Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, e835ee836

CASE REPORT

Common peroneal nerve injury during a straight legraising test, the result of an intraneural ganglion

Jiaan Zhu*, Yeqing Jiang, Yizhou Hu, Chunyan Xing

Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai 200233, China

Received 24 March 2010; accepted 20 July 2010

KEYWORDSCommon peronealnerve;Ultrasonography;Straight-leg raising test

* Corresponding author. Tel.: þ8654488254.

E-mail address: zhuja@sjtu.edu.cn

1748-6815/$-seefrontmatterª2010Bridoi:10.1016/j.bjps.2010.07.019

Summary We report a case of iatrogenic common peroneal nerve (CPN) injury duringa straight-leg raising test. Significant swelling in the CPN was observed on ultrasound, mostlikely due to the loss of the normal fascicular pattern. A postoperative pathological diagnosisindicated a sheath ganglion and high degree of mucinous degeneration of the CPN. A follow-up3 months after the operation showed marked improvement in the patient’s symptoms, corrob-orated by an electromyogram.ª 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published byElsevier Ltd. All rights reserved.

Case report

A 57-year-old male patient presented to us with leg pain.He had no previous injury and no significant medical historyother than a previous clinical diagnosis of a prolapsedintervertebral disc. As soon as the straight-leg raiseexamination was performed, he immediately felt greatpain on his left leg. A week later, the pain subsided but hefelt some numbness in his right leg. At this point, he visitedour clinic. An electromyogram (EMG) was used to evaluatethe possible common peroneal nerve (CPN) injury andshowed polyphasic waves and a decreased nerve conduc-tion velocity. Ultrasound examination through the left

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(J. Zhu).

tishAssociationofPlastic,Reconstruc

fossa poplitea revealed significant swelling of the CPN,indicating a loss of the normal fascicular pattern (Figure 1).During the surgery, the left CPN was found to be enlargedwith tremelloid material in the neurilemma for 12 cm. Thetremelloid material was cleared and neurolysis was carriedout. A pathological diagnosis indicated a sheath ganglionand a high degree of mucinous degeneration of the leftCPN.

A follow-up 3 months after the operation showedmarked improvement in the patient’s EMG and symptoms.

Discussion

The most frequent cause of iatrogenic nerve injury is usuallythe interruption of nerve continuity during surgery or othermedical procedures.1 Although the straight-leg raising testcausingCPN injury is extremely rare, therewouldbeacertainrisk of damage in such test. Ultrasonography can show

tiveandAestheticSurgeons.PublishedbyElsevierLtd.All rightsreserved.

Figure 1 A longitudinal sonogram of common peroneal nervewith loss of normal fascicular pattern.

e836 J. Zhu et al.

fascicular bundles, epineurium and perineurium, so it isa useful and effective tool for assessing peripheral nerveinjuries.2 For iatrogenic nerve injury, as described in thiscase, ultrasonography may be helpful in revealing themorphological features, which may in turn be useful fora clinical diagnosis.

Conflict of interest statement

None Declared.

Funding

None.

Acknowledgements

Many thanks are given to Mr. Robert Yu and Charita Scott fortheir help in revising the linguistic construction of thismanuscript.

References

1. Murovic JA. Lower-extremity peripheral nerve injuries: a Loui-siana State University Health Sciences Center literature reviewwith comparison of the operative outcomes of 806 LouisianaState University Health Sciences Center sciatic, common pero-neal, and tibial nerve lesions. Neurosurgery 2009;65:A18e23.

2. Bianchi S. Ultrasound of the peripheral nerves. Joint Bone Spine2008;75:643e9.