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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: Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.The purpose of this article is to review the normal anatomy and pathologic conditions of the peroneal nerve around the knee.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

Normal anatomy of the peroneal nerve at the level of the posterolateral corner of the right knee. Schematic drawing of a sagittal (a) and coronal (b) view with corresponding axial T1-WI of a right knee; the levels are indicated by the transparent boxes. On the schematic drawing the nerve is seen branching off the sciatic nerve, turning around the biceps femoris muscle (BF), passing through the peroneal tunnel between the insertion of the peroneus longus muscle (PL) and the fibula. As it exits the tunnel, it trifurcates in a deep (D) and superficial peroneal nerve (S) and a recurrent or articular branch (A). The articular branch is the entrance port for intraneural ganglia originating from the proximal tibiofibular joint (see the section on intraneural ganglia). Axial T1-WI at the level of the distal femur (c) shows the common peroneal nerve (white arrow) and the tibial nerve (black arrow) as they branch off the sciatic nerve. Note the intimate relationship of the common peroneal nerve with the medial side of the biceps femoris muscle (B). Axial T1-WI at the level of the femoral condyles (d) shows the common peroneal nerve (white arrow) between the short head of the biceps femoris (B) and the lateral head of the gastrocnemius muscle (G), a site of possible entrapment in case of variant course of the short head of the biceps femoris. The fascicles of the deep and superficial peroneal nerve can sometimes be discerned from this level on, the former more anteriorly, the latter more posteriorly, corresponding to the location of the anterior and lateral compartment of the lower leg. Axial T1-WI at the level of the fibular head (e). The common peroneal nerve (white arrow) is found posteriorly and can be traced by the fat around it. The peroneus longus (*) and anterior tibial muscle (**) are already seen at the most proximal parts of the lateral and anterior compartments. Axial T1-WI at the level just below the fibular neck (f) shows the superficial and deep peroneal nerve (white arrow). Because of their more horizontal course at this level, they are more difficult to discern from each other. At the 12 o’clock position the articular branch can be visualised as a small black dot surrounded by hyperintense fat (arrowhead). a adapted with permission from ref [50]. b adapted with permission from ref [10]
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Fig1: Normal anatomy of the peroneal nerve at the level of the posterolateral corner of the right knee. Schematic drawing of a sagittal (a) and coronal (b) view with corresponding axial T1-WI of a right knee; the levels are indicated by the transparent boxes. On the schematic drawing the nerve is seen branching off the sciatic nerve, turning around the biceps femoris muscle (BF), passing through the peroneal tunnel between the insertion of the peroneus longus muscle (PL) and the fibula. As it exits the tunnel, it trifurcates in a deep (D) and superficial peroneal nerve (S) and a recurrent or articular branch (A). The articular branch is the entrance port for intraneural ganglia originating from the proximal tibiofibular joint (see the section on intraneural ganglia). Axial T1-WI at the level of the distal femur (c) shows the common peroneal nerve (white arrow) and the tibial nerve (black arrow) as they branch off the sciatic nerve. Note the intimate relationship of the common peroneal nerve with the medial side of the biceps femoris muscle (B). Axial T1-WI at the level of the femoral condyles (d) shows the common peroneal nerve (white arrow) between the short head of the biceps femoris (B) and the lateral head of the gastrocnemius muscle (G), a site of possible entrapment in case of variant course of the short head of the biceps femoris. The fascicles of the deep and superficial peroneal nerve can sometimes be discerned from this level on, the former more anteriorly, the latter more posteriorly, corresponding to the location of the anterior and lateral compartment of the lower leg. Axial T1-WI at the level of the fibular head (e). The common peroneal nerve (white arrow) is found posteriorly and can be traced by the fat around it. The peroneus longus (*) and anterior tibial muscle (**) are already seen at the most proximal parts of the lateral and anterior compartments. Axial T1-WI at the level just below the fibular neck (f) shows the superficial and deep peroneal nerve (white arrow). Because of their more horizontal course at this level, they are more difficult to discern from each other. At the 12 o’clock position the articular branch can be visualised as a small black dot surrounded by hyperintense fat (arrowhead). a adapted with permission from ref [50]. b adapted with permission from ref [10]

Mentions: The common peroneal nerve is the lateral division of the sciatic nerve. It courses from the posterolateral side of the knee around the biceps femoris tendon and the fibular head to the anterolateral side of the lower leg. Its relationship to the most important landmarks is illustrated on Fig. 1. On MRI the peroneal nerve and its branches can most easily be identified on axial T1-WI as small bundles of fascicles cushioned in surrounding fatty tissue (Fig. 1c, d, e and f).Fig. 1


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)

Normal anatomy of the peroneal nerve at the level of the posterolateral corner of the right knee. Schematic drawing of a sagittal (a) and coronal (b) view with corresponding axial T1-WI of a right knee; the levels are indicated by the transparent boxes. On the schematic drawing the nerve is seen branching off the sciatic nerve, turning around the biceps femoris muscle (BF), passing through the peroneal tunnel between the insertion of the peroneus longus muscle (PL) and the fibula. As it exits the tunnel, it trifurcates in a deep (D) and superficial peroneal nerve (S) and a recurrent or articular branch (A). The articular branch is the entrance port for intraneural ganglia originating from the proximal tibiofibular joint (see the section on intraneural ganglia). Axial T1-WI at the level of the distal femur (c) shows the common peroneal nerve (white arrow) and the tibial nerve (black arrow) as they branch off the sciatic nerve. Note the intimate relationship of the common peroneal nerve with the medial side of the biceps femoris muscle (B). Axial T1-WI at the level of the femoral condyles (d) shows the common peroneal nerve (white arrow) between the short head of the biceps femoris (B) and the lateral head of the gastrocnemius muscle (G), a site of possible entrapment in case of variant course of the short head of the biceps femoris. The fascicles of the deep and superficial peroneal nerve can sometimes be discerned from this level on, the former more anteriorly, the latter more posteriorly, corresponding to the location of the anterior and lateral compartment of the lower leg. Axial T1-WI at the level of the fibular head (e). The common peroneal nerve (white arrow) is found posteriorly and can be traced by the fat around it. The peroneus longus (*) and anterior tibial muscle (**) are already seen at the most proximal parts of the lateral and anterior compartments. Axial T1-WI at the level just below the fibular neck (f) shows the superficial and deep peroneal nerve (white arrow). Because of their more horizontal course at this level, they are more difficult to discern from each other. At the 12 o’clock position the articular branch can be visualised as a small black dot surrounded by hyperintense fat (arrowhead). a adapted with permission from ref [50]. b adapted with permission from ref [10]
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Related In: Results  -  Collection

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Fig1: Normal anatomy of the peroneal nerve at the level of the posterolateral corner of the right knee. Schematic drawing of a sagittal (a) and coronal (b) view with corresponding axial T1-WI of a right knee; the levels are indicated by the transparent boxes. On the schematic drawing the nerve is seen branching off the sciatic nerve, turning around the biceps femoris muscle (BF), passing through the peroneal tunnel between the insertion of the peroneus longus muscle (PL) and the fibula. As it exits the tunnel, it trifurcates in a deep (D) and superficial peroneal nerve (S) and a recurrent or articular branch (A). The articular branch is the entrance port for intraneural ganglia originating from the proximal tibiofibular joint (see the section on intraneural ganglia). Axial T1-WI at the level of the distal femur (c) shows the common peroneal nerve (white arrow) and the tibial nerve (black arrow) as they branch off the sciatic nerve. Note the intimate relationship of the common peroneal nerve with the medial side of the biceps femoris muscle (B). Axial T1-WI at the level of the femoral condyles (d) shows the common peroneal nerve (white arrow) between the short head of the biceps femoris (B) and the lateral head of the gastrocnemius muscle (G), a site of possible entrapment in case of variant course of the short head of the biceps femoris. The fascicles of the deep and superficial peroneal nerve can sometimes be discerned from this level on, the former more anteriorly, the latter more posteriorly, corresponding to the location of the anterior and lateral compartment of the lower leg. Axial T1-WI at the level of the fibular head (e). The common peroneal nerve (white arrow) is found posteriorly and can be traced by the fat around it. The peroneus longus (*) and anterior tibial muscle (**) are already seen at the most proximal parts of the lateral and anterior compartments. Axial T1-WI at the level just below the fibular neck (f) shows the superficial and deep peroneal nerve (white arrow). Because of their more horizontal course at this level, they are more difficult to discern from each other. At the 12 o’clock position the articular branch can be visualised as a small black dot surrounded by hyperintense fat (arrowhead). a adapted with permission from ref [50]. b adapted with permission from ref [10]
Mentions: The common peroneal nerve is the lateral division of the sciatic nerve. It courses from the posterolateral side of the knee around the biceps femoris tendon and the fibular head to the anterolateral side of the lower leg. Its relationship to the most important landmarks is illustrated on Fig. 1. On MRI the peroneal nerve and its branches can most easily be identified on axial T1-WI as small bundles of fascicles cushioned in surrounding fatty tissue (Fig. 1c, d, e and f).Fig. 1

Bottom Line: Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.The purpose of this article is to review the normal anatomy and pathologic conditions of the peroneal nerve around the knee.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