Is this Common peroneal nerve ??

[emad]

Hi all ;

A 22 years guy works for the electircal company in my town went to a citizen asking him to pay the Bill , the man went crazy , because the bill was very high and pointed his knife toward the man ,s left thigh , the stap wound site was at the antro-lateral surface of the thigh lower third since april 2005 .

The wounded man went to the emergency room , the surgeon stitched the wounded site , the injury was so deep .

Now , i found the following :

doris is 4
eversion 1
planter 4+
knee ext 4 +
knee flex 4+

SLT ++
Tinel ,s sign + over the site


He complains saying i can walk on my toes , but i can not walk on my heels.

First of all, we do not have reliable objective NCV tests here , so i have to depend on my clinical reasoing skills to deal with the case , as some of the physicians dealt with the case considered it as sciatic nerve injury , others considered it femoral nerve ........:sad:

Secondly, I belive surely it is peroneal nerve problem , may be adhesions , scars surrounding it , may be injured i do not know .

What are your views ???

Best regards

Emad

[fapt]

Hi emad,
Accroding to your post, I don't think so yet.
Because the wound area. He wound is at the antro-lateral surface of the thigh.
Accroding to the anatomy, the branch of the common paroneal nerve is at the fibular head. So i think that the patient might have sciatic nerve injury.

The nerve was cut or compressed?

BTW
Tinel ,s sign +?? where?

Thanks a lot!!

[emad]

Hi ;

could you please review the anatomy of the common peroneal nerve course .

If the scitaic nerve is affected , the motor affection would be severe , diable with drop foot , I can assure that it is only the superficial peroneal nerve which is a more cutaneous nerve than motor supplier like the deep peroneal nerve .

I tried to search for an image to clear up the issue , but i failed .

Regards

Emad

[fapt]

hi,
First of all, i had seen the anatomy
I want to know the 1/3 of lower thigh...where is the wound at the thigh
Is it near the popliteus or near the top of the 1/3 of the lower thigh?
If it was near the popliteus, it might be injury this nerve.

The sciatica have 2 componment of nerve groups. These are tibial and common peroneal nerve...
http://www.netanatomy.com/GA/ga_frame.htm


and the web can give you some ideas
http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZB2KOBGJC&sub_cat=185

I know the patient have the symptoms of this common peroneal nerve symptom.
But the wound site..i am so confused about this. WWWhy did it cause this injury?

Thanks a lot..
This is an interesting case. The patient will get better.

Cheers, Lin

[emad]

HI lin:

Sorry that i asked you to review the anatomy , for me this is normal , and for any person , personally , i am not superior to reviewing books daily .

By the way , the link you gave is not so clear , i met before clearer images.

Regarding the site of the injury ,it is exactly 10-15 cm above the knee axis , anterolateral aspect , the direction of the knife probably was inferomedial .

Meanwhile The deep peroneal nerve was affected because there is sensory loss in the cleft between the first and second toes .

I like to tell you that i posted the topic on NOI , and REh edge ;
http://www.noigroup.com/cgi-bin/ubbcgi/ultimatebb.cgi?ubb=get_topic;f=5;t=000400

http://www.rehabedge.com/ubb/ultimatebb.php?/ubb/get_topic/f/15/t/000192.html

all my best regards .

Emad

[fapt]

It is fine Emad
More discussion, more learning.

[Arun]

Emad,
I too would assume it as a common peroneal nerve injury as you did. Perhaps most of the injury might have been to the fibres supplying the lateral peroneal nerve which supply the peroneal muscles...

How is the patients condition now? Is he coming for follow up reviews?
Regards

[emad]

Hi Arun :

right !

there was not much progress ,i referred him to a surgeon .



Regards

Emad