Superficial Peroneal Nerve Release in the Lower Leg 5 Mackinnon SE1 Yee A1 October 9, 2016Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.Compression of the superficial peroneal nerve (SPN) is due to the superficial fascial layer that encapsulates the SPN and its distal entrapment point called the transverse crural ligament. These structures are typically the cause for numbness and pain in the territory of the SPN. Release of the SPN involves the longitudinal release of the superficial fascial layer and the transverse crural ligament. A lateral and anterior fasciotomy is also performed both longitudinally and transversely. Care is taken to look for two branches of the SPN and decompress both branches. This release is performed on patients that present with peroneal neuropathy that fail to resolve from conservative management and have symptoms that localize to the territory of the SPN. In this case, the patient presented with a complex history of neuropathic pain in the lower left leg following multiple knee surgeries over a span of many years. During examination, the patient was able to tolerate light touch related to compression-type injury rather than withdrawing from severe pain in keeping with a neurectomy-type injury; thus compression neuropathy and not neuroma injury was suspected. The scratch collapse test with ethyl chloride revealed provocation, first at the common peroneal nerve at the fibular head, then second at the saphenous nerve in the thigh, and then third at the SPN. Her surgical management included the release of these three nerves. This video outlines the surgical technique for releasing the SPN in the lower leg.Keywords: peroneal nervesuperficial peroneal nervecompression neuropathynerve decompression You must login to view the full article and extended video on this page. Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:20 - Incision00:00:28 - Superficial Dissection and Exposure00:00:42 - Identifying the Superficial Fascial Layer00:00:51 - Identifying the Superficial Peroneal Nerve Deep to the Fascial Layer00:01:24 - Identifying the Distal Border of the Transverse Crural Ligament00:01:32 - Reviewing the Cutaneous Branches of the Superficial Peroneal Nerve00:01:39 - Proximal Exposure of the Superficial Fascial Layer00:01:46 - Identifying the Anterior Fat Landmark in Relation to the Superficial Peroneal Nerve00:01:50 - Incising the Superficial Fascial Layer to the Fat Landmark00:02:00 - Incising the Superficial Fascial Layer to the Superficial Peroneal Nerve00:03:12 - Palpating Proximally and Release the Proximal Superficial Fascial Layer00:03:31 - Horizontal Release of the Superficial Fascial Layer00:04:10 - Release of the Distal Superficial Fascia Layer00:04:28 - Demonstrating the Rigidity of the Transverse Crural Ligament00:04:40 - Release of the Transverse Crural Ligament00:05:17 - Additional Horizontal Release of the Superficial Fascial Layer00:05:30 - Proximal Check for Compressive Fascia through Palpating and Releasing00:06:08 - Credits You must login to view the full article and extended video on this page. Leave a Comment Cancel replyYou must be logged in to post a comment.