Peroneal neuropathy

Vs

Sciatic neuropathy
Piriformis Syndrome
• Hypertrophied piriformis muscle could compress the sciatic nerve.
Criteria for definite piriformis syndrome
• (1) sciatic neuropathy clinically,
• (2) electrophysiologic evidence of sciatic neuropathy,
• (3) surgical exploration showing entrapment of the sciatic nerve
within a hypertrophied piriformis muscle, and
• (4) subsequent improvement following surgical decompression.
• Patient has more pain while sitting than standing; worsening of symptoms with flexion,
adduction, and internal rotation of the hip.

• history of trauma or unusual body habitus (especially very thin); and tenderness in the
mid-buttock that reproduces the pain and paresthesias.

• The FAIR (flexion, adduction, internal rotation) maneuver: with the patient lying supine,
the examiner passively flexes, adducts, and internally rotates the hip, stretching the
piriformis muscle
• standard nerve conduction studies and needle EMG are normal

• The one electrophysiologic test proposed to be of value is a modification of the H

reflex.

• In piriformis syndrome, the H reflex is reported to be prolonged when performed

with the hip in flexion, adduction, and internal rotation (FAIR test) compared to
the normal anatomic position
Normal
• The EDB muscle usually is chosen as the recording site for peroneal motor studies.

• However, in patients with a foot drop, it is weakness of the TA that accounts for the clinical
deficit.

• Hence, recording the TA when performing the peroneal motor study often is more useful than the
routine motor study recording the EDB
• PNFN is typically diagnosed on NCS by showing conduction block across the knee.

• A conduction block at the knee is recognized by a significant drop in amplitude and area between
the fibular neck and lateral popliteal stimulation sites.
• An APN is recognized on routine peroneal motor studies as a significant increase in amplitude and
area at the fibular neck and lateral popliteal stimulation sites.

• peroneal neuropathy at the fibular neck (PNFN) and an APN - low-amplitude motor response
stimulating at the ankle, a higher response stimulating at the fibular neck, and then a lower
response again stimulating at the lateral popliteal fossa.

• to check for an APN—one simply stimulates posterior to the lateral malleolus while recording the
EDB muscle.

• There is a small deflection if APN is present

discussion
• Clinical differentiation of sciatic neuropathy mimicking peroneal
neuropathy-
• ankle jerk – absent; sensation of sole of foot – affected
• If L5 S1 radiculopathy clinically – but hip abduction is weak; perform
imaging of sciatic nerve separately.
• Neurosonogram – indicated in progressive mononeuropathy