Italian multicentre study of peroneal mononeuropathy at the fibular head: study design and preliminary results

  • Irene AprileEmail author
  • P. Caliandro
  • F. Giannini
  • M. Mondelli
  • P. Tonali
  • M. Foschini
  • L. Padual
  • Italian CTS and other entrapments Study Group
Part of the Acta Neurochirurgica book series (NEUROCHIRURGICA, volume 97)


Background. The most common entrapment in the lower extremity is peroneal mononeuropathy (PM) at the fibular head. Several studies of this condition have been published but, until now, no wide multicenter clinical-neurophysiological studies on PM are available. In recent years, multicenter studies have been suggested; moreover it is commonly accepted that a multiperspective approach provides more comprehensive results.

Method. The Italian CTS and other entrapments Study Group has designed a strict clinical and neurophysiological protocol to carry out a wide multicentre study on PM at the fibular head. In addition to traditional clinical-neurophysiological evaluation, the group has also adopted validated disability and patient-oriented measurements in order to obtain more comprehensive and reliable data about this entrapment. The study was designed: 1) to identify predisposing factors; 2) to better assess the clinical picture; 3) to evaluate relationships between etiological, clinical and neurophysiological findings; 4) to evaluate the natural evolution of the entrapment. Study design is described.

Findings. During the period from November 2002 to January 2004, 69 patients were enrolled consecutively in eleven Italian centres. Our preliminary data show that PM involves men more frequently than women (M:F = 3.9:1). With regard to the predisposing factors, PM is idiopathic (16%) or due to surgery (21.7%), prolonged posture (23.2%), weight loss (14.5%), external compres- sion (5.8%), arthrogenic cyst at the fibula (1.40%o), trauma (10.1%); it also occurred in bedridden patients (7.3%). Unexpectedly, peroneal nerve lesions were due not only to surgical operation close to the peroneal region, but were also associated with thoracic-abdominal surgery. Usually PM involves both terminal branches; patients complain of motor deficit in 99.5% of cases, sensory symptoms in 87.9% and pain in 19.7%.

Conclusions. Our preliminary results provide some interesting information and confirm the usefulness of multicentre and multiper-spective studies to standardise the approach to nerve entrapment.


Peroneal mononeuropathy multicentre study predisposing factor patient-oriented neurophysiology group 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    AAOS, Committee on Outcomes Studies (1995) Instrument development: overview and general health measures. Outcomes and effectiveness in Musculoskeletal research and practice. San DiegoGoogle Scholar
  2. 2.
    Apolone G, Mosconi P, Ware JE (1997) Questionario sullo stato di salute SF-36. Milano, Guerini e associateGoogle Scholar
  3. 3.
    April I, Padua L, Padua R, D’Amico P, Meloni A, Caliandro P, Pauri F, Tonali P (2000) Peroneal mononeuropathy: predisposing factors, and clinical and neurophysiological relationships. Neurol Sci 21(6): 367–371CrossRefPubMedGoogle Scholar
  4. 4.
    April I, Padua L, Caliandro P, Pazzaglia C, Tonali P (2003) Peroneal nerve palsy caused by thrombosis of crural veins. Neurology 13;60(9): 1559–1560Google Scholar
  5. 5.
    Aulisa L, Tamburelli F, Padua R, Lupparelli S, Tonali P, Padua L (1998) Intraneural cyst of the peroneal nerve: clinical and neurophysiological follow-up in one atypical case. Child’s Nerv Syst 14: 222–225Google Scholar
  6. 6.
    Barker A, Powell RA (1997) Guidelines exist on ownership of data and authorship in multicentre collaboration. BMJ Vol 314: 10–46PubMedGoogle Scholar
  7. 7.
    Bendszus M, Koltzenburg M (2002) Footdrop after peroneal nerve lesion. J Neurol Neurosurg Psychiatry 72(1): 42PubMedGoogle Scholar
  8. 8.
    Bendszus M, Reiners K, Perez J, Solymosi L, Koltzenburg M (2002) Peroneal nerve palsy caused by thrombosis of crural veins. Neurology 11;58(11): 1675–1677PubMedGoogle Scholar
  9. 9.
    Dillavou ED, Anderson LR, Bernet RA, Mularski RA, Hunter GC, Fiser SM, Rappaport WD (1997) Lower extremity iatrogenic nerve injury due to compression during intraabdominal surgery. Am J Surg 173: 504–508PubMedGoogle Scholar
  10. 10.
    Edwards BN, Tullo HS, Noble PC (1987) Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthopaedics Related Res 136–141Google Scholar
  11. 11.
    Esselman PC, Tomski MA, Robinson LR, Zisfein J, Marks S (1993) Selective Deep Peroneal Nerve Injury Associated with Arthroscopic Knee Surgery. Muscle Ner 16: 1188–1192Google Scholar
  12. 12.
    Katirji BM, Wilbourn AJ (1988) Common Peroneal Mononeuropathy. A clinical and electrophysiologic study of 116 lesions. Neurology 38: 1723–1728PubMedGoogle Scholar
  13. 13.
    Katirji B (1999) Peroneal neuropathy. Neurol Clin 17: 567–591PubMedGoogle Scholar
  14. 14.
    Korner-Bitensky N, Mayo N, Cabot R, Becker R, Coopersmith H (1989) Motor and functional recovery after stroke: accuracy of physical therapists’ predictions. Arch Phys Med Rehab 70: 95–99Google Scholar
  15. 15.
    Levi N (1998) Is preoperative tibial traction responsible for peroneal nerve palsy in patients with a fractured hip? Acta Ortho-paedica Belgica 64: 273–275Google Scholar
  16. 16.
    Marshall FJ, Kieburtz K, McDermott M, Kurlan R, Shoulson I (1996) Clinical research in neurology. From Observation to Experimentation. Neurol Clin 14(2): 451–466PubMedGoogle Scholar
  17. 17.
    Padua L, Padua R, Lo Monaco M, Aprile I, Tonali P (1999) Multiperspective assessment of carpal tunnel syndrome: a multicenter study. Italian CTS Study Group. Neurology 10;53(8): 1654–1659PubMedGoogle Scholar
  18. 18.
    Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P; Italian CTS Study Group (2001) Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology 12;56(11): 1459–1466PubMedGoogle Scholar
  19. 19.
    Padua R, Padua L, Ceccarelli E, Romanini E, Bondi R, Zanoli G, Campi A (2001) Cross-cultural adaptation of the lumbar North American Spine Society questionnaire for Italian-speaking patients with lumbar spinal disease. Spine 1;26(15): E344–347PubMedGoogle Scholar
  20. 20.
    Resende LAL, Silva MD, Kimaid PAT, Schiavao V, Zanini MA, Faleiros AT (1997) Compression of the peripheral branches of the sciatic nerve by lipoma. Electromyogr Clin Neurophysiol 37: 251–255PubMedGoogle Scholar
  21. 21.
    Rodeo SA, Sobel M, Weiland AJ (1993) Deep Peroneal-Nerve Injury as a Result of Arthroscopic Meniscectomy. J Bone Joint Surg 75-A: 1221–1224Google Scholar
  22. 22.
    Schmalzried TP, Amustutz C, Dorey F (1991) Nerve palsy associated with total hip replacement. J Bone Joint Surg 73-A: 1074–1080Google Scholar
  23. 23.
    Sourkes M, Stewart JD (1991) Common peroneal neuropathy: a study of selective motor and sensory involvement. Neurology 41(7): 1029–1033PubMedGoogle Scholar
  24. 24.
    Ware JE, Sherborn CD (1992) The MOS 36-item short form health survey (SF-36) (1992) I. Conceptual framework and item selection. Med Care 30: 473–483PubMedGoogle Scholar
  25. 25.
    Ware JE (1994) SF-36 Physical and mental health summary scales: a user’s manual. New England Medical Centre, BostonGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Irene Aprile
    • 1
    • 2
    Email author
  • P. Caliandro
    • 1
  • F. Giannini
    • 3
  • M. Mondelli
    • 4
  • P. Tonali
    • 1
  • M. Foschini
    • 1
  • L. Padual
    • 1
    • 2
  • Italian CTS and other entrapments Study Group
  1. 1.Department of Neuroscience, Institute of NeurologyUniversità CattolicaRomaItaly
  2. 2.Fondazione Don C. GnocchiRomaItaly
  3. 3.Department of NeurosciencesUniversity of SienaSienaItaly
  4. 4.EMG Service ASL 7SienaItaly

Personalised recommendations