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Repetitive Plantar Flexion Test as an Adjunct Tool for the Diagnosis of Common Peroneal Nerve Entrapment Neuropathy.
World Neurosurg 2016; 86:484-9WN

Abstract

OBJECTIVE

The diagnosis of common peroneal nerve entrapment neuropathy (CPNEN) is based on clinical symptoms and nerve conduction studies. However, nerve conduction studies may not detect abnormalities. Under the hypothesis that repetitive plantar flexion that loads the peroneal nerve (PN) at the entrapment point without lumbar loading would be a useful CPNEN provocation test, we evaluated the repetitive plantar flexion (RPF) test as an adjunct diagnostic tool for CPNEN. The study design was a retrospective analysis of prospectively collected data.

METHODS

Our study population consisted of 18 consecutive patients whose ipsilateral CPNEN improved significantly after PN neurolysis. Using repetitive ankle plantar flexion as a CPNEN provocation test, results were recorded as positive when it elicited numbness and/or pain in the affected area of the PN.

RESULTS

The RPF test induced symptoms on all affected sides in the course of 57.4 seconds (range, 14-120 seconds). In 3 patients it induced numbness in the affected area of the PN in the normal leg. Receiver operating characteristic analysis showed that the diagnostic sensitivity and accuracy of the test were 94.4% each. The suggested cutoff point was 110 seconds and the area under the receiver operating characteristic curve was 0.97 (95% confidence interval 0.93-1.02). The positive and the negative predictive values were 89.5% and 94.1%, respectively.

CONCLUSIONS

Our simple RPF test elicited the symptoms of CPNEN and our provocation test helped to identify dynamic PN entrapment neuropathy as the origin of intermittent claudication.

Authors+Show Affiliations

Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan. Electronic address: 4649nao-iwamoto@nms.ac.jp.Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Chiba, Japan.Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan.Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan.Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26433094

Citation

Iwamoto, Naotaka, et al. "Repetitive Plantar Flexion Test as an Adjunct Tool for the Diagnosis of Common Peroneal Nerve Entrapment Neuropathy." World Neurosurgery, vol. 86, 2016, pp. 484-9.
Iwamoto N, Kim K, Isu T, et al. Repetitive Plantar Flexion Test as an Adjunct Tool for the Diagnosis of Common Peroneal Nerve Entrapment Neuropathy. World Neurosurg. 2016;86:484-9.
Iwamoto, N., Kim, K., Isu, T., Chiba, Y., Morimoto, D., & Isobe, M. (2016). Repetitive Plantar Flexion Test as an Adjunct Tool for the Diagnosis of Common Peroneal Nerve Entrapment Neuropathy. World Neurosurgery, 86, pp. 484-9. doi:10.1016/j.wneu.2015.09.080.
Iwamoto N, et al. Repetitive Plantar Flexion Test as an Adjunct Tool for the Diagnosis of Common Peroneal Nerve Entrapment Neuropathy. World Neurosurg. 2016;86:484-9. PubMed PMID: 26433094.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Repetitive Plantar Flexion Test as an Adjunct Tool for the Diagnosis of Common Peroneal Nerve Entrapment Neuropathy. AU - Iwamoto,Naotaka, AU - Kim,Kyongsong, AU - Isu,Toyohiko, AU - Chiba,Yasuhiro, AU - Morimoto,Daijiro, AU - Isobe,Masanori, Y1 - 2015/12/18/ PY - 2015/07/31/received PY - 2015/09/22/revised PY - 2015/09/23/accepted PY - 2015/10/4/entrez PY - 2015/10/4/pubmed PY - 2016/6/21/medline KW - Common peroneal nerve entrapment neuropathy KW - Provocation test KW - Repetitive plantar flexion SP - 484 EP - 9 JF - World neurosurgery JO - World Neurosurg VL - 86 N2 - OBJECTIVE: The diagnosis of common peroneal nerve entrapment neuropathy (CPNEN) is based on clinical symptoms and nerve conduction studies. However, nerve conduction studies may not detect abnormalities. Under the hypothesis that repetitive plantar flexion that loads the peroneal nerve (PN) at the entrapment point without lumbar loading would be a useful CPNEN provocation test, we evaluated the repetitive plantar flexion (RPF) test as an adjunct diagnostic tool for CPNEN. The study design was a retrospective analysis of prospectively collected data. METHODS: Our study population consisted of 18 consecutive patients whose ipsilateral CPNEN improved significantly after PN neurolysis. Using repetitive ankle plantar flexion as a CPNEN provocation test, results were recorded as positive when it elicited numbness and/or pain in the affected area of the PN. RESULTS: The RPF test induced symptoms on all affected sides in the course of 57.4 seconds (range, 14-120 seconds). In 3 patients it induced numbness in the affected area of the PN in the normal leg. Receiver operating characteristic analysis showed that the diagnostic sensitivity and accuracy of the test were 94.4% each. The suggested cutoff point was 110 seconds and the area under the receiver operating characteristic curve was 0.97 (95% confidence interval 0.93-1.02). The positive and the negative predictive values were 89.5% and 94.1%, respectively. CONCLUSIONS: Our simple RPF test elicited the symptoms of CPNEN and our provocation test helped to identify dynamic PN entrapment neuropathy as the origin of intermittent claudication. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/26433094/Repetitive_Plantar_Flexion_Test_as_an_Adjunct_Tool_for_the_Diagnosis_of_Common_Peroneal_Nerve_Entrapment_Neuropathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(15)01248-6 DB - PRIME DP - Unbound Medicine ER -