Superficial Peroneal Nerve Anatomy - Everything You Need To Know - Dr. Nabil Ebraheimby nabil ebraheim 6 years ago
Dr. Ebraheim’s educational animated video describes the anatomy of the superficial peroneal nerve in a very easy and simple animation.
The common peroneal nerve is a branch of the sciatic nerve that travels posterior to the tendon of the biceps femoris and it passes across the neck of the fibula, piercing the peroneus longus muscle and then dividing into the deep and superficial peroneal nerves. The deep peroneal nerve pierces the intermuscular septum and supplies the muscles of the anterior compartment of the leg. The deep peroneal nerve gives a sensory branch to the web space between the first and second toes. The web space is not supplied by the superficial peroneal nerve.
The superficial peroneal nerve supplied the lateral compartment of the leg. The superficial peroneal nerve is sometimes called subcutaneous because some parts of the nerve go through muscle and some parts are cutaneous. In the proximal part of the leg, the superficial peroneal nerve goes through the substance of the peroneus longus muscle. In the middle third of the leg, the nerve is located between the peroneus longus and brevis. It then is seen in the groove between the peroneus brevis and the extensor digitorum longus. In the distal third of the leg, the superficial peroneal nerve then pierces the fascia to become superficial. The superficial peroneal nerve at this level can almost be seen through the skin.
The superficial peroneal nerve gives motor innervation to the peroneus longus and peroneus brevis muscles. Eversion of the foot is the main function of the peroneus longus and brevis muscles. The function of the peroneus muscles can be tested by having the patient evert the foot against resistance.
Injury to the common peroneal nerve will involve problems of both the superficial peroneal nerve and the deep peroneal nerve. Common sites of entrapment involving the superficial peroneal nerve. At the ankle, the superficial peroneal nerve divides into the intermediate dorsal cutaneous and the medial dorsal cutaneous branches. The superficial peroneal nerve has a variable course and becomes superficial to the peroneus longus muscle in the distal third portion of the lower leg.
Anatomical variation of the superficial peroneal nerve:
•73% in lateral compartment
•14% in anterior compartment
•12% divides and branches into two compartments: one branch in the anterior and one branch in lateral
•Less than 1% the nerve will become superficial to the peroneus longus muscle and pierce the cural fascia in the lateral compartment.
The superficial peroneal nerve divides into sensory branches that supply the skin of the dorsum of the foot. The medial dorsal branch of the nerve divides into two medial branches with one branch going to the medial side of the big toe and the other to the adjacent side of the second and third toes. The lateral branch of the superficial peroneal nerve divides into two branches with one branch going to the third and fourth toes, and the other branch going to the fourth and fifth toes.
Blind injection of the superficial peroneal nerve at the ankle: landmarks for injection
•Anterior tibial border (shin of the tibia)
•10 cc of local anesthetic around the syndesmotic area
Ultrasound guided injection of the superficial peroneal nerve:
•Position of the patient: the patient should be positioned supine.
•Good understanding of the muscular anatomy of the lower leg is necessary I determining the position of the nerve.
•Use betadine to clean the injection site
•Position of the probe: place the probe over the lateral aspect of the leg in the lower distal region.
•Position of the needle: injection can b performed along either the long or short axis.
Percutaneous submuscular plating can endanger the superficial peroneal nerve. The superficial peroneal nerve may become injured during fasciotomy of the lateral compartment.
Lateral leg incision: the lateral incision is made halfway between the tibia and the fibula for release of the anterior and lateral compartments. The superficial peroneal nerve can b e injured during release of the lateral compartment.
The anterolateral approach, especially the extensile approach, used for the distal tibia and pilon fractures may endanger the superficial peroneal nerve.
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