Common Peroneal Nerve Self Exam

Dr. Williams demonstrates how to perform a self examination for common peroneal nerve pain.

Today I wanted to try to talk with you about the common peroneal nerve and what the symptoms are, and how you might be able to potentially check for yourself whether that nerve may be pinched or whether or not they may be a problem. The common pineal nerve wraps or comes from the sciatic nerve from your buttock, it wraps, goes down the thigh and then turns into the sciatic nerve turns into the common peroneal nerve and the tibial nerve but the common peroneal nerve at your knee. It wraps around the outside of the knee and then heads down at the top of the foot, and patients who have a very severe problem with this can often have a foot drop. a foot drop means you can't lift your foot up, okay, it's paralyzed or weak, could have a partial foot drop where the nerve just doesn't the foot does not come up and it doesn't go outward okay. The common peroneal nerve lifts the foot up and it lifts the foot outward. it also gives you sensation to the top of your foot all the way down to your toes but to the top of them only. not the bottom. Patients who have a problem with this have tingling, buzzing, burning electrical shocking sensations, weird creepy crawlies, water dribbling down their foot all the time or bugs crawling on them or things that feel nervy. Sometimes they'll just have a very deep ache on the outside of the knee below the knee, not the knee joint itself but below the knee on that outside area where I showed you before.

Frequently, this is one of the most common procedures we do to decompress this nerve, it's actually one of my favorite procedures to be honest with you and it's actually extremely successful in appropriate patients, and we have a great track record of helping patients with this kind of pain. This nerve can get easily entrapped or stretched with an ankle injury, just a simple ankle sprain is probably one of the most common ways that we see this nerve impinged or entrapped causing burning, tingling. Some people may be misdiagnosed with chronic regional pain syndrome after a seemingly benign ankle sprain. We see this in patients who have diabetes. It's very common that they're diagnosed with pure diabetic neuropathy, but quite frequently this nerve may become entrapped at the knee causing burning, tingling, searing pain to the top of the foot. If you have pain on the bottom of the foot that comes from a different nerve, but it also can be pinched but specifically the top of the foot is the common peroneal nerve. And so we encourage people, sometimes when they call us, to ask us if we can help them, occasionally we'll talk to them over the telephone, it's very challenging to have them diagnose this but we'll try to show you how you can figure this out if it exists. And while it doesn't substitute at all for an inpatient in-person visit, it is certainly helpful and so I will show you where this nerve is and how you can kind of test for it. and it's not a perfect sign, it's not a perfect science, but it certainly is helpful and encouraging to patients who've been suffering if they can elicit what's called the tinel sign which is that funny bone feeling that electrical shocking feeling that runs down their leg when they touch the nerve or palpate the nerve or manipulate the nerve and that's a really good sign that we may be able to help that person and it's certainly worth contacting us so we can talk to you about it. Thanks.

So here's how I would instruct you to check your own common peroneal  nerve. the common peroneal nerve runs on the outside of your knee. Now I haven't quite been able to figure out how to do this without showing you my hairy legs, so I apologize, most patients have not seen their surgeon's hairy leg, but I can't figure out how else to do it. So here's the outside of my knee, okay, and what I usually tell patients is they put their left hand on their left knee or their right hand on the right knee and move their hand outward to the side, and you will find a bone that is on the outside of the knee. It's not on the upper side of the knee, it's on the bottom side of the knee, it's called the fibula or the fibular head. It's a round bone, it's right about here. Another way to find it is you come up from your muscular calf and you come up and you feel a little bony prominence right there. That's where the common peroneal nerve lives right here okay. And you can feel it sometimes if you're a thin or muscular person, if you have a little extra tissue it may be hard to feel, but you can feel it by rubbing right here. You can actually pull your finger right up on the bone, and sometimes you can actually feel the nerve itself, it's right below the fibular head. and you may have to use google or something to look this up, but this is where the nerve is so if you want to determine whether or not that nerve may be stuck there's two ways to do it. One, you do this, you tweak it up and down, okay. That would probably be very uncomfortable if that nerve was a real problem for you, or you can put one finger right below the bone literally below the bone. Here's the bone right here and here's the nerve where my finger is and so you put it there and you can tap on it again using your first finger and second finger with love and some passion here. You want to tap on it right here on your fingertip, and you want to see if you get an explosion of energy, of electricity. Something that feels like a funny bone sensation that shoots all the way down your leg, into the top of your foot okay. And so that's how we would recommend that you check for a compression of the common peroneal on your own, by yourself with no one else around, you can do this yourself.