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Repetitive Plantar Flexion (Provocation) Test for the Diagnosis of Intermittent Claudication due to Peroneal Nerve Entrapment Neuropathy: Case Report.
NMC Case Rep J. 2015 Oct; 2(4):140-142.NC

Abstract

The diagnosis of peroneal nerve (PN) entrapment neuropathy (PNEN) is based on clinical symptoms and nerve conduction studies. However, these studies do not always detect PNEN. Our 64-year-old patient suffered persistent left L5 numbness after two lumbar surgeries. Two years before admission to our institute his left leg pain gradually reappeared. When walking, his numbness in the left lower thigh to the dorsum of the foot increased. Electrophysiological testing revealed no conduction block on the PN. To identify the origin of his intermittent symptoms we performed loading of repetitive ankle plantar flexion in the at-rest posture to avoid the lumbar factor. We used this provocation test to check for PNEN because it occurs at a site where the PN passes the soleus- and the peroneus longus muscle (SM, PLM). The symptoms appeared reproducibly within 10 s of loading. PN neurolysis under local anesthesia showed that the PN was strongly compressed by the SM and PLM. This procedure eased his symptoms and he was able to walk without elicitation of numbness and pain upon repetitive ankle plantar flexion. In our case, repetitive plantar flexion elicited the symptoms and this provocation test may be useful to identify PN dynamic entrapment neuropathy as the origin of intermittent claudication.

Authors+Show Affiliations

Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Chiba.Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Hokkaido.Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Chiba.Department of Neurosurgery, Nippon Medical School, Tokyo.Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Chiba.Department of Neurosurgery, Nippon Medical School, Tokyo.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

28663985

Citation

Kim, Kyongsong, et al. "Repetitive Plantar Flexion (Provocation) Test for the Diagnosis of Intermittent Claudication Due to Peroneal Nerve Entrapment Neuropathy: Case Report." NMC Case Report Journal, vol. 2, no. 4, 2015, pp. 140-142.
Kim K, Isu T, Kokubo R, et al. Repetitive Plantar Flexion (Provocation) Test for the Diagnosis of Intermittent Claudication due to Peroneal Nerve Entrapment Neuropathy: Case Report. NMC case report journal. 2015;2(4):140-142.
Kim, K., Isu, T., Kokubo, R., Morimoto, D., Kobayashi, S., & Morita, A. (2015). Repetitive Plantar Flexion (Provocation) Test for the Diagnosis of Intermittent Claudication due to Peroneal Nerve Entrapment Neuropathy: Case Report. NMC Case Report Journal, 2(4), 140-142. https://doi.org/10.2176/nmccrj.2014-0430
Kim K, et al. Repetitive Plantar Flexion (Provocation) Test for the Diagnosis of Intermittent Claudication Due to Peroneal Nerve Entrapment Neuropathy: Case Report. NMC case report journal. 2015;2(4):140-142. PubMed PMID: 28663985.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Repetitive Plantar Flexion (Provocation) Test for the Diagnosis of Intermittent Claudication due to Peroneal Nerve Entrapment Neuropathy: Case Report. AU - Kim,Kyongsong, AU - Isu,Toyohiko, AU - Kokubo,Rinko, AU - Morimoto,Daijiro, AU - Kobayashi,Shiro, AU - Morita,Akio, Y1 - 2015/09/11/ PY - 2015/04/24/received PY - 2015/06/08/accepted PY - 2017/7/1/entrez PY - 2015/9/11/pubmed PY - 2015/9/11/medline KW - diagnosis KW - entrapment neuropathy KW - neurolysis KW - peroneal nerve KW - provocation test SP - 140 EP - 142 JF - NMC case report journal VL - 2 IS - 4 N2 - The diagnosis of peroneal nerve (PN) entrapment neuropathy (PNEN) is based on clinical symptoms and nerve conduction studies. However, these studies do not always detect PNEN. Our 64-year-old patient suffered persistent left L5 numbness after two lumbar surgeries. Two years before admission to our institute his left leg pain gradually reappeared. When walking, his numbness in the left lower thigh to the dorsum of the foot increased. Electrophysiological testing revealed no conduction block on the PN. To identify the origin of his intermittent symptoms we performed loading of repetitive ankle plantar flexion in the at-rest posture to avoid the lumbar factor. We used this provocation test to check for PNEN because it occurs at a site where the PN passes the soleus- and the peroneus longus muscle (SM, PLM). The symptoms appeared reproducibly within 10 s of loading. PN neurolysis under local anesthesia showed that the PN was strongly compressed by the SM and PLM. This procedure eased his symptoms and he was able to walk without elicitation of numbness and pain upon repetitive ankle plantar flexion. In our case, repetitive plantar flexion elicited the symptoms and this provocation test may be useful to identify PN dynamic entrapment neuropathy as the origin of intermittent claudication. SN - 2188-4226 UR - https://www.unboundmedicine.com/medline/citation/28663985/Repetitive_Plantar_Flexion__Provocation__Test_for_the_Diagnosis_of_Intermittent_Claudication_due_to_Peroneal_Nerve_Entrapment_Neuropathy:_Case_Report_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28663985/ DB - PRIME DP - Unbound Medicine ER -
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