arthroscopic procedure.

24. Myasthenia gravis after vaccination

Introduction: The accessory peroneal nerve (APN) is an anatomic variation that can potentially cause disturbance in electrodiagnostic (EDX) studies. This anomaly is detected by nerve conduction studies. There are no recent studies regarding the prevalence of this anatomic variation. Objectives: To determine the presence and prevalence of the APN in an EDX medicine clinic. Methods: In a cross-sectional descriptive study that took place from March 2009 to July 2010, 230 cases comprising 460 legs were referred for EDX studies of upper limb problems. Compound muscle action potentials and nerve conduction velocities of the deep peroneal nerve were measured by needle electromyography by stimulating the DPN at the knee, ankle, and lateral malleolous areas accordingly and recording from the extensor digitorum brevis muscle. Results: The study population included 120 females (52%) and 110 (47%) males with a mean age of 42.1 13.5 years. The APN was detected in 28 patients (12%). Ten (17.9%) had bilateral APN and in the remaining 18 cases (82.1%), the APN was unilateral. Gender distribution was similar, which means half of the cases (14 patients) belonged to each gender. Conclusion: The prevalence of the APN 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

22. Correlation of nerve conduction parameters in diagnosing ulnar neuropathy at the elbow

Introduction: The accessory peroneal nerve (APN) is an anatomic variation that can potentially cause disturbance in electrodiagnostic (EDX) studies. This anomaly is detected by nerve conduction studies. There are no recent studies regarding the prevalence of this anatomic variation. Objectives: To determine the presence and prevalence of the APN in an EDX medicine clinic. Methods: In a cross-sectional descriptive study that took place from March 2009 to July 2010, 230 cases comprising 460 legs were referred for EDX studies of upper limb problems. Compound muscle action potentials and nerve conduction velocities of the deep peroneal nerve were measured by needle electromyography by stimulating the DPN at the knee, ankle, and lateral malleolous areas accordingly and recording from the extensor digitorum brevis muscle. Results: The study population included 120 females (52%) and 110 (47%) males with a mean age of 42.1 13.5 years. The APN was detected in 28 patients (12%). Ten (17.9%) had bilateral APN and in the remaining 18 cases (82.1%), the APN was unilateral. Gender distribution was similar, which means half of the cases (14 patients) belonged to each gender. Conclusion: The prevalence of the APN in this study was 12.2% (17.9% bilateral and 82.1% unilateral).

23. Facial palsy after vaccination

Introduction: The accessory peroneal nerve (APN) is an anatomic variation that can potentially cause disturbance in electrodiagnostic (EDX) studies. This anomaly is detected by nerve conduction studies. There are no recent studies regarding the prevalence of this anatomic variation. Objectives: To determine the presence and prevalence of the APN in an EDX medicine clinic. Methods: In a cross-sectional descriptive study that took place from March 2009 to July 2010, 230 cases comprising 460 legs were referred for EDX studies of upper limb problems. Compound muscle action potentials and nerve conduction velocities of the deep peroneal nerve were measured by needle electromyography by stimulating the DPN at the knee, ankle, and lateral malleolous areas accordingly and recording from the extensor digitorum brevis muscle. Results: The study population included 120 females (52%) and 110 (47%) males with a mean age of 42.1 13.5 years. The APN was detected in 28 patients (12%). Ten (17.9%) had bilateral APN and in the remaining 18 cases (82.1%), the APN was unilateral. Gender distribution was similar, which means half of the cases (14 patients) belonged to each gender. Conclusion: The prevalence of the APN in this study was 12.2% (17.9% bilateral and 82.1% unilateral).

Role of Surgical Decompression of Lower Extremity Nerves in Painful Neuropathy (P06.152)

Objective: To assess the efficacy of surgical decompression of lower extremity nerves in painful neuropathy. Background Surgical decompression of peripheral nerves is being increasingly used as an alternative approach to treatment for painful neuropathy. The procedure is however unproven (Neurology 66:1805–1808, 2006). In this prospective study, 4 patients were evaluated for benefits of decompression surgery. Design/Methods: 4 consecutive patients (3W, 1 M; mean age 53), who had already agreed to undergo decompressive surgery for their painful peripheral neuropathy underwent the following evaluations prior to surgery and at 3- and 6 months after surgery: directed history including the 11 point numerical rating of pain scale (0-10), a directed examination, nerve conduction study and skin biopsy. Total neuropathy score (TNS) was calculated. Quality of life (QoL) questionnaire (SF36) form was also administered. Surgical procedure consisted of decompression of medial plantar, lateral plantar, and calcaneal nerves at the tarsal tunnel region, common peroneal at fibular head, and deep peroneal nerve at the dorsal foot. Results: All patients had documentation of small fiber>larger fiber neuropathy and had reduced intraepidermal fiber density on skin biopsy. Neuropathy was from diabetes (2), glucose intolerance (1), and idiopathic (1). Mean TNS scores before and after surgery (6 month follow-up)were as follows: symptom score (3.2/3.2), examination score (5.2/5.25), nerve conduction score (3.2/4.0), and total neuropathy score (11.7/12.5). The mean pain and QoL(SF 36)scores from baseline to 6 months after surgery were 10/6.7 and 34/64 respectively. Overall 3 of 4 showed subjective improvement in pain and QoL. Postoperative complications included: serous drainage (1)and wound Infection requiring antibiotics and admission (1). Conclusions: Subjective improvement in pain and QoL can occur after decompressive surgery in painful neuropathy patients despite lack of improvement in objective measures of neuropathy. Supported by: The Neuropathy Association. Disclosure: Dr. Chaudhry has received personal compensation for activities with Novartis. Dr. Chaudhry has received personal compensation in an editorial capacity for the Neurologist. Dr. Chaudhry has received royalty payments from Abbott Laboratories, Inc. and Johnson & Johnson. Dr. Belzberg has nothing to disclose. Dr. Rosson has received (royalty or license fee or contractual rights) payments from Aegeria, LLC.Dr. Rosson has received research support from Lifecell, Corp.