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Chronic lower leg pain: entrapment of common peroneal nerve or tibial nerve

  • Aniek van Zantvoort
  • Maikel Setz
  • Adwin Hoogeveen
  • Percy van Eerten
  • Marc ScheltingaEmail author
Leitthema

Abstract

Young individuals with chronic exercise-induced lower leg pain (ELP) who have normal compartmental muscle pressures and normal imaging occasionally suffer from a nerve entrapment syndrome. These patients have consistently undergone a variety of diagnostic tests and often futile therapies prior to arriving at the correct diagnosis. Awareness among traumatologists regarding these nerve entities is low. A lower leg discomfort that is frequently present at night but worsens during exercise combined with altered foot skin sensations suggests an entrapment of the common peroneal or tibial nerve. If conservative therapies fail, neurolysis is advised.

Keywords

Compartment syndrome Nerve entrapment Exercise Nerve block Conservative treatment 

Chronischer Unterschenkelschmerz: Einklemmung des N. peronaeus communis oder des N. tibialis

Zusammenfassung

Junge Menschen mit chronischen belastungsabhängigen Unterschenkelschmerzen, bei denen normale Druckverhältnisse im Muskelkompartiment herrschen und ein unauffälliger Befund in der bildgebenden Diagnostik vorliegt, leiden gelegentlich an einem Nerveneinklemmungssyndrom. Bei diesen Patienten werden durchweg eine ganze Reihe diagnostischer Untersuchungen und oftmals vergebliche Therapien durchgeführt, bevor die richtige Diagnose gestellt wird. Traumatologen sind sich dieser Nervenerkrankungen nur in geringem Maße bewusst. Beschwerden im Unterschenkel, die häufig nachts auftreten und unter Belastung zunehmen, in Kombination mit Veränderungen der Empfindung in der Haut des Fußes sind Hinweise auf eine Einklemmung der N. peronaeus communis oder des N. tibialis. Bei Versagen konservativer Therapieansätze wird die Neurolyse empfohlen.

Schlüsselwörter

Kompartmentsyndrom Nerveneinklemmung Körperliche Belastung Nervenblockade Konservative Behandlung 

Notes

Compliance with ethical guidelines

Conflict of interest

A. van Zantvoort, M. Setz, A. Hoogeveen, P. van Eerten and M. Scheltinga declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

The supplement containing this article is not sponsored by industry.

References

  1. 1.
    Prukner P, Khan K (2016) Brukner & Khan’s Clinical Sports Medicine, 5th edn. McGraw-Hill, Australia, SydneyGoogle Scholar
  2. 2.
    Winkes M, van Zantvoort A, de Bruijn J, Smeets S, van der Cruijsen-Raaijmakers M, Hoogeveen A, Scheltinga M (2016) Fasciotomy for lower leg deep posterior compartment syndrome: A prospective study. Am J Sports Med 44(5):1309–1316CrossRefGoogle Scholar
  3. 3.
    de Bruijn JA, van Zantvoort APM, van Klaveren D, Winkes MB, van der Cruijsen-Raaijmakers M, Hoogeveen AR, Teijink JAW, Scheltinga MR (2018) Factors predicting lower leg chronic exertional compartment syndrome in a large population. Int J Sports Med 39(1):58–66CrossRefGoogle Scholar
  4. 4.
    van Zantvoort APM, Setz M, Hoogeveen AR, Scheltinga MR (2018) Common peroneal nerve entrapment in the differential diagnosis of chronic exertional compartment syndrome of the lateral lower leg: A report of 5 cases. Orthop J Sports Med 6(8):2325967118787761PubMedPubMedCentralGoogle Scholar
  5. 5.
    Mol FMU, Jansen CH, Dijk WV, Eerten PV, Scheltinga MR, Roumen RM (2019) Factors predicting outcome after anterior neurectomy in patients with chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome (ACNES). Surgery 165(2):417–422CrossRefGoogle Scholar
  6. 6.
    van Assen T, Brouns JA, Scheltinga MR, Roumen RM (2015) Incidence of abdominal pain due to the anterior cutaneous nerve entrapment syndrome in an emergency department. Scand J Trauma Resusc Emerg Med 23:19CrossRefGoogle Scholar
  7. 7.
    Williams EH, Rosson GD, Hagan RR, Hashemi SS, Dellon AL (2012) Soleal sling syndrome (proximal tibial nerve compression): results of surgical decompression. Plast Reconstr Surg 129(2):454–462CrossRefGoogle Scholar
  8. 8.
    Fabre T, Piton C, Andre D, Lasseur E, Durandeau A (1998) Peroneal nerve entrapment. J Bone Joint Surg Am 80(1):47–53CrossRefGoogle Scholar
  9. 9.
    Humphreys DB, Novak CB, Mackinnon SE (2007) Patient outcome after common peroneal nerve decompression. J Neurosurg 107(2):314–318CrossRefGoogle Scholar
  10. 10.
    Edwards PH Jr, Wright ML, Hartman JF (2005) A practical approach for the differential diagnosis of chronic leg pain in the athlete. Am J Sports Med 33(8):1241–1249CrossRefGoogle Scholar
  11. 11.
    van Zantvoort AP, Cuppen P, Scheltinga MR (2017) Management and patients perspective regarding a common peroneal nerve schwannoma: a rare cause of lower leg pain in a young individual. Bmj Case Rep 4:2017Google Scholar
  12. 12.
    Burrus MT, Werner BC, Starman JS, Gwathmey FW, Carson EW, Wilder RP, Diduch DR (2015) Chronic leg pain in athletes. Am J Sports Med 43(6):1538–1547CrossRefGoogle Scholar
  13. 13.
    Clanton TO, Solcher BW (1994) Chronic leg pain in the athlete. Clin Sports Med 13(4):743–759PubMedGoogle Scholar
  14. 14.
    Ladak A, Spinner RJ, Amrami KK, Howe BM (2013) MRI findings in patients with tibial nerve compression near the knee. Skelet Radiol 42(4):553–559CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Aniek van Zantvoort
    • 1
  • Maikel Setz
    • 1
  • Adwin Hoogeveen
    • 1
  • Percy van Eerten
    • 1
  • Marc Scheltinga
    • 1
    Email author
  1. 1.Departments of Surgery, Neurology and Sports MedicineMaxima Medical CenterVeldhovenThe Netherlands

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