Longitudinal multimodal assessment of neuropathy in a porcine neuritis model.

Primary Total Knee Arthroplasty in Patients Who Have Neuromuscular Disorders and Genu Recurvatum Using a Rotating-Hinge Implant: A Case Series With a Mean 4-Year Follow-Up.

Introduction: Postpartum neuropathies have long been recognized as potential complications of childbirth. Commonly affected nerves include femoral, sciatic, lumbosacral plexus, lateral femoral cutaneous, and peroneal nerves. Risk factors include prolonged second stage of labor, maternal short stature, fetal macrosomia, instrumental deliveries, hyperflexed positioning, and neuraxial anesthesia. Most reported cases are managed conservatively and ultimately resolve within weeks or months after delivery. Case Report: We describe a case of new-onset foot drop following an uncomplicated spontaneous vaginal delivery. To our knowledge, very few cases of postpartum foot drop secondary to lumbar disc herniation requiring surgical decompression have been reported. Conclusion: Although most postpartum lower extremity neuropathies resolve with time and conservative therapy, clinicians should maintain a high index of suspicion for structural causes when symptoms are severe or progressive. This case underscores the importance of prompt recognition and evaluation of new neurologic symptoms, even after apparently uncomplicated deliveries, to facilitate timely intervention and optimize recovery.

Common peroneal nerve (CPN) injury is an uncommon complication associated with skeletal traction. Neurological deficits occurring after removal of upper tibial pin traction (UTPT) are exceedingly rare and sparsely reported in the literature. A 27-year-old male sustained a closed left subtrochanteric femur fracture following a road traffic accident. Preoperative UTPT was applied with no immediate neurological deficit. UTPT was removed intraoperatively before definitive fixation. Postoperatively, the patient developed left-sided foot drop. Electromyography and nerve conduction velocity studies at 6 weeks demonstrated neuropraxia of the CPN. Although UTPT is considered a safe and effective method for temporary fracture stabilization, clinicians should be aware of the potential for rare traction-related nerve injuries. Early recognition, appropriate splintage, and rehabilitation can result in favorable outcomes.

Peripheral nerve blockade of the lower extremity focuses on two major nerves: the sciatic and femoral. Both nerves lie near large vascular structures and can require significant volumes of injectate to produce a reliable analgesic blockade. Moreover, blockade of these nerves leads to corresponding muscle weakness that can be unnecessary or even undesirable for recovery following surgery.New-generation, high-resolution ultrasound (US) probes facilitate the visualization of selective nerves in the lower extremity. Therefore, blockade of these nerves can be performed at multiple locations that can be individualized for specific patients undergoing forefoot and midfoot surgeries. This article describes an educational approach for selective lower extremity blocks of the saphenous, tibial, sural, superficial peroneal, and deep peroneal nerves with corresponding clinical applications for common forefoot and midfoot surgeries. These techniques are presented in a stepwise approach with surface and corresponding US anatomy. Cadaveric dissections are also included with some of the described techniques to emphasize the anatomical relationships. Each of these techniques, in this educational review, begins with easily identifiable surface landmarks and follows a stepwise approach.Understanding of these lower extremity selective nerve blocks allows for targeted low-volume blockade of specific sensory distributions, individualized to each patient.

To synthesise the literature on pre- and intra-operative nerve mapping used to prevent iatrogenic nerve injuries during ankle arthroscopy. This scoping review followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was conducted using MEDLINE and Embase on 24 July 2024. Findings extracted from eligible studies were tabulated and synthesised. The search identified 270 articles, of which 9 met inclusion/exclusion criteria and were included in the review. Two studies described a mapping technique without reporting any outcomes, and three studies evaluated mapping techniques on cadavers and four on live patients. Four studies reported on visualisation and/or palpation, one study on arthroscopic transillumination, three on ultrasound and two on near-infrared light (NIR). There were only two comparative studies that showed that pre-operative ultrasound mapping places the nerves at safer distances from the portals and that ultrasound is more effective in the identification of the superficial peroneal nerve (SPN) than visualisation and/or palpation. Visualisation and/or palpation of the SPN is the most effective in ankle maximal plantar flexion and inversion and reduces the risk of nerve injury. There was no saphenous nerve injury with percutaneous screw insertion while using NIR. A reduction in nerve injuries during ankle arthroscopy might be achievable by using pre- or intra-operative nerve mapping with visualisation and/or palpation, ultrasound or (for nerves accompanied by the veins) NIR. The limited evidence suggests that pre-operative ultrasound might be potentially the most effective mapping method, but more comparative and prospective studies are needed to fully confirm these findings.

This study investigates the relationship between National Cancer Institute Common Terminology Criteria (NCI-CTC) for grading bortezomib-induced peripheral neuropathy (BIPN) and objective motor/sensory nerve dysfunctions assessed by nerve conduction studies (NCS). It also evaluates the correlation between specific nerve conduction abnormalities and progression- free survival (PFS). Thirty-three patients with multiple myeloma developing peripheral neuropathy during bortezomib treatment were enrolled. Participants were grouped based on NCI-CTC toxicity scores (< 2, n=17; ≥ 2, n=16). Comprehensive NCS were performed, assessing compound muscle action potentials (CMAP), motor conduction velocities (MCV), sensory nerve action potentials (SNAP), and sensory conduction velocities (SCV) across ulnar, median, tibial, peroneal, sural, and superficial peroneal nerves. Correlation analyses were used to examine the association between NCS parameters and PFS. Patients with higher NCI-CTC grades (≥ 2) exhibited significant reductions in motor and sensory nerve conduction parameters. Notably, the peroneal nerve showed significant decreases in CMAP (p=0.0059) and MCV (p=0.0223). The superficial peroneal nerve displayed a significant reduction in SCV (p=0.0189). A strong positive correlation was found between median nerve SNAP and longer PFS (r=0.558, p=0.001). The findings indicate that higher clinical grades of BIPN (NCI-CTC ≥ 2) are associated with objective neurophysiological evidence of worsened nerve function, with the peroneal nerve being particularly affected. The correlation between median nerve SNAP and PFS suggests that NCS parameters could potentially serve as prognostic markers in patients with BIPN. Bortezomib-induced neurotoxicity leads to significant impairments in both motor and sensory nerve conduction. Median nerve SNAP shows promise as a predictor for PFS, underscoring the potential value of NCS in monitoring neurotoxicity and guiding clinical management in patients receiving bortezomib.

Refined model of common peroneal nerve injury and regeneration: A neurophysiological, morphometric, and functional analysis in the adult rat.

To evaluate the relationship between the diabetic profile and human β-nerve growth factor (HβNGF), calcitonin gene-related peptide (CGRP), endothelin-1 (ET-1), and von Willebrand factor (VWF) in distinguishing painful from painless diabetic neuropathy. A case-control study. Department of Diabetic Foot, Baqai Institute of Diabetes and Endocrinology, Karachi, Pakistan, from October 2023 to August 2024. A total of 150 patients with Type I or II diabetes were recruited after IRB approval. Following informed consent, data on demographics, clinical examination, nerve conduction studies (peroneal, tibial, median, and sural nerves), and biochemical parameters (FBS, RBS, HbA1c, HβNGF, CGRP, ET-1, and VWF) were collected. Based on the NCS and DN4 questionnaire, participants were categorised into controls (no neuropathy), painless neuropathy, and painful neuropathy groups. Data were analysed using IBM SPSS version 23.0, with p <0.05 considered significant. Patients with painful neuropathy exhibited significantly lower VWF levels (p = 0.002) and higher fasting blood glucose (p = 0.01). Age, BMI, weight, and duration of diabetes differed significantly among the groups. Logistic regression identified duration of diabetes as the only independent predictor of painful neuropathy in both univariate (OR = 1.30) and multivariate analyses (OR = 1.47). FBS showed a positive correlation with diabetes duration (r = 0.188, p = 0.02). The duration of diabetes independently predicts painful diabetic neuropathy. Reduced VWF levels in patients with painful neuropathy suggest a potential role as a diagnostic biomarker. Further longitudinal studies are recommended. Diabetes mellitus, Diabetic peripheral neuropathy, β-Nerve growth factor, CGRP, Endothelin-1, von Willebrand factor.

Tonic motor activation (TOMAC) is a non-pharmacological treatment for moderate-to-severe medication-refractory Restless Legs Syndrome (RLS). This bilateral wearable device applies high-frequency electrical stimulation to the peroneal nerve, engaging the therapeutic mechanism while minimizing sleep discomfort. A recent meta-analysis evaluated TOMAC in RLS using aggregate data, which precluded subgroup analyses. The aim of our systematic review and meta-analysis was to extract individual participant data to enable the evaluation of TOMAC as adjunctive treatment and monotherapy in RLS. This study was registered on PROSPERO (CRD420251005571). Web of Science, Scopus, and PubMed were searched, from inception to March 31, 2025, to identify studies evaluating TOMAC for RLS. Risk of bias (Cochrane Risk of Bias Tool and Downs and Black checklist) and quality of evidence (Oxford Centre for Evidence-Based Medicine 2011 guidelines) of eligible studies were assessed. Primary outcomes were changes in International RLS Study Group Rating Scale (IRLS) score for efficacy and in Medical Outcomes Study Sleep Problem Index II (MOS-II) score for sleep improvement. Main safety outcome was the incidence of device-related adverse events. Subgroup analyses evaluated TOMAC as adjunctive therapy and as monotherapy, as well as by age, RLS age-of-onset, sex, RLS severity, and stimulation amplitude. Five studies from the United States were extracted including three randomized-controlled-trials with 252 participants for analyses (69 monotherapy/183 adjunctive TOMAC therapy). Relative to sham, TOMAC significantly reduced IRLS score both as adjunctive therapy (MD: 3.39, p=0.0001) and monotherapy (mean difference [MD]: 3.80, p=0.0047), and significantly reduced MOS-II score both as adjunctive therapy (MD: 8.23, p=0.0006) and monotherapy (MD: 9.65, p=0.0236). There were no significant differences in IRLS MD based on age, age of RLS onset, sex, RLS severity, and stimulation amplitude. Mild discomfort was the only adverse event with higher prevalence for TOMAC than sham. These results suggest that TOMAC is a tolerable non-pharmacological treatment that reduces RLS symptoms and improves sleep, both as adjunctive therapy and as monotherapy.

Supercharge end-to-side (SETS) nerve transfer enhances motor recovery in proximal nerve injuries by providing early reinnervation. However, the optimal indications and mechanisms remain unclear. This study examined the role of donor nerves using rat models of varying injury severity to clarify the clinical indications for SETS. Eighty female Sprague–Dawley rats were assigned to five groups: Control, Mild-SETS(–), Mild-SETS(+), Severe-SETS(–), and Severe-SETS(+). The tibial nerve was transected, decellularized, and reconstructed with a 10 mm (mild) or 20 mm (severe) graft. SETS consisted of end-to-side coaptation of the donor peroneal nerve to the tibial nerve 5 mm distal to the graft. Assessments included the sciatic functional index (SFI; measured every 4 weeks), compound muscle action potentials (CMAPs), gastrocnemius weight, and immunostaining for neurofilament (NF)-positive axons and S100β-positive Schwann cells at 8 and 16 weeks. In mild models, SETS accelerated early recovery in CMAP amplitude and muscle weight without affecting long-term outcomes. In severe models, SETS showed significant increases in CMAP amplitude and muscle weight at 16 weeks. NF-positive axons and S100β-positive Schwann cells increased distal to the coaptation site at 8 and 16 weeks in mild models, whereas both distal and proximal increases were observed in severe models. Donor nerves in SETS enable early arrival of axons and Schwann cells, leading to faster motor improvement. In the long term, spontaneous recovery compensates in mild models, whereas severe models benefit from sustained donor support that promotes regeneration. SETS nerve transfer may therefore be particularly useful in selected mild cases where rapid recovery is desired, and especially in severe cases where spontaneous regeneration is insufficient.

Background: Compound muscle action potential (CMAP) parameters provide objective information on peripheral neuromuscular function, yet comparisons between track athletes and sedentary individuals remain limited, particularly when stratified by sex. This exploratory study examined whether CMAP parameters differ between sprinters and sedentary controls, with a secondary descriptive analysis of female middle-distance runners. Methods: A total of 48 participants (27 females, 21 males) aged 15 to 28 years were recruited by convenience from a restricted-access athletic population. The main comparisons focused on sprinters versus sex-matched sedentary controls, analyzed separately in females (9 sprinters, 10 controls) and males (10 sprinters, 11 controls). Female middle-distance runners (n = 8) were retained as an exploratory subgroup. Bilateral peroneal nerve conduction studies were performed in the extensor digitorum brevis. Outcomes included latency, amplitude, nerve conduction velocity, and CMAP duration. Main comparisons used Welch's t-tests, supplemented by Mann-Whitney U tests. Effect sizes (Hedges' g) and 95% confidence intervals were reported. A BMI-adjusted model examined whether the main female finding remained after accounting for BMI. Results: Female sprinters showed significantly higher right-sided CMAP amplitude than sedentary females (Welch p = 0.017; Hedges' g = 1.32; 95% CI of the mean difference, 0.68 to 5.44 mV), supported by non-parametric testing (p = 0.025). The group effect remained significant after BMI adjustment. No other comparisons reached statistical significance. In males, no significant differences were observed. Conclusions: The main finding was a higher right-sided CMAP amplitude in female sprinters compared with sedentary controls, reasonably consistent across complementary parametric, non-parametric, and BMI-adjusted analyses. Given the small sample and exploratory design, these findings warrant cautious interpretation and replication in larger studies.

Background:Common peroneal nerve (CPN) neuropathy may result from trauma or iatrogenic injury. Complete decompression requires precise incision placement. This study aimed to define surface landmarks and incisional guidelines for optimal CPN decompression.Methods:Thirty lower limbs from 15 cadavers were studied with knees flexed at 90 degrees. Dissection exposed the CPN, allowing measurement of compression sites between the intermuscular septa and distances from key anatomical landmarks. The CPN angle to the fibular axis and distances from the tibial tubercle and crest were measured by 2 orthopedic surgeons.Results:The mean compression length between the anterior crural intermuscular septum and posterior crural intermuscular septum (PCIMS) was 25.2 ± 5.1 mm, and between the PCIMS and innominate intermuscular septum was 35.6 ± 6.4 mm. Mean distances from bony landmarks to the CPN were 19.0 ± 4.4 mm from the fibular head, 29.4 ± 4.5 mm from the fibular tip, and 54.7 ± 5.6 mm from the Gerdy tubercle. The anterior crural intermuscular septum was located 35.2 ± 12.1 mm distal to the tibial tubercle and 43.2 ± 8.6 mm posterior to the tibial crest, whereas the PCIMS was 22.1 ± 9.1 mm distal and 65.6 ± 8.3 mm posterior. The CPN lay 37.4 ± 6.6 degrees from the fibular axis at the fibular neck.Conclusions:A 37-degree orientation from the fibular neck provides a simple, reproducible guideline for incision planning in CPN decompression. The tibial tubercle and tibial crest serve as confirmatory landmarks to ensure complete release of the intermuscular septa.

Current thresholds for motor conduction block on nerve conduction studies are primarily based on expert opinion and fail to consider individual patient- or nerve-specific characteristics. In this article, we aimed to improve diagnostic accuracy for identifying partial motor conduction block and determine the influence of latency difference (LD) between proximal and distal stimulation on amplitude decay in unaffected nerves. We developed the multivariate extrapolated truncated fit model to establish reference limits for amplitude decay depending on LD using existing nerve conduction studies data and compared these with existing literature values and with published thresholds for conduction block. A total of 67,266 investigations of the forearm or lower leg segments of the median, ulnar, peroneal, and tibial nerves were included. The mean multivariate extrapolated truncated fit upper limits (model +2SD) for amplitude decay in nerves with normal distal amplitude/decreased distal amplitude were: Median 14.3%/24.1%, Ulnar 17.5%/34.4%, Peroneal 27.7%/41%, and Tibial 46%/57.1%. For the four nerves, we observed 1.7% to 5.1% increases in amplitude decay per ms increase in LD. Contrary to the multivariate extrapolated truncated fit reference limits, existing thresholds for conduction block produced inconsistent positive rates between nerves with a high risk of false positive and negative results. Amplitude decay on nerve conduction studies was dependent on LD, and the multivariate extrapolated truncated fit model showed promise as a tool to create reference limits from large data sets. Reference limits adjusted for LD could improve diagnosis of inflammatory polyneuropathies and other conditions with conduction block.

Background: Functional reconstruction to restore limb length of the upper limbs after sarcoma resection is always challenging for reconstructive surgeons, particularly in pediatric patients, keeping in mind the necessity of matching the growth of limbs. We present our cases of using vascularized proximal fibula free flap, along with physis based on anterior tibial vessels, for upper limb reconstruction. Methods: In this study, we conducted a retrospective analysis of 14 consecutive patients who underwent vascularized proximal fibula flap transfer for autologous functional reconstruction following oncologic resection of the humerus between April 2022 and April 2024. We evaluated all patients preoperatively and postoperatively, documenting outcomes like an increase in bone length, bony union, and donor site morbidity. Results: A total of 14 patients with an average age of 9.0 ± 2.4 years were included in this study. The average length of the humerus defect after surgical resection was 14.4 ± 2.3 cm. All patients had a smooth postoperative period with no wound healing issues and 100% flap survival rate. There was a measurable increase in bone flap length with complete bone union in all cases. One patient experienced brief common peroneal nerve palsy postoperatively. In none of the cases was knee instability noted. The mean follow-up period was 17.4 ± 2.6 months. The mean Musculoskeletal Tumor Society (MSTS) score was 29. Conclusion: Vascularized proximal fibula free flap based on anterior tibial vessels not only restores immediate limb length, but the growth allows long-term increase in limb length with minimal donor site morbidity.

The modified Broström operation is the gold standard surgical approach for chronic lateral ankle instability. The aim of surgical treatment for chronic lateral ankle instability is to shorten and repair the lax lateral ligaments, once the healing process is complete, the sutures will no longer be necessary. While non-absorbable sutures are commonly used, they may cause complications, such as inflammation and foreign body reactions. The purpose of this study was to evaluate the clinical outcomes of the modified Broström operation using absorbable sutures, which we expected to yield favorable results. From 2019 to 2023, 157 cases of mechanical chronic lateral ankle instability treated with the modified Broström operation using absorbable sutures were analyzed retrospectively Functional outcomes were assessed using preoperative and postoperative AOFAS Ankle-Hindfoot scores and Karlsson-Peterson scores. The mean AOFAS score improved from 66.84 (range: 36-98) preoperatively to 88.20 (range: 55-100) postoperatively, and the mean Karlsson score improved from 53.67 (range: 25-95) to 82.29 (range: 35-100). Recurrence of instability or sprains occurred in 6.3% of cases, with only two patients (1.2%) requiring reoperation. Complications other than recurrence were rare, limited to a single case of superficial peroneal nerve injury and one deep infection. Multivariate analysis revealed that younger age was associated with a higher risk of recurrence. The modified Broström operation using absorbable sutures demonstrated favorable functional improvement with low recurrence and complication rates, suggesting that it may represent a safe and effective surgical option.

In a recent article published in Cell Research, Chen et al. reported that light flickering at 40Hz effectively counteracts chronic pain in Complete Freund Adjuvant (CFA)-treated mice and in mice whose tibial and common peroneal nerves were ligated (spared nerve injury, SNI) [1]. These mice served as models for inflammatory and neuropathic pain, respectively. After establishing that 40Hz light flickering exerted analgesia in both pain models, a systematic search started for the neuronal pathways involved and the conditions required for this effect. The combination of retrograde and anterograde tracing techniques indicated that retinal ganglion cells (RGCs) project monosynaptically to the central amygdala (CeA), and chemogenetic or optogenetic activation of this pathway simulates the effects of 40Hz light stimulation. Genetic sensors for adenosine expressed in the CeA proved that such a light stimulation caused an increase in the local concentration of adenosine, via the promotion of the equilibrative adenosine transporter-mediated outflow of the nucleoside from CNS cells. The enriched adenosine levels apparently stimulated A2A receptors (Rs) as proved by the abolition of 40Hz light flickering-induced analgesia by pharmacological blockade of A2ARs, or their genetic knockdown/knockout. The target neurons in the CeA were identified as belonging to the proenkephalin-containing type; their selective ablation abolished the effect of light stimulation. Finally, two capsaicin injections, 3h apart, the second one either combined with saline or the protein synthesis inhibitor anisomycin, showed that anisomycin deleted chronic pain memory traces. Hence, 40Hz light flickering may be a non-pharmacological manipulation for alleviating chronic pain in humans, without the cardiovascular and CNS side effects inherent to systemic adenosine application.

BackgroundPeripheral nerve injury with deficits has poor functional prognosis, making motor function assessment during nerve regeneration crucial. Recently, pigs have been used as research animals for peripheral nerve regeneration from a translational perspective. However, the established methods for evaluating motor function remain insufficient, and the development of motor function assessment protocols for evaluating paralysis in medium-to large-sized animals is necessary.MethodsBilateral video recordings of healthy pigs (n = 4) walking straight ahead were obtained. A common peroneal nerve injury model was established on the left side of the animal (n = 3), and similar videos were recorded at 1 and 3 months post-operatively. Stride length, stance phase duration, swing phase duration, gait cycle duration, maximum heel height, joint angles, and foot velocity during one gait cycle were evaluated before and after surgery. Deep learning for posture estimation was employed to analyze joint angles and foot velocities.ResultsThe post-operative stance phase duration on the intact side was prolonged and the maximum heel height on the impaired side was significantly higher after surgery. The accuracy of the posture estimated using deep learning was comparable to that estimated using manual human labeling. The ankle angle on the impaired side increased post-operatively and significant changes in foot velocity were observed at the end of the swing phase. Changes in walking patterns of the animals caused by nerve regeneration were also captured.ConclusionsDeep learning-based gait analysis enabled the quantitative and objective identification of the characteristics of common peroneal nerve palsy and compensatory movements during one gait cycle. This analytical method is a potentially useful technique for studying recovery from paralysis associated with nerve regeneration.

Cutaneous arteritis (CA) is a skin-limited medium-vessel vasculitis. Some patients with CA also exhibit extracutaneous manifestations, such as vasculitic peripheral neuropathy (VPN). VPN is likely underdiagnosed because nerve biopsies are invasive and often impractical. This study proposed the concept of provisional CA to better identify patients with neuropathic involvement and to evaluate the prevalence and electrophysiological features of VPN. We retrospectively analysed patients with provisional CA treated at the Severance Hospital between 2011 and 2024. Provisional CA was defined as skin-limited medium-vessel vasculitis with neuropathic symptoms in the lower limbs irrespective of a nerve biopsy. VPN was defined based on established clinical and electrophysiological criteria. Demographic, clinical, and laboratory data were collected from the electronic medical records. Thirty-six patients met the provisional CA criteria. The median age was 51.0 years, and 36.1% of the patients were male. Among these, 22 (61.1%) demonstrated electrophysiological evidence of VPN. Pure sensory neuropathy and sensorimotor involvement were observed in 59.1% and 40.9% of patients, respectively. The most frequently affected nerves were the peroneal (63.6%) and sural (54.5%) nerves. No significant differences were found between the patients with and without VPN in terms of age, sex, skin manifestations, or laboratory findings. VPN was prevalent in patients with provisional CA. Clinical features alone were insufficient to predict nerve involvement. Nerve conduction studies serve as a valuable diagnostic tool when a nerve biopsy is not feasible and may facilitate the earlier detection and management of neuropathic complications in skin-limited vasculitis.

Introduction. Previous research has demonstrated the high efficacy of peripheral magnetic stimulation (PMS) in the postoperative period of athletes for increasing strength and muscle tissue hypertrophy. Scientific and experimental substantiation for the use of PMS within the medical and biological support system for elite sports to improve the functional capabilities of the musculoskeletal system (MSS) in healthy athletes represents a relevant research task. Objective. Study of the effect of rhythmic PMS on the functional capabilities of MSS in male athletes. Materials and methods. The study was conducted at the Yug-Sport Rehabilitation and Recovery Center for Athletes in Kislovodsk (Russia). In total, 38 highly qualified male athletes were involved, who were divided into three groups: experimental group 1 (EG1) — 15 individuals, experimental group 2 (EG2) — 8 individuals, and the control group (CG) — 15 individuals. PMS was administered using a BTL-6000 Super Inductive System high-intensity magnetotherapy device, following two protocols for modulation and stimulation frequency. In the athletes, the following parameters were assessed: electrophysiological studies (electroneuromyography), rheovasography, and dynamometry of the lower limbs. These assessments were conducted before the intervention, after the first session, and after a course of eight PMS treatment sessions. In the control group, PMS was not applied. All parameters in this group were measured before and after the training camp period. Results. The application of PMS to the posterior aspect of the left and right thigh at an intensity above the motor threshold (25–80%) and a frequency modulation of 1–150 Hz (EG1) contributed to a decrease in latency parameters and an increase in motor conduction velocity, as well as the M-response amplitude and area upon stimulation of the peroneal nerve. The application of PMS to the same area and at the same intensity, but with a frequency modulation of 1–50 Hz (EG2), increased the M-response amplitude and area. An increase in peripheral hemodynamics in the vessels of the lower limbs and in the strength parameters of the hip flexor and extensor muscles was revealed, along with an improvement in intermuscular coordination. Conclusions. The application of PMS in highly qualified athletes contributes to an increase in the functional capabilities of MSS, manifested in improved parameters of neuromuscular transmission, peripheral hemodynamics, and strength capabilities.