Common Peroneal Nerve Release at the Fibular Head 7 Mackinnon SE1 Yee A1 November 3, 2016Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.Entrapment of the common peroneal nerve (CPN) at the fibular head is an under-recognized lower extremity neuropathy that contributes to weakness of the musculature within the anterior and lateral compartments of the leg and progress to foot drop. As well, there can be numbness/pain within the territory of the superficial and deep peroneal nerve. Compression of the CPN can be attributed primarily to the posterior crural intermuscular septum found deep to the leading-edge of the peroneus longus. The anterior crural intermuscular septum and a third intermuscular septum are also associated with this compression neuropathy, as well as the surrounding fascia layer that entraps the CPN on top of the deep tendinous fascia. These structures are released to decompress the CPN at the fibular head. Motor branches from the CPN have been seen to pierce these intermuscular septums. 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 CPN at the fibular head, then second at the saphenous nerve in the thigh, and then third at the superficial peroneal nerve. Her surgical management included the release of these three nerves. This video outlines the surgical technique for releasing the CPN at the fibular head. The lateral sural cutaneous nerve was not evident in this case.Keywords: peroneal nervefoot dropcompression neuropathynerve decompressioncrural intermuscular septumscommon peroneal nerve 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 - Incision00:00:32 - Exposure and Superficial Dissection00:00:47 - Identifying and Exposing the Superficial Fascial Layer00:01:19 - Palpating the Common Peroneal Nerve and Leading-edge of the Peroneus Longus00:01:32 - Dividing the Superficial Fascial Layer to Expose the Common Peroneal Nerve00:02:02 - Identifying the Common Peroneal Nerve00:02:50 - Incising the Superficial Fascia to Reveal the Muscular and Tendinous Layers00:03:20 - Exposing the Posterior Crural Intermuscular Septum00:03:55 - Dividing the Posterior Crural Intermuscular Septum00:04:03 - Exposing and Dividing the Tendinous Fascia Posterior to the Common Peroneal Nerve00:04:53 - Exposing the Anterior Crural Intermuscular Septum00:05:03 - Dividing the Anterior Crural Intermuscular Septum00:05:09 - Additional Division the Posterior Crural Intermuscular Septum00:05:27 - Exposing the Intermuscular Septum (Most Anterior)00:05:38 - Dividing the Intermuscular Septum (Most Anterior)00:06:24 - Proximal Release of the Common Peroneal Nerve00:06:56 - Making a Trough in the Soleus Muscle Posterior to the Common Peroneal Nerve00:07:19 - 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.