Peroneal Nerve exploration and decompression surgical technique
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The common peroneal nerve is vulnerable to entrapment at the peroneal tunnel as it crosses the fibular neck. There are a number of local structures that may be contributing to compression of this nerve and this guide will demonstrate how to deal with each of these in turn. Extrinsic compression may also result from a lesion such as a ganglion. The nerve may also require exploration in this region following trauma about the knee, either direct trauma associated with fracture of the proximal fibula or indirect traction trauma associated with multiligamentous knee dislocation. The peroneal nerve is prone to injury due to the relative tethering of the deep peroneal nerve as it traverses the septum between lateral and anterior compartments of the lower leg.
Common peroneal nerve entrapment may result in weakness of the anterior or peroneal muscle groups or pain, parasthaesia and numbness in the cutaneous territories of the deep or superficial peroneal nerves.
Entrapment of this nerve may have a variety of causes including local trauma or surgery around the knee. In our experience a great many cases result from a nerve that is recovering from a previous peroneal or sciatic level injury and undergoes ‘auto-entrapment’ in this narrow region, as it increases in volume during the recovery phase.
Releasing the nerve in these cases can be rewarding. An immediate improvement in function is occasionally seen, but in more significant lesions to the nerve that may involve demyelination or axonopathy a longer time course for recovery should be expected. For a non-recovering nerve lesion, consideration must be given to reconstructive procedures such as tendon or nerve transfers.
Tahseen Chaudhry, Consultant hand and peripheral nerve surgeon
Peripheral Nerve Unit, Birmingham hand centre, Queen Elizabeth Hospital Birmingham
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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