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Objective To investigate the anatomical characteristics of the biceps femoris short head (BS) and determine the optimal needle placement for BS examination.Methods Twenty-one lower limbs were dissected. The distances from the medial and lateral margins of the biceps femoris long head (BL) tendon to the common fibular nerve (CFN) (M_CFN_VD and L_CFN_VD, respectively) and the distance from the lateral margin of the BL tendon to the lateral margin of the BS (L_BS_HD) were measured 5 cm proximal to the tip of the fibular head (P1), four fingerbreadths proximal to the tip of the fibular head (P2), and at the upper apex of the popliteal fossa (P3).Results The BS was located lateral to the BL tendon. The CFN was located along the medial margin of the BL tendon. The median values were 2.0 (P1), 3.0 (P2), and 0 mm (P3) for M_CFN_VD; and 17.4 (P1), 20.2 (P2), and 21.8 mm (P3) for L_CFN_VD; and 8.1 (P1), 8.8 (P2), and 13.0 mm (P3) for L_BS_VD.Conclusion The lateral approach to the BL tendon was safer than the medial approach for examining the BS. Amore proximal insertion site around the upper apex of the popliteal fossa was more accurate than the distal insertion site. In this study, we propose a safer and more accurate approach for electromyography of the BS.

Objective To present the branching patterns and anatomical course of the common fibular nerve (CFN) and its relationship with fibular head (FH). Methods A total of 21 limbs from 12 fresh cadavers were dissected. The FH width (FH_width), distance between the FH and CFN (FH_CFN), and thickness of the nerve were measured. The ratio of the FH_CFN to FH_width was calculated as follows

Embora o acometimento do nervo fibular seja uma das neuropatias mais comuns nos membros inferiores, a lesão bilateral ainda é pouco citada na literatura. Apresentamos uma mulher jovem com doença de nervo fibular comum pouco tempo após a descompressão cirúrgica bem sucedida no membro contralateral. O principal achado é o déficit motor, com a típica marcha escarvante. A eletroneuromiografia continua sendo a propedêutica ideal, considerando atualmente novas modalidades em estudo. Mesmo que em diferentes apresentações, até o momento, a descompressão cirúrgica do nervo fibular parece ser a modalidade terapêutica de melhor resultado.

RESUMO Lesões de nervos periféricos levam a perda funcional elevada no tecido muscular. Assim, muitas pesquisas têm investigado técnicas cirúrgicas, como neurorrafias, e recursos terapêuticos, como eletroestimulação, para melhorar a funcionalidade de um músculo reinervado após lesão periférica. Este estudo tem como objetivo investigar os efeitos da eletroestimulação com corrente russa (2.500Hz, 4ms, 10 seg. de contração por 20 seg. de relaxamento, modulação de 10Hz e 100 Hz) na recuperação funcional após secção e neurorrafia término-lateral do coto distal do nervo fibular comum à face lateral do nervo tibial em ratos. Foram utilizados 25 ratos Wistar, machos, com 80 dias de vida, fornecidos pelo Biotério Central da Universidade Sagrado Coração (Bauru, SP, Brasil). Os animais foram divididos aleatoriamente em cinco grupos: grupo-controle Inicial (GCI), grupo-controle final (GCF), grupo experimental não tratado (GENT), grupo neurorrafia término-lateral com estimulação russa (GNTLER) e grupo-controle desnervado (GCD). A corrente russa foi iniciada cinco dias após neurorrafia e aplicada no músculo tibial cranial do GNTLER, 3 vezes por semana, totalizando 36 sessões. A estimulação elétrica foi eficaz para aumentar a amplitude e diminuir a latência do músculo reinervado, além de aumentar a força muscular em comparação ao GCD. Diante disso, conclui-se que a eletroestimulação de média frequência (corrente russa) foi eficiente na recuperação funcional do músculo tibial cranial após neurorrafia término-lateral do nervo fibular comum. RESUMEN Las lesiones de los nervios periféricos ocasionan una elevada pérdida funcional en el tejido muscular. De esta manera, en muchos estudios se han investigado técnicas quirúrgicas, como neurorrafias, y recursos terapéuticos, como la electroestimulación, para mejorar la funcionalidad del músculo reinervado tras una lesión periférica. El presente estudio tiene como objetivo investigar los efectos de la electroestimulación con corrente rusa (2.500Hz, 4ms, 10 seg. de contracción por 20 seg. de relajación, modulación de 10Hz y 100Hz) en la recuperación funcional tras la sección y neurorrafia término-lateral del muñón distal del nervio fibular común en la parte lateral del nervio tibial en ratas. Se utilizaron 25 ratas Wistar, machos, con 80 días de vida, proporcionadas por el Biotério Central de la Universidade do Sagrado Coração (Bauru, SP, Brasil). Se dividieron aleatoriamente los animales en cinco grupos: grupo de control inicial (GCI), grupo de control final (GCF), grupo experimental no tratado (GENT), grupo de neurorrafia término-lateral con estimulación rusa (GNTLER) y grupo de control denervado (GCD). La corriente rusa se inició cinco días tras la neurorrafia, siendo que la aplicó al músculo tibial craneal del GNTLER 3 veces a la semana, con un total de 36 sesiones. La estimulación eléctrica se mostró efectiva para aumentar la amplitud y disminuir la latencia del músculo reinervado, además de aumentar la fuerza muscular en comparación con el GCD. Por lo tanto, se concluye que la estimulación eléctrica de frecuencia media (corriente rusa) fue eficaz en la recuperación funcional del músculo tibial craneal tras la neurorrafia término-lateral del nervio fibular común. ABSTRACT Peripheral nerve injury leads to a high functional loss of muscle tissue. Thus, many studies have investigated surgical techniques, such as neurorraphies, and therapeutic resources, such as electrical stimulation, to improve the functionality of reinnervated muscle after peripheral injury. This study aims to investigate the effects of electrical stimulation with Russian Current (2,500Hz, 4ms, 10:20 sec contraction/relaxation, modulated at 10Hz and 100Hz) in the functional recovery after section and end-to-side neurorrhaphy of the peroneal nerve distal stump common to the lateral face of the tibial nerve in rats. In this study, 25 male Wistar rats with 80 days of life were used, provided by the Universidade Sagrado Coração (USC), Bauru, SP, Brazil. The animals were randomly divided into five groups: Initial Control Group (ICG), Final Control Group (FCG), Untreated Experimental Group (UEG), End-to-Side Neurorrhaphy with Russian Stimulation Group (ENRSG), and Denervated Control Group (DCG). The Russian Current was started 5 days after neurorrhaphy and applied to the cranial tibial muscle of the ENRSG, 3 times a week, totaling 36 sessions. We observed that the electrical stimulation with Russian Current (ENRSG) was effective to increase amplitude (mV) and to decrease the latency (ms) of the reinnervated muscle, besides increasing the muscle strength when compared with the denervated control group. Therefore, we concluded that the average frequency electrical stimulation (Russian current) was efficient in the functional recovery of the cranial tibial muscle after the end-lateral neurorrhaphy of the common fibular nerve.

Compression syndromes affecting the common fibular nerve are common and frequently caused by direct pressure upon the fibular tip region. Here, we describe a case of a 50-year-old male presenting with sudden foot drop, which had developed spontaneously. He was on oral anticoagulants due to hereditary thrombophilia (factor-V-Leiden). Neurophysiology examination revealed a common peroneal nerve lesion at the fibular tip. T1-weighted magnetic resonance imaging (MRI) showed a not further classifiable hyperintensity within the common peroneal nerve. Surgical exploration revealed a diffuse intraneural hematoma, which was not evacuated. During follow-up, the nerve function recovered almost completely. In retrospect, MRI findings indicated a hematoma supported by the history of anticoagulant medication.

Background: The progress of pediatric surgery and increasingly better diagnosis of fetal defects require detailed knowledge of human developmental anatomy. Precise knowledge of the anatomy of innervation of the lower extremities corresponds to this subject and is not only cognitive but also clinically important. The end of the common fibular nerve is superficially located in the area exposed to frequent injuries as well as in the area subject to possible surgical repair procedures. Materials and methods: The analysis was carried out on 200 human foetuses aged from the 113 th day to 222 nd day of foetal life. The study material is a part of local fetal collection. The study incorporated the following methods: anthropological, preparational and image acquisition which was acquired with the use of high-resolution digital camera. Statistical analysis was carried out with the use of STATISTICA package. Results: Based on the research results the new typology of the examined nerve was determined. The head of the fibula was the criterion: (i) high division – above the head of the fibula (1%); (ii) intermediate division – at the height of the head of the fibula (34%); (iii) low division – below the head of the fibula (65%). The mathematical analysis did not reveal statistically significant bilateral and gender differences. Moreover the additional branch was observed in 30% of fetuses, regardless of age class. This branch occurred in 50% of cases in both sides of the fetus. This nerve was defined as the accessory fibular nerve (nervus fibularis/peroneus accessorius). Conclusions: The created unique typology of the terminal division of common fibular nerve is an important supplement to the anatomical knowledge and at the same time, due to the peripheral and superficial location of the described structures, it has a relatively high clinical significance.

Measured nerve conduction velocity in the fibular nerve increases across the knee during hip flexion. This is due to stretching of sciatic and fibular nerves. We modeled the additional nerve length required for the sciatic nerve to course around the flexed hip, based upon distance between the hip and the sciatic nerve on magnetic resonance imaging (MRI). The median distance from the femoral head to the sciatic nerve was 41 mm. The model predicted that 64 mm of sciatic nerve is required for hip flexion. This impacts our understanding of lower limb nerve conduction studies and clinical straight leg raising tests.

The os intermetatarseum is located between the medial cuneiform and the base of the first and second metatarsals. Literature reviews have found few symptomatic cases of this condition since the 19th century. We report the case of a young female athlete, 20 years old, with sudden pain in the back of the midfoot after a jump. The os intermetatarseum is the rarest accessory bone in the foot and is typically asymptomatic. The presence of this bone should be considered when patients, especially young athletes, present with pain in the dorsum of the foot and compressive symptoms of the deep fibular nerve. Level of Evidence V; Therapeutic Studies; Expert Opinion.

There are few histomorphometric studies on the unmyelinated fibers of the fibular nerve in rats, and the number of experimental studies using this nerve has been increasing in the last years. Sixty-two percent of the endoneurial area from 10 fibular nerves of adult Wistar rats was scanned by electron microscopy, and digitized. The total number of unmyelinated axons (1.882 ± 271) was significantly lesser, and their axon diameters (0.2 µm to 2.8 µm) significantly higher than that determined in previous studies. The histogram peaked at 1 µm. The differences could be due to the nerve sampled area, the number and the age of the animals evaluated, and the laboratory techniques used. This study brings new and referential data to be used in experimental investigations involving histomorphometric evaluation of the rat fibular nerve. RESUMO Embora o nervo fibular de ratos venha sendo incluído progressivamente em maior número de estudos experimentais nos últimos anos, há poucos estudos a respeito das suas fibras amielínicas. Os nervos fibulares de 10 ratos Wistar adultos foram avaliados através de microscopia óptica e eletrônica. Varredura sistemática através de microscopia eletrônica de transmissão das áreas fasciculares da porção distal no nervo foi realizada. Em média, 62% da área endoneural foi digitalizada. O número total de axônios amielínicos encontrados (1.882 ± 271) foi significativamente menor e as medidas dos diâmetros axonais (0,2 µm a 2,8 µm) maiores do que o determinado em estudos prévios. O pico do histograma foi constituído por fibras de 1µm. As diferenças podem ser devidas à amostragem de maior área endoneural, ao número e à idade dos animais avaliados, e as técnicas laboratoriais utilizadas. Os dados obtidos podem ser considerados referenciais para o nervo fibular de ratos Wistar adultos.

The formation of the neuromuscular junction (nmj) is based on molecular cascades initiated by neural agrin as well as electrical activity in the neuromuscular structures. This review focuses on the latter factor, emphasizing the multiplicity of its mechanisms in the process of synapse elimination following initial polyneuronal innervation. Pre- and post-synaptic components of activity have in fact been identified through experiments on an adult model of nmj formation: ectopic reinnervation of the rat soleus muscle by the fibular nerve. Two activity-dependent elimination processes are thus compared: competition between distributed nmjs, which depends on evoked muscle impulse activity, and competition between axons converging on single nmjs, which instead depends on differences in the timing of impulses in the converging axons.

OBJETIVO: Verificar a influência da irradiação do laser de baixa intensidade na regeneração do nervo fibular comum de ratos após lesão por esmagamento. MÉTODOS: Foram utilizados 25 ratos, divididos em três grupos: 1) nervo intacto, e não tratados; 2) nervo lesado, e não tratado; 3) nervo lesado, e laser irradiado sobre a região medular correspondente às raízes do nervo ciático e subsequentemente no trajeto do nervo lesado. A irradiação foi realizada por 14 dias consecutivos. RESULTADOS: Foram avaliados por meio da análise funcional da marcha, através do índice funcional do peroneiro, e por análise morfométrica através do número total de fibras nervosas mielinizadas e sua densidade, número total de células de Schwann, número total de vasos sanguíneos e sua área, diâmetro mínimo da fibra e razão-G. CONCLUSÃO: De acordo com a análise estatística, não houve diferença significativa entre os grupos, e os autores concluem que a irradiação do laser de baixa intensidade possui pouca ou nenhuma influência na regeneração nervosa e recuperação funcional. Trabalho experimental. OBJECTIVE: to investigate the influence of low intensity laser irradiation on the regeneration of the fibular nerve of rats after crush injury. METHODS: twenty-five rats were used, divided into three groups: 1) intact nerve, no treatment; 2) crushed nerve, no treatment; 3) crush injury, laser irradiation applied on the medullary region corresponding to the roots of the sciatic nerve and subsequently on the course of the damaged nerve. laser irradiation was carried out for 14 consecutive days. RESULTS: animals were evaluated by functional gait analysis with the peroneal functional index and by histomorphometric analysis using the total number of myelinated nerve fibers and their density, total number of schwann cells, total number of blood vessels and the occupied area, minimum diameter of the fiber diameter and g-quotient. CONCLUSION: according to the statistical analysis there was no significant difference among groups and the authors conclude that low intensity laser irradiation has little or no influence on nerve regeneration and functional recovery. Laboratory investigation.

OBJECTIVE: To investigate the influence of low intensity laser irradiation on the regeneration of the fibular nerve of rats after crush injury. METHODS: Twenty-five rats were used, divided into three groups: 1) intact nerve, no treatment; 2) crushed nerve, no treatment; 3) crush injury, laser irradiation applied on the medullary region corresponding to the roots of the sciatic nerve and subsequently on the course of the damaged nerve. Laser irradiation was carried out for 14 consecutive days. RESULTS: Animals were evaluated by functional gait analysis with the peroneal functional index and by histomorphometric analysis using the total number of myelinated nerve fibers and their density, total number of Schwann cells, total number of blood vessels and the occupied area, minimum diameter of the fiber diameter and G-quotient. CONCLUSION: According to the statistical analysis there was no significant difference among groups and the authors conclude that low intensity laser irradiation has little or no influence on nerve regeneration and functional recovery. Laboratory investigation.

OBJETIVO: Analisar o efeito do laser nas doses de 5, 10 e 20J/cm² na reparação do nervo fibular de ratos após esmagamento. Os resultados foram avaliados por meio da análise funcional da marcha e de parâmetros morfométricos. MÉTODOS: Lesão por esmagamento controlado do nervo fibular comum direito e submetidos a intensidades crescentes (G1: sem irradiação; G2: sham; G3: 5J/cm²; G4: 10J/cm²; G5: 20J/cm²) de irradiação do laser diretamente sobre o local da lesão por 21 dias consecutivos. A análise funcional da marcha foi realizada a intervalos semanais, tendo sido medido o índice funcional do fibular (IFF). Os animais foram sacrificados nos 21º dia pós-operatório para remoção do nervo fibular, que foi preparado para a análise morfométrica. RESULTADOS: Não houve diferença significativa (p>0,05) dos valores da análise de marcha (IFF) entre os grupos em qualquer momento de avaliação para o parâmetro. A área total da secção transversal do nervo foi significantemente maior no grupo 2 do que nos grupos 3 e 4, enquanto a densidade de fibras foi significantemente maior no grupo 4 do que no demais grupos. CONCLUSÃO: A irradiação com o laser AsGaAl de baixa potência não acelerou a regeneração do nervo fibular com nenhuma das doses utilizadas. Nível de Evidência I, Estudos terapêuticos - Investigação dos Resultados do Tratamento.

Is there an ordered pattern in the recruitment of postganglionic sympathetic neurones? Using new multi-unit action potential detection and analysis techniques we sought to determine whether the activation of sympathetic vasomotor neurones during stress is governed by the size principle of recruitment. Multi-unit postganglionic sympathetic activity (fibular nerve) was collected from five male subjects at rest and during periods of elevated sympathetic stress (end-inspiratory apnoeas; 178 ± 37 s(mean ± S.D.)). Compared to baseline (0.24 ± 0.04 V), periods of elevated stress resulted in augmented sympathetic burst size (1.34 ± 0.38 V, P < 0.05). Increased burst size was directly related to both the number of action potentials within a multi-unit burst of postganglionic sympathetic activity (r= 0.88 ± 0.04, P < 0.001 in all subjects), and the amplitude of detected action potentials (r= 0.88 ± 0.06, P < 0.001 in all subjects). The recruitment of larger, otherwise silent, neurons accounted for approximately 74% of the increase in detected action potentials across burst sizes. Further, action potential conduction velocities (inverse of latencies) were increased as a function of action potential size (R2= 0.936, P= 0.001). As axon diameter is positively correlated with action potential size and conduction velocity, these data suggest that the principle of ordered recruitment based on neuronal size applies to postganglionic sympathetic vasomotor neurones. This information may be pertinent to our understanding of reflex-specific recruitment strategies in postganglionic sympathetic nerves, patterns of vasomotor control during stress, and the malleability of sympathetic neuronal properties and recruitment in health and disease.

Category: Ankle Introduction/Purpose: The bifurcation of the sciatic nerve results in the common peroneal nerve, along with the tibial nerve. A commonly block used before foot and ankle surgery is the sciatic block. This block requires an ultrasound or neurostimulation for accurate placement and can take time to administer effectively. We believe that the common peroneal, or high fibular nerve block, may be equivalent in some clinical circumstances to the sciatic block and does not require additional imaging for accurate placement. Methods: In this study, a mixture comprised of 5 mL 0.5% bupivacaine and 5 mL 1% lidocaine was used for each patient. Certain surface anatomic landmarks were used to place the block without ultrasound or neurostimulation. The time spent administering the block was recorded. Patients were not given pain medicines in the recovery unit unless the block did not work. A follow-up questionnaire was completed within 24 hours following surgery, and this was used to assess aspects of the patient’s post-operative experience. These include the number of hours following surgery that the patient: 1) first felt pain, 2) first took pain medication, 3) first felt tingling, 4) fully regained feeling in his/her leg, and 5) could wiggle his/her toes. Also, any complications were recorded. Results: This study involved 21 patients with an average age of 51. The most common procedures used with the block were hardware removal of the fibula and open reduction internal fixation of the fibula. The block took on average less than 3 minutes to administer and ultrasound was not used in any cases. No patients were given pain medicines in the recovery unit. None of the patients reported any complications, specifically, there were no cases of foot drop or any persistent paresthesias. The average time it took for patients to first feel pain after the block was approximately 8 hours. On average, patients first took pain medication approximately 11 hours after surgery, and regained sensation in their leg 15 hours after surgery. Conclusion: The benefits of the common peroneal block are multifold, as their clinical outcomes were positive and patients did not experience any complications. Also, from a surgeon perspective, the block is quick to administer and does not require ultrasound or neurostimulation.

OBJETIVO: Comparar clínica e anatomicamente os limites do nervo fibular na zona de segurança de Gerdy em cadáveres. MÉTODOS: Foram utilizados 50 espécimes anatômicos de joelhos e medidos clinicamente (antes de dissecção) para determinar as distâncias e ângulos entre: o tubérculo de Gerdy e a região posterior da fíbula (cm), ângulo entre a linha correspondente à região posterior da fíbula e a crista tibial (graus) e o ângulo entre o tubérculo de Gerdy e crista tibial (graus). Após a dissecção das peças anatômicas, os joelhos foram novamente medidos, para determinar as distâncias e ângulos entre: o tubérculo de Gerdy e o nervo fibular (cm), ângulo entre o nervo fibular, na região posterior da fíbula e a crista tibial (graus) e o ângulo entre o tubérculo de Gerdy e crista tibial (graus). RESULTADOS: Existe aumento significativo da distância entre o tubérculo de Gerdy e a região posterior da fíbula (cm), após dissecção, em média 0,26cm (p = 0,018), o que corresponde a 8,6% (p = 0,007) e também existe diminuição significativa do ângulo entre a região posterior da fíbula e a crista tibial após dissecção, em média de 3º (p = 0,047), que corresponde a 2,1% (p = 0,06). CONCLUSÃO: Apesar da diferença antes e depois da dissecção, a zona de segurança de Gerdy pode ser considerada segura para os procedimentos ortopédicos, na região proximal da tíbia, evitando danos ao nervo fibular e seus ramos. OBJECTIVE: to clinically and anatomically compare the limits of the fibular nerve in Gerdy's Safe Zone in cadavers. METHODS: Fifty anatomical knee specimens were clinically measured (before dissection) to determine the distances and angles between: Gerdy's tubercle and the posterior region of fibula (cm); the angle between the line corresponding to the posterior region of fibula and the tibia crest (degrees); and the angle between Gerdy's tubercle and tibial crest (degrees). After dissection of the anatomical parts, the knees were measured again, to determine the distances and angles between: Gerdy's tubercle and the fibular nerve (cm), the angle between the fibular nerve, in the posterior region of the fibula, and the tibial crest (degrees), and the angle between Gerdy's tubercle and the tibial crest (degrees). RESULTS: There was a significant increase in the distance between Gerdy's tubercle and the posterior region of fibula (cm), after dissection, of an average 0.26 cm (p = 0.018), corresponding to 8.6% (p = 0.007). There was also a significant reduction in the angle between the posterior region of fibula and the tibial crest after dissection, of an average 3º (p = 0.047), corresponding to 2.1% (p = 0.06). CONCLUSION: Despite the difference before and after dissection, Gerdy's Safety Zone can be considered safe for orthopedic procedures involving the proximal region of the tibia, preventing damage to the fibular nerve and its branches.

Objective: To clinically and anatomically compare the limits of the fibular nerve in Gerdy's safe zone in cadavers. Methods: Fifty anatomical knee specimens were clinically measured (before dissection) to determine the distances and angles between Gerdy's tubercle and the posterior region of the fibula (cm); the angle between the line corresponding to the posterior region of the fibula and the tibial crest (degrees); and the angle between Gerdy's tubercle and the tibial crest (degrees). After dissection of the anatomical specimens, the knees were measured again, to determine the distances and angles between Gerdy's tubercle and the fibular nerve (cm); the angle between the fibular nerve, in the posterior region of the fibula, and the tibial crest (degrees); and the angle between Gerdy's tubercle and the tibial crest (degrees). Results: There was a significant increase in the distance between Gerdy's tubercle and the posterior region of fibula (cm), after dissection: an average of 0.26 cm (p = 0.018), corresponding to 8.6% (p = 0.007). There was also a significant reduction in the angle between the posterior region of the fibula and the tibial crest after dissection: an average of 3° (p = 0.047), corresponding to 2.1% (p = 0.06). Conclusion: Despite the difference from before to after dissection, Gerdy's safe zone can be considered safe for orthopedic procedures involving the proximal region of the tibia, thereby avoiding damage to the fibular nerve and its branches.

INTRODUCTIONSchwannomas are benign, encapsulated, slow-growing and usually solitary tumors originating from Schwann cells of the peripheral nerve sheath. Schwannomas of the superficial peroneal nerves are very rare, and therefore scarcely documented in the literature. The authors report a case of a diagnosed superficial fibular nerve sheath tumor with an unreported clinical presentation.PRESENTATION OF CASEA 52-year-old Caucasian female arrived to our Orthopedics Department complaining of pain and numbness of the lateral aspect of her left leg. These symptoms were present for a year and were more evident at the end of the day, or after a long time in the orthostatic position. No evidence of other medical illnesses was found. There was no record of prior traumatic events related to that limb. Diagnosis of a benign peripheral nerve tumor was achieved and the patient was treated by surgical excision of the lesion.DISCUSSIONThe intermittent symptomatology presentation on this case suggest a mechanical compression etiology, allied to classical pain and paresthesia often exhibited by this kind of the tumor. An intracompartimental pressure elevation could explain why the symptoms disclosed an episodic pattern, due to a constricted, inclosed nerve.CONCLUSIONWe describe a rare case of a patient with an unusual superficial peroneal nerve Schwannoma clinical presentation. Literature on this topic is scarce and, therefore, this case report intends to add further data about this kind of lesion.

The common fibular nerve (CFN), is a branch of the sciatic nerve (SN) that exits the popliteal fossa and is located at the tuberculum of the fibula. At the tuberculum of the fibula, the CFN bifurcates into deep (DFN) and superficial (SFN) fibular nerves. Forty fetuses were micro-dissected to (i) describe the course of the CFN in relation to the tuberculum and neck of the fibula in fetuses; (ii) describe the branches, distribution and relation of the DFN and SFN to muscles within the anterolateral compartment of the leg. The CFN, DFN and SFN were present in all specimens dissected; the CFN measured a mean length (mm) of 16.03 and 16.69 on the right and left sides respectively. Bifurcation of the CFN related to the tuberculum of fibula (right; left) - above 20/80 (25%); 14/80 (17.5%); below 6/80 (7.5%); 10/80 (12.5%) and at the tuberculum 54/80 (67.5%); 56/80 (70%). The DFN bifurcated into medial and lateral branches in 68/80 (85%) and 54/80 (67.5%) on the right and left sides, respectively. The SFN bifurcated into a medial branch in 78/80 (97.5%) and 76/80 (95%) on right and left sides, respectively and a lateral branch in 78/80 (97.5%) and 76/80 (95%) on right and left sides, respectively. The course and distribution of the CFN, DFN and SFN were consistent with the literature reviewed and descriptions found in standard anatomical textbooks. However, our findings show that the DFN has a variable number of branching patterns, which is unique to this fetal study and an intermediate branch of the SFN which was recorded in 3/80 cases.

Objective The spastic hemiplegic patient often presents dystonia of extensor hallucis longus (EHL) and, more rarely, extensor digitorum longus (EDL). This dystonia is difficult to treat by tendon lengthening, because its primum movens is purely neurological without retraction musculo-tendinous. A hyponeurotisation by partial section of the branches of the common and deep fibular nerve(s) could be a therapeutic alternative to botulinum toxin injections. Its technique has never been described. Material/patients and methods Ten legs from formalin-preserved corpses were dissected. The number of branches to EHL and EDL, their level of emergence from the common and deep fibular nerves, and their entry point into the muscle have been measured from the lateral femoral-tibial articular space (LTF). Results There was always a common trunk to the EDL and the EHL, arisen on average at 10.3 cm (8.2–13.6) from the LTF line. Six times out of 10 in addition to this common one (3), two (2) or three (1) additional branches to the EDL, arisen between 4.6 and 12 cm downstream the LTF line. Six times out of 10 in addition to this common trunk existed one (4) or two (2) additional branches to the EHL, arisen between 13 and 26 cm downstream the LTF line. Discussion–conclusion This first study allow establishing the surgical technique of the hyponeurotisation of muscles LEH and LEO. The first results are presented.

Objective To establish the diagnostic cutoff value of ultrasonographic measurement for common fibular neuropathy (CFN) at the fibular head (FH). Methods Twenty patients with electrodiagnostically diagnosed CFN at the FH and 30 healthy controls were included in the study. The cross-sectional area (CSA) of sciatic nerve at mid-thigh level, common fibular nerve at popliteal fossa (PF), and common fibular (CF) nerve at FH were measured. Additionally, the difference of CF nerve CSA at the FH between symptomatic side and asymptomatic side (ΔSx–Asx), the ratio of CF nerve CSA at FH to at PF (FH/PF), and the ratio of CF nerve CSA at the FH symptomatic side to asymptomatic side (Ratio Sx–Asx) were calculated. Results CSA at the FH, FH/PF, ΔSx–Asx, and Ratio Sx–Asx showed significant differences between the patient and control groups. The cutoff value for diagnosing CFN at the FH was 11.7 mm2 for the CSA at the FH (sensitivity 85.0%, specificity 90.0%), 1.70 mm2 for the ΔSx–Asx (sensitivity 83.3%, specificity 97.0%), 1.11 for the FH/PF (sensitivity 47.1%, specificity 93.3%), and 1.24 for the Ratio Sx–Asx (sensitivity 72.2%, specificity 96.7%). Conclusion The ultrasonographic measurement and cutoff value could be a valuable reference in diagnosing CFN at the FH and improving diagnostic reliability and efficacy.

rtheses: custom made shoes with springs, moulded rigid ankle-foot orthesis, lastic tractor “Liberte©”. The mean follow-up is presently less than 6 months. esults.– 12 patients (15 feet) were included: 7 had fibular nerve deficiency, 2 ad Charcot-Marie-Tooth disease and two had moderately spastic hemiplegia. ur first results show positive assessment by the patients. The qualities they mphasize are stability and range of motion. urther reading . Girardeau, O. Dubourg, H. Teysssedre, DT. N’Guyen. « Essai comparatif entre ispositifs orthetiques statiques et dynamiques de cheville dans les maladies euromusculaires ». Journal de readaptation medicale 2005;25(3):105–109. . Demers, R. Weiss-Lambrou, B. Ska. “The Quebec user evaluation of satisfacion with assistive technology (QUEST 2.0): an overview and recent progress”. echnology and Disability 2002;14:101–105.

O estudo da recuperação de lesões nervosas periféricas do isquiático, fibular e tibial, obtidos através da análise motora, é considerado um bom critério de avaliação para a quantificação do grau de avaliação nervosa. O sistema de Análise Funcional dos Nervos Periféricos - AFNP que tem a funcionalidade da informatização deste processo, além de fornecer ao usuário uma maior agilidade na avaliação, permite ao pesquisador a utilização de um número maior de animais nos grupos experimentais, facilitando não só a captação, bem como o armazenamento e o processamento dos dados. A flexibilidade foi um resultado muito importante a ser ressaltado, pois mais de um usuário tem a possibilidade de interagir no sistema. The study of the peripheral nerve regeneration after sciatic, fibular and tibial injuries, obtained through motion analysis, is regarded as a good evaluation criterion for quantifying the degree of nervous evaluation. The Functional Analysis of the Peripheral Nerves (AFNP) system that can transform this process into a computed one, not only provides the user with a higher evaluation agility, but also allows researchers to use a larger number of animals on experimental groups, facilitating the capture and data storage and processing, as well. Flexibility was a very important result to be highlighted, because more than one user is able to interact with the system.

A utilização de aloenxerto de nervo conservado em glicerol é uma alternativa a auto-enxertia em casos de lesões de nervos periféricos com perda de substância que diminui a morbidade cirúrgica e provem material suficiente para a reparação neural. O objetivo deste trabalho foi comparar o grau de reparação nervosa, utilizando análises histológica e funcional, através da interposição de enxerto autógeno (grupo A), de tubo de veia conservada em glicerol (grupo B) e de interposição de nervo alógeno conservado em glicerol (grupo C) em defeitos de 5 mm no nervo fibular de ratos Wistar. A análise histológica foi feita após o sacrifício dos animais( 6 semanas) , usando o corante azul de toluidina a 1%. No grupo A (auto-enxerto) verificou-se reação tecidual perineural e escape de fibras axonais mielinizadas para fora dos limites do epineuro que foi maior se comparada ao verificado no Grupo B (Veia autógena + glicerol) e Grupo C (aloenxerto de nervo).A avaliação funcional foi feita através da análise dos padrões das pegadas das patas posteriores dos ratos ("Walking Track Analysis"), nos períodos: pré-operatório, pós-operatório imediato, na terceira e sexta semanas. Na recuperação funcional, não houve diferença estatisticamente significativa entre os três grupos em nenhum dos períodos avaliados. The use of glycerol-preserved nerve allograft is an alternative to autografting in cases of peripheral nerve injury with loss of substance, which decreases surgical morbidity and provides sufficient material for neural repair. The objective of this study was to compare the degree of nervous repair, through interposition of autogenous graft (Group A), of glycerol-preserved vein tube (Group B), and interposition of glycerol-preserved allogenic nerve (Group C) in 5-mm defects of Wistar rats' fibular nerve, using histological and functional analyses. In group A (autograft) a perineural tissue reaction and myelinated axonal fibers escape out of the epineurium boundaries were greater when compared to those observed in Group B (autogenous vein + glycerol) and Group C (nerve allograft). The functional evaluation was made by analysis of the patterns of rats' posterior footprints (Walking Track Analysis) in preoperative, early postoperative period, week 3 and week 6. Regarding functional recovery, in none of the evaluated periods was there a statistically significant difference between the three groups.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:04Z No. of bitstreams: 1 S1413-35552007000300009.pdf: 201476 bytes, checksum: cacc2ca543950e028c64010997da79a4 (MD5) Made available in DSpace on 2013-08-22T19:03:04Z (GMT). No. of bitstreams: 1 S1413-35552007000300009.pdf: 201476 bytes, checksum: cacc2ca543950e028c64010997da79a4 (MD5) Previous issue date: 2007-06-01 Made available in DSpace on 2013-09-30T20:04:32Z (GMT). No. of bitstreams: 2 S1413-35552007000300009.pdf: 201476 bytes, checksum: cacc2ca543950e028c64010997da79a4 (MD5) S1413-35552007000300009.pdf.txt: 22734 bytes, checksum: 6eb529d2572642b08cf5952cc1242fc4 (MD5) Previous issue date: 2007-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:16:35Z No. of bitstreams: 2 S1413-35552007000300009.pdf: 201476 bytes, checksum: cacc2ca543950e028c64010997da79a4 (MD5) S1413-35552007000300009.pdf.txt: 22734 bytes, checksum: 6eb529d2572642b08cf5952cc1242fc4 (MD5) Made available in DSpace on 2014-05-20T15:16:35Z (GMT). No. of bitstreams: 2 S1413-35552007000300009.pdf: 201476 bytes, checksum: cacc2ca543950e028c64010997da79a4 (MD5) S1413-35552007000300009.pdf.txt: 22734 bytes, checksum: 6eb529d2572642b08cf5952cc1242fc4 (MD5) Previous issue date: 2007-06-01 CONTEXTO: A síndrome do músculo piriforme pode ter como causa a passagem anormal do nervo ciático ou de uma de suas partes pelo ventre do músculo piriforme. OBJETIVO: Analisar as relações anatômicas e métricas entre o músculo piriforme e o nervo ciático, contribuindo com o conhecimento anátomo-clínico da região glútea. MÉTODO: Foram utilizados 20 cadáveres adultos de ambos os sexos. O nervo ciático e o músculo piriforme foram dissecados, medidos e fotodocumentados. RESULTADOS: Observou-se que 85% das 40 regiões glúteas apresentaram o nervo como tronco único, passando pela borda inferior do músculo piriforme, e 15% mostraram uma variação bilateral, caracterizada pela passagem do nervo fibular comum através do músculo piriforme. Os dados obtidos não revelaram diferenças estatisticamente significantes. CONTEXT: Piriform muscle syndrome can be caused by abnormal passage of the sciatic nerve or one of its parts through the belly of the piriform muscle. OBJECTIVE: To analyze the anatomical and measurement relationships between the piriform muscle and the sciatic nerve in order to contribute towards better anatomoclinical understanding of the gluteal region. METHOD: Twenty adult cadavers of both sexes were used. The sciatic nerve and piriform muscle were dissected, measured and photodocumented. RESULTS: The sciatic nerve was seen to be a single trunk passing through the lower margin of the piriform muscle in 85% of the 40 gluteal regions, and 15% showed bilateral variation characterized by the passage of the common fibular nerve through the piriform muscle. The data obtained did not show any statistically significant differences. Universidade Federal de Juiz de Fora Centro de Ciências da Saúde Faculdade de Fisioterapia Universidade Federal de São Carlos (UFSCar) Departamento de Morfologia e Patologia Secretaria Municipal de Saúde Universidade Estadual Paulista Julio de Mesquita filho Faculdade de Medicina Veterinária e Zootecnia Universidade Estadual Paulista Julio de Mesquita filho Faculdade de Medicina Veterinária e Zootecnia