Neuromuscular DiseasesNeuromuscular DiseasesНервно-мышечные болезни2222-87212413-0443Publishing House ABV Press50610.17650/2222-8721-2022-12-4-29-36LECTURES AND REVIEWSЛЕКЦИИ И ОБЗОРЫPeroneal nerve palsy (injury) in fibullar tunnel syndromeНейропатия малоберцового нерва: общие подходы к диагностике и терапииhttps://orcid.org/0000-0002-9529-3891LunevaI. E.ЛуневаИ. Е.
Russian Federation

Irina Evgenievna Luneva  

80 Volokolamskoe Shosse, Моscow 125367

Ирина Евгеньевна Лунева 

125367 Москва, Волоколамское шоссе, 80

luneva@neurology.ruhttps://orcid.org/0000-0002-7924-3405GrishinaD. A.ГришинаД. А.
Russian Federation

80 Volokolamskoe Shosse, Моscow 125367

125367 Москва, Волоколамское шоссе, 80

https://orcid.org/0000-0003-3956-6362SuponevaN. A.СупоневаН. А.
Russian Federation

80 Volokolamskoe Shosse, Моscow 125367

125367 Москва, Волоколамское шоссе, 80

Research Center of NeurologyФГБНУ «Научный центр неврологии»1312202212429361312202213122022Copyright ©; 2022, Luneva I.E., Grishina D.A., Suponeva N.A.Copyright ©; 2022, Лунева И.Е., Гришина Д.А., Супонева Н.А.2022Luneva I.E., Grishina D.A., Suponeva N.A.Лунева И.Е., Гришина Д.А., Супонева Н.А.https://creativecommons.org/licenses/by/4.0https://nmb.abvpress.ru/jour/article/view/506

While compression neuropathies of the nerves of the lower limbs are not a common pathology, peroneal nerve neuropathy is the most common of them. Peroneal nerve compression most commonly occurs at or around the head of the fibula, but can also occur in the lower leg, ankle, or foot. Neurophysiological and neuroimaging methods are effective in diagnosing peroneal nerve compression and determining the type of damage. The first line of therapy is lifestyle modification, avoidance of compressive postures, ankle joint orthotics, treatment of knee joint instability when detected, kinesiotherapy. An important role in the correction of symptoms is played using anticholinesterase drugs, the effectiveness of which in diseases of peripheral nervous system has been shown in a number of domestic studies. If conservative treatment fails, surgical treatment is recommended. The diagnosis of peroneal neuropathy is associated with a good prognosis and most patients experience complete recovery of nerve function.

Нейропатия малоберцового нерва является самой распространенной из перечня компрессионных нейропатий нервов нижних конечностей. Компрессия малоберцового нерва чаще всего происходит на уровне головки малоберцовой кости, но также может возникать в области голени, лодыжки или на стопе. Нейрофизиологические и нейровизуализационные методы информативны в диагностике компрессии малоберцового нерва и определении типа повреждения. Терапией 1‑й линии являются изменение образа жизни, профилактика компримирующих поз, ортезирование голеностопного сустава, коррекция нестабильности коленного сустава при ее наличии, кинезиотерапия. Важную роль в отношении коррекции двигательных и чувствительных симптомов играет использование препаратов, ингибирующих холинэстеразу, эффективность которых при заболеваниях периферической нервной системы была продемонстрирована в ряде отечественных исследований. Прогноз нейропатии малоберцового нерва благоприятный, и у большинства пациентов наблюдается полное или практически полное восстановление функции нерва. При неэффективности консервативного лечения рекомендованы хирургические методики.

peroneal nerve palsyfibularis tunnel syndrometunnel neuropathiesmononeuropathyнейропатия малоберцового нервафибулярный синдромтуннельные нейропатиимононейропатия1. Bowley M.P., Doughty C.T. Entrapment Neuropathies of the Lower Extremity. Med Clin North Am 2019;103(2):371–82. DOI: 10.1016/j.mcna.2018.10.013Bowley M.P., Doughty C.T. Entrapment Neuropathies of the Lower Extremity. Med Clin North Am 2019;103(2):371–82. DOI: 10.1016/j.mcna.2018.10.0132. Kernohan J., Levack B., Wilson J.N. Entrapment of the superficial peroneal nerve: three case reports. J Bone Joint Surg Br 1985;67:60, 61.Kernohan J., Levack B., Wilson J.N. Entrapment of the superficial peroneal nerve: three case reports. J Bone Joint Surg Br 1985;67:60, 61.3. Cruz-Martinez A., Arpa J., Palau F. Peroneal neuropathy after weight loss. J Peripher Nerv Syst 2000;5(2):101–5. DOI: 10.1046/j.1529-8027.2000.000 07.xCruz-Martinez A., Arpa J., Palau F. Peroneal neuropathy after weight loss. J Peripher Nerv Syst 2000;5(2):101–5. DOI: 10.1046/j.1529-8027.2000.000 07.x4. Moatshe G., Dornan G.J., Løken S. et al. Demographics and injuries associated with knee dislocation: A prospective review of 303 patients. Orthop J Sport Med 2017;5(5). DOI: 10.1177/2325967117706521Moatshe G., Dornan G.J., Løken S. et al. Demographics and injuries associated with knee dislocation: A prospective review of 303 patients. Orthop J Sport Med 2017;5(5). DOI: 10.1177/23259671177065215. Carender C.N., Bedard N.A., An Q. et al. Common peroneal nerve injury and recovery after total knee arthroplasty: a systematic review. Arthroplast Today 2020;6(4):662–7. DOI: 10.1016/j.ar td.2020.07.017Carender C.N., Bedard N.A., An Q. et al. Common peroneal nerve injury and recovery after total knee arthroplasty: a systematic review. Arthroplast Today 2020;6(4):662–7. DOI: 10.1016/j.ar td.2020.07.0176. Idusuyi O.B., Morrey B.F. Peroneal nerve palsy after total knee arthroplasty: Assessment of predisposing and prognostic factors. J Bone Jt Surg Ser A 1996;78(2):177–84. DOI: 10.2106/00004623-19960200 0-00003Idusuyi O.B., Morrey B.F. Peroneal nerve palsy after total knee arthroplasty: Assessment of predisposing and prognostic factors. J Bone Jt Surg Ser A 1996;78(2):177–84. DOI: 10.2106/00004623-19960200 0-000037. Beller J., Trockel U., Lukoschek M. Peronäusläsionen nach KTEPimplantation unter verwendung einer postoperativ fortgeführten periduralen analgesie. Orthopade 2008;37(5):475–80. DOI: 10.1007/s00132-008-1257-xBeller J., Trockel U., Lukoschek M. Peronäusläsionen nach KTEPimplantation unter verwendung einer postoperativ fortgeführten periduralen analgesie. Orthopade 2008;37(5):475–80. DOI: 10.1007/s00132-008-1257-x8. Park J.H., Restrepo C., Norton R. et al. Common peroneal nerve palsy following total knee arthroplasty: Prognostic factors and course of recovery. J Arthroplasty 2013;28(9):1538–42. DOI: 10.1016/j.arth.2013.02.025Park J.H., Restrepo C., Norton R. et al. Common peroneal nerve palsy following total knee arthroplasty: Prognostic factors and course of recovery. J Arthroplasty 2013;28(9):1538–42. DOI: 10.1016/j.arth.2013.02.0259. Meadows J.R., Finnoff J.T. Lower extremity nerve entrapments in athletes. Curr Sports Med Rep 2014;13(5):299–306. DOI: 10.1249/JSR.0000000000000083Meadows J.R., Finnoff J.T. Lower extremity nerve entrapments in athletes. Curr Sports Med Rep 2014;13(5):299–306. DOI: 10.1249/JSR.000000000000008310. Canella C., Demondion X., Guillin R. et al. Anatomic study of the superficial peroneal nerve using sonography. AJR Am J Roentgenol 2009;193:174–9.Canella C., Demondion X., Guillin R. et al. Anatomic study of the superficial peroneal nerve using sonography. AJR Am J Roentgenol 2009;193:174–9.11. Agthong S., Huanmanop T., Sasivongsbhakdi T. et al. Anatomy of the superficial peroneal nerve related to the harvesting for nerve graft. Surg Radiol Anat 2008;30:145–8.Agthong S., Huanmanop T., Sasivongsbhakdi T. et al. Anatomy of the superficial peroneal nerve related to the harvesting for nerve graft. Surg Radiol Anat 2008;30:145–8.12. Logullo F., Ganino C., Lupidi F. et al. Anterior tarsal tunnel syndrome: A misunderstood and a misleading entrapment neuropathy. Neurol Sci 2014;35(5):773–5. DOI: 10.10 07/s10072-013-1601-8Logullo F., Ganino C., Lupidi F. et al. Anterior tarsal tunnel syndrome: A misunderstood and a misleading entrapment neuropathy. Neurol Sci 2014;35(5):773–5. DOI: 10.10 07/s10072-013-1601-813. Poage C., Roth C., Scott B. Peroneal nerve palsy. J Am Acad Orthop Surg 2016;24(1):1–10. DOI: 10.5435/JAAOS-D-14-00420Poage C., Roth C., Scott B. Peroneal nerve palsy. J Am Acad Orthop Surg 2016;24(1):1–10. DOI: 10.5435/JAAOS-D-14-0042014. Bregman P.J., Schuenke M.J. Commentary on the diagnosis and treatment of superficial peroneal (fibular) nerve injury and entrapment. Persp Anat Med Surg 2016;1–7. DOI: 10.1053/j.jfas.2015.11.005Bregman P.J., Schuenke M.J. Commentary on the diagnosis and treatment of superficial peroneal (fibular) nerve injury and entrapment. Persp Anat Med Surg 2016;1–7. DOI: 10.1053/j.jfas.2015.11.00515. Garg B. Peroneal nerve palsy: evaluation and management. J Am Acad Orthop Surg 2016;24(5):e49. DOI: 10.5435/JAAOSD-16-00045Garg B. Peroneal nerve palsy: evaluation and management. J Am Acad Orthop Surg 2016;24(5):e49. DOI: 10.5435/JAAOSD-16-0004516. Mediouni Z., de Roquemaurel A., Dumontier C. et al. Is carpal tunnel syndrome related to computer exposure at work? A review and meta-analysis. Clin Chem 2014;56(2):204–8.Mediouni Z., de Roquemaurel A., Dumontier C. et al. Is carpal tunnel syndrome related to computer exposure at work? A review and meta-analysis. Clin Chem 2014;56(2):204–8.17. Song B., Marathe A., Chi B. et al. Hydrodissection as a therapeutic and diagnostic modality in treating peroneal nerve compression. Baylor Univ Med Cent Proc 2020;33(3):465, 466. DOI: 1 0.1080/08998280.2020.1758006Song B., Marathe A., Chi B. et al. Hydrodissection as a therapeutic and diagnostic modality in treating peroneal nerve compression. Baylor Univ Med Cent Proc 2020;33(3):465, 466. DOI: 1 0.1080/08998280.2020.175800618. Tabor M., Emerson B., Drucker R. et al. High-stepping crosscountry athlete. Curr Sports Med Rep 2017;16(5):314–6. DOI: 10. 1249/JSR.0000000000000396Tabor M., Emerson B., Drucker R. et al. High-stepping crosscountry athlete. Curr Sports Med Rep 2017;16(5):314–6. DOI: 10. 1249/JSR.000000000000039619. Sanchez M., Yoshioka T., Ortega M. et al. Ultrasound-guided platelet-rich plasma injections for the treatment of common peroneal nerve palsy associated with multiple ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 2013. DOI: 10.1007/s00167-013-2479-ySanchez M., Yoshioka T., Ortega M. et al. Ultrasound-guided platelet-rich plasma injections for the treatment of common peroneal nerve palsy associated with multiple ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 2013. DOI: 10.1007/s00167-013-2479-y20. Авакян Г.Н., Авакян Г.Г. Клинико-электронейромиографическое исследование эффективности ипидакрина у пациентов с мононевропатиями. Журнал неврологии и психиатрии им. С.С. Корсакова 2015;115(9):17–22. Avakian G.N., Avakian G.G. A clinical-electroneuromyographic study of the effecacy of ipidacrine in patients with mononeuropathy. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry 2015;115(9):17–22. (In Russ.)Авакян Г.Н., Авакян Г.Г. Клинико-электронейромиографическое исследование эффективности ипидакрина у пациентов с мононевропатиями. Журнал неврологии и психиатрии им. С.С. Корсакова 2015;115(9):17–22. Avakian G.N., Avakian G.G. A clinical-electroneuromyographic study of the effecacy of ipidacrine in patients with mononeuropathy. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry 2015;115(9):17–22. (In Russ.)21. Левин О.С., Матвиевская О.В. Оценка эпидемиологических данных о влиянии терапии препаратом Ипигрикс® на двигательные и чувствительные функции у амбулаторных пациентов с заболеваниями периферической нервной системы (результаты наблюдательного исследования «ИМПУЛЬС»). Медицинский алфавит. Неврология и психиатрия 2019;1(2):11–4. DOI: 10.33667/2078-5631-2019-1-2(377)-11-14 Levin O.S., Matvievskaya O.V. Evaluation of epidemiological data on effect of therapy with Ipigrix® on motor and sensory functions in ambulatory patients with various diseases of peripheral nervous system. Meditsinskiy alphavit. Nevrologiya i psikhiatria = Medical Alphabet. Neurology and Psychiatry 2019;1(2):11–14. (In Russ.)Левин О.С., Матвиевская О.В. Оценка эпидемиологических данных о влиянии терапии препаратом Ипигрикс® на двигательные и чувствительные функции у амбулаторных пациентов с заболеваниями периферической нервной системы (результаты наблюдательного исследования «ИМПУЛЬС»). Медицинский алфавит. Неврология и психиатрия 2019;1(2):11–4. DOI: 10.33667/2078-5631-2019-1-2(377)-11-14 Levin O.S., Matvievskaya O.V. Evaluation of epidemiological data on effect of therapy with Ipigrix® on motor and sensory functions in ambulatory patients with various diseases of peripheral nervous system. Meditsinskiy alphavit. Nevrologiya i psikhiatria = Medical Alphabet. Neurology and Psychiatry 2019;1(2):11–14. (In Russ.)22. Стандарты специализированной медицинской помощи. Доступно по: https://www.rosminzdrav.ru/ministry/61/22/stranitsa-979/stranitsa-983/2-standarty-spetsializirovannoymeditsinskoy-pomoschi Standards for specialized medical care. Available at: https://www.rosminzdrav.ru/ministry/61/22/stranitsa-979/stranitsa-983/2-standarty-spetsializirovannoy-meditsinskoy-pomoschi (In Russ.)Стандарты специализированной медицинской помощи. Доступно по: https://www.rosminzdrav.ru/ministry/61/22/stranitsa-979/stranitsa-983/2-standarty-spetsializirovannoymeditsinskoy-pomoschi Standards for specialized medical care. Available at: https://www.rosminzdrav.ru/ministry/61/22/stranitsa-979/stranitsa-983/2-standarty-spetsializirovannoy-meditsinskoy-pomoschi (In Russ.)23. Fortier L.M., Markel M., Thomas B.G. et al. An Update on Peroneal Nerve Entrapment and Neuropathy. Orthoped Rev 2021;13(2). DOI: 10.52965/001c.24937Fortier L.M., Markel M., Thomas B.G. et al. An Update on Peroneal Nerve Entrapment and Neuropathy. Orthoped Rev 2021;13(2). DOI: 10.52965/001c.2493724. Hanyu-Deutmeyer A., Pritzlaff S.G. Peripheral nerve stimulation for the 21st century: sural, superficial peroneal, and tibial nerves. Pain Med 2020;21(Suppl 1):S64–S67. DOI: 10.1093/pm/pna a202Hanyu-Deutmeyer A., Pritzlaff S.G. Peripheral nerve stimulation for the 21st century: sural, superficial peroneal, and tibial nerves. Pain Med 2020;21(Suppl 1):S64–S67. DOI: 10.1093/pm/pna a20225. Poage C., Roth C., Scott B. Peroneal nerve palsy: evaluation and management. J Am Acad Orthop Surg 2016. DOI: 10.5435/JAAOS-D-14-00420Poage C., Roth C., Scott B. Peroneal nerve palsy: evaluation and management. J Am Acad Orthop Surg 2016. DOI: 10.5435/JAAOS-D-14-0042026. Souter J., Swong K., McCoyd M. et al. Surgical results of common peroneal nerve neuroplasty at lateral fibular neck. World Neurosurg 2018. DOI: 10.1016/j.wneu.2018.01.0 61Souter J., Swong K., McCoyd M. et al. Surgical results of common peroneal nerve neuroplasty at lateral fibular neck. World Neurosurg 2018. DOI: 10.1016/j.wneu.2018.01.0 6127. Morimoto D., Isu T., Kim K. et al. Microsurgical decompression for peroneal nerve entrapment neuropathy. Neurol Med Chir 2015;55(8):669–73. DOI: 10.2176/nmc.oa.2014-0454Morimoto D., Isu T., Kim K. et al. Microsurgical decompression for peroneal nerve entrapment neuropathy. Neurol Med Chir 2015;55(8):669–73. DOI: 10.2176/nmc.oa.2014-045428. Dhinsa B.S., Hussain L., Singh S. The management of dorsal peroneal nerve compression in the midfoot. Foot 2018. DOI: 10.1016/j.foot.2017.12.005Dhinsa B.S., Hussain L., Singh S. The management of dorsal peroneal nerve compression in the midfoot. Foot 2018. DOI: 10.1016/j.foot.2017.12.00529. Linden K., Hicks K., Wolff G. et al. Clinical outcomes of nerve transfers in peroneal nerve palsy: a systematic review and metaanalysis. J Reconstr Microsurg 2019;35(1):57–65. DOI: 10.1055/s-0038-1667047Linden K., Hicks K., Wolff G. et al. Clinical outcomes of nerve transfers in peroneal nerve palsy: a systematic review and metaanalysis. J Reconstr Microsurg 2019;35(1):57–65. DOI: 10.1055/s-0038-166704730. Schweitzer M., Jones C. Tendon transfers for the drop foot. Foot Ankle Clin N Am 2014;19:65–71. DOI: 10.1016/j.fcl.2013.12.002Schweitzer M., Jones C. Tendon transfers for the drop foot. Foot Ankle Clin N Am 2014;19:65–71. DOI: 10.1016/j.fcl.2013.12.00231. Jeng C., Myerson M. The uses of tendon transfers to correct paralytic deformity of the foot and ankle. Foot Ankle Clin 2004;9:319–37.Jeng C., Myerson M. The uses of tendon transfers to correct paralytic deformity of the foot and ankle. Foot Ankle Clin 2004;9:319–37.32. Elsner A., Barg A., Stufkens S.A. et al. Lambrinudi arthrodesis with posterior tibialis transfer in adult drop-foot. Foot Ankle Int 2010;31(1):30–7. DOI: 10.3113/FAI.2010.0030Elsner A., Barg A., Stufkens S.A. et al. Lambrinudi arthrodesis with posterior tibialis transfer in adult drop-foot. Foot Ankle Int 2010;31(1):30–7. DOI: 10.3113/FAI.2010.0030