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Peroneal nerve: Normal anatomy and pathologic findings on routine MRI of the knee.

Van den Bergh FR, Vanhoenacker FM, De Smet E, Huysse W, Verstraete KL - Insights Imaging (2013)

Bottom Line: On a routine MR examination without dedicated MR-neurography sequences the peroneal nerve can readily be assessed.Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.In the second part we discuss the different pathologic conditions: accidental and surgical trauma, and intraneural and extraneural compressive lesions. • Six anatomical features contribute to the vulnerability of the peroneal nerve around the knee. • MR signs of muscle denervation within the anterior compartment are important secondary signs for evaluation of the peroneal nerve. • The most common lesions of the peroneal nerve are traumatic or compressive. • Intraneural ganglia originate from the proximal tibiofibular joint. • Axial T1-weighted images are the best sequence to visualise the peroneal nerve on routine MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, AZ Sint-Maarten Duffel-Mechelen, campus Duffel, Rooienberg 25, 2570, Duffel, Belgium.

ABSTRACT

Background: Peroneal nerve lesions are not common and are often exclusively assessed clinically and electromyographically.

Methods: On a routine MR examination without dedicated MR-neurography sequences the peroneal nerve can readily be assessed. Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.

Results: The purpose of this article is to review the normal anatomy and pathologic conditions of the peroneal nerve around the knee.

Conclusion: In the first part the variable anatomy of the peroneal nerve around the knee will be emphasized, followed by a discussion of the clinical findings of peroneal neuropathy and general MR signs of denervation. Six anatomical features may predispose to peroneal neuropathy: paucity of epineural tissue, biceps femoris tunnel, bifurcation level, superficial course around the fibula, fibular tunnel and finally the additional nerve branches. In the second part we discuss the different pathologic conditions: accidental and surgical trauma, and intraneural and extraneural compressive lesions.

Teaching points: • Six anatomical features contribute to the vulnerability of the peroneal nerve around the knee. • MR signs of muscle denervation within the anterior compartment are important secondary signs for evaluation of the peroneal nerve. • The most common lesions of the peroneal nerve are traumatic or compressive. • Intraneural ganglia originate from the proximal tibiofibular joint. • Axial T1-weighted images are the best sequence to visualise the peroneal nerve on routine MRI.

No MeSH data available.


Related in: MedlinePlus

Neuroma. Schematic drawing (a) showing the two types of nerve damage. A normal nerve (1 and 4) is surrounded by a nerve sheath on both sides. A complete disruption of the nerve (2) results in disorganised sprouting of nerve fascicles and fibrous tissue (3). This creates a ‘ballon-on-a-string’ or ‘green-onion’ image, typical of a terminal (posttraumatic) neuroma. Wallerian degeneration occurs distally in the nerve. A partial laceration of the nerve (5) causes focal regeneration with hypertrophy of the nerve fascicles and fibrosis. This creates a focal asymmetrical thickening on imaging (6). Sagittal T2-WI image (b) shows a hypointense terminal neuroma (black arrow) after accidental surgical transection of the peroneal nerve. Note also associated hypointense strands of scar tissue (white arrowhead) in the adjacent subcutaneous fat
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Fig10: Neuroma. Schematic drawing (a) showing the two types of nerve damage. A normal nerve (1 and 4) is surrounded by a nerve sheath on both sides. A complete disruption of the nerve (2) results in disorganised sprouting of nerve fascicles and fibrous tissue (3). This creates a ‘ballon-on-a-string’ or ‘green-onion’ image, typical of a terminal (posttraumatic) neuroma. Wallerian degeneration occurs distally in the nerve. A partial laceration of the nerve (5) causes focal regeneration with hypertrophy of the nerve fascicles and fibrosis. This creates a focal asymmetrical thickening on imaging (6). Sagittal T2-WI image (b) shows a hypointense terminal neuroma (black arrow) after accidental surgical transection of the peroneal nerve. Note also associated hypointense strands of scar tissue (white arrowhead) in the adjacent subcutaneous fat

Mentions: Penetrating wounds can result in a complete or partial disruption of the nerve fascicles. If the nerve sheath is disrupted and the fascicles are separated, the regenerating nerve fascicles and Schwann cells will sprout randomly, creating a terminal ‘neuroma’ or stump neuroma [18]. Spindle or lateral neuromas occur when the nerve sheath is partially or fully intact [22]. They occur distally from the damaged nerve ending and represent a local response to the trauma with fusiform or lateral thickening (Fig. 10).Fig. 10


Peroneal nerve: Normal anatomy and pathologic findings on routine MRI of the knee.

Van den Bergh FR, Vanhoenacker FM, De Smet E, Huysse W, Verstraete KL - Insights Imaging (2013)

Neuroma. Schematic drawing (a) showing the two types of nerve damage. A normal nerve (1 and 4) is surrounded by a nerve sheath on both sides. A complete disruption of the nerve (2) results in disorganised sprouting of nerve fascicles and fibrous tissue (3). This creates a ‘ballon-on-a-string’ or ‘green-onion’ image, typical of a terminal (posttraumatic) neuroma. Wallerian degeneration occurs distally in the nerve. A partial laceration of the nerve (5) causes focal regeneration with hypertrophy of the nerve fascicles and fibrosis. This creates a focal asymmetrical thickening on imaging (6). Sagittal T2-WI image (b) shows a hypointense terminal neuroma (black arrow) after accidental surgical transection of the peroneal nerve. Note also associated hypointense strands of scar tissue (white arrowhead) in the adjacent subcutaneous fat
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3675257&req=5

Fig10: Neuroma. Schematic drawing (a) showing the two types of nerve damage. A normal nerve (1 and 4) is surrounded by a nerve sheath on both sides. A complete disruption of the nerve (2) results in disorganised sprouting of nerve fascicles and fibrous tissue (3). This creates a ‘ballon-on-a-string’ or ‘green-onion’ image, typical of a terminal (posttraumatic) neuroma. Wallerian degeneration occurs distally in the nerve. A partial laceration of the nerve (5) causes focal regeneration with hypertrophy of the nerve fascicles and fibrosis. This creates a focal asymmetrical thickening on imaging (6). Sagittal T2-WI image (b) shows a hypointense terminal neuroma (black arrow) after accidental surgical transection of the peroneal nerve. Note also associated hypointense strands of scar tissue (white arrowhead) in the adjacent subcutaneous fat
Mentions: Penetrating wounds can result in a complete or partial disruption of the nerve fascicles. If the nerve sheath is disrupted and the fascicles are separated, the regenerating nerve fascicles and Schwann cells will sprout randomly, creating a terminal ‘neuroma’ or stump neuroma [18]. Spindle or lateral neuromas occur when the nerve sheath is partially or fully intact [22]. They occur distally from the damaged nerve ending and represent a local response to the trauma with fusiform or lateral thickening (Fig. 10).Fig. 10

Bottom Line: On a routine MR examination without dedicated MR-neurography sequences the peroneal nerve can readily be assessed.Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.In the second part we discuss the different pathologic conditions: accidental and surgical trauma, and intraneural and extraneural compressive lesions. • Six anatomical features contribute to the vulnerability of the peroneal nerve around the knee. • MR signs of muscle denervation within the anterior compartment are important secondary signs for evaluation of the peroneal nerve. • The most common lesions of the peroneal nerve are traumatic or compressive. • Intraneural ganglia originate from the proximal tibiofibular joint. • Axial T1-weighted images are the best sequence to visualise the peroneal nerve on routine MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, AZ Sint-Maarten Duffel-Mechelen, campus Duffel, Rooienberg 25, 2570, Duffel, Belgium.

ABSTRACT

Background: Peroneal nerve lesions are not common and are often exclusively assessed clinically and electromyographically.

Methods: On a routine MR examination without dedicated MR-neurography sequences the peroneal nerve can readily be assessed. Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.

Results: The purpose of this article is to review the normal anatomy and pathologic conditions of the peroneal nerve around the knee.

Conclusion: In the first part the variable anatomy of the peroneal nerve around the knee will be emphasized, followed by a discussion of the clinical findings of peroneal neuropathy and general MR signs of denervation. Six anatomical features may predispose to peroneal neuropathy: paucity of epineural tissue, biceps femoris tunnel, bifurcation level, superficial course around the fibula, fibular tunnel and finally the additional nerve branches. In the second part we discuss the different pathologic conditions: accidental and surgical trauma, and intraneural and extraneural compressive lesions.

Teaching points: • Six anatomical features contribute to the vulnerability of the peroneal nerve around the knee. • MR signs of muscle denervation within the anterior compartment are important secondary signs for evaluation of the peroneal nerve. • The most common lesions of the peroneal nerve are traumatic or compressive. • Intraneural ganglia originate from the proximal tibiofibular joint. • Axial T1-weighted images are the best sequence to visualise the peroneal nerve on routine MRI.

No MeSH data available.


Related in: MedlinePlus