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Kim et al. Common diseases mimicking lumbar disc herniation

course on the bone, external compression neuropathy
is not infrequent. However, EN has been reported in
patients whose daily activities failed to account for its
elicitation. [48-50]

The symptoms are pain and paresthesia of the
affected area on the lateral aspect of the lower calf
and the dorsum of the foot. Drop foot is a severe
symptom, although some patients report only pain and
paresthesia without severe paresis. [48-52] Walking and
prolonged standing may lead to symptom exacerbation
and intermittent claudication.
Figure 6: The common peroneal nerve (arrow) runs around the
fibular head, then between the soleus and the peroneus longus Diagnosis and treatment
muscle (PLM) (*), and then into the PLM. Patients experience pain
and paresthesia of the affected area, the lateral aspect of the lower CPN-EN cannot be diagnosed radiologically. While
calf, and the dorsum of the foot (**) nerve conduction studies may be useful, the anomaly
may not be detectable in patients with dynamic
anterior lateral region of the thigh; they are elicited by neuropathy-like intermittent claudication. [48-51,53] In these
hip joint movement and alleviated by squatting. Some situations, it can be difficult to distinguish CPN-EN
patients complain of intermittent claudication. [38,41,42] from lumbar spine disease because the symptomatic
area is similar to L5 radiculopathy with intermittent
Diagnosis and treatment claudication. [48-50] CPN-EN diagnosis is based on
The symptoms above and Tinel-like signs at the clinical symptoms. Although the Tinel-like sign is useful
nerve penetration site inside the superior iliac spine diagnostic information, it may be absent. [51]
are diagnostically relevant. In some patients without
clear Tinel-like symptoms, the disappearance of Repetitive plantar flexion of the ankle joint is a useful
symptoms after nerve block is useful for a diagnosis. provocation test because the CPN is entrapped by
Electrophysiological studies can also be helpful. the PLM and soleus muscle; [48,49] these muscles are
Patients with symptoms clearly attributable to LFCN- most heavily loaded during maximum plantar flexion.
EN may report perception anomalies on the outside CPN-EN results in intermittent claudication. At a
of the thigh when the nerve is compressed in the cutoff of 110 s, sensitivity and specificity were 94.1%,
pelvis or in the presence of a retroperitoneal tumor. suggesting that the repetitive plantar flexion test is
Consequently, pelvic lesions must be ruled out when diagnostically useful. [48]
blocking fails to be effective.
When conservative treatment fails, surgical neurolysis
Conservative therapy and nerve block are effective in around the fibular head under local anesthesia is a
90% of patients. [42-44] Tagliafico et al. [42] reported that useful treatment. It is important to intraoperatively
80% of patients improved after a single block; others confirm sufficient decompression by ankle movement
required 2 blocks to decrease symptoms. The nerve because dynamic neuropathy is an important factor in
block is applied at the site with Tinel-like symptoms, CP-NEN etiology.
2 cm inside and 2 cm below the anterior superior iliac
spine. As the anesthetic infiltrates the femoral nerve Superficial peroneal nerve EN
running on the inside, approximately 5% of patients Definition and symptoms
experience transient femoral nerve paralysis. [43,45] CPN-EN is more common than superficial peroneal
Non-responders to conservative therapy may require nerve (SPN)-EN. The SPN bifurcates from the CPN
neurolysis or neurectomy under local anesthesia. [38,46,47]
around the fibular head and runs along the peroneal
Common peroneal nerve EN tunnel between the peroneus longus/brevis muscles
and the extensor digitorum longus muscle. The SPN
Definition and symptoms can be entrapped in this area.
Common peroneal nerve (CPN)-EN is the most
common peripheral entrapment neuropathy eliciting leg Patients with SPN entrapment report pain and
symptoms. The CPN runs around the fibular head and paresthesia in the affected area, the lateral aspect
then between the soleus and peroneus longus muscle of the lower calf, and the dorsum of the foot. Styf
(PLM) to the inner PLM [Figure 6]; it can become and Morbergfound SPN entrapment in 17 of 480
entrapped in this area. As the nerve runs a shallow (3.5%) patients with chronic leg pain. [54] According to
Mini-invasive Surgery ¦ Volume 1 ¦ June 30, 2017 47