Skip to main content
  • Original article
  • Open access
  • Published:

Electrophysiological study of accessory deep peroneal nerve in a sample of Egyptian subjects

Abstract

Introduction

Accessory deep peroneal nerve (ADPN) is the most common anomalous innervation present in the lower limb.

Aim

The aim of this study was to determine the prevalence of ADPN electrophysiologically in a sample of healthy Egyptian individuals.

Subjects and methods

This cross-sectional study included 200 lower limbs from 100 [56 (56%) women and 44 (44%) men] Egyptian apparently healthy volunteers. Motor nerve conduction studies for the peroneal nerve and ADPN were done.

Results

ADPN was found in 20 (10%) lower limbs of 17 (17%) subjects. There was no statistically significant difference between the occurrence of ADPN in women versus men (P=0.797). ADPN was found in 11 (55%) right lower limbs and in nine (45%) left lower limbs. There was no statistically significant difference between the occurrence of ADPN in right lower limbs versus left lower limbs among subjects with ADPN (P=0.637). It was present bilaterally in three (17.65%) subjects. There was no statistically significant difference between the occurrence of bilateral ADPN in women versus men (P=0.761). Among the 14 (82.35%) subjects with unilateral ADPN, it was present in the right side in eight (57.14%) subjects. There was no statistically significant difference between the occurrence of unilateral ADPN in the right side versus left side (P=0.579).

Conclusion

This study demonstrated that ADPN prevalence in the referred Egyptian sample through electrodiagnostic studies of lower limbs was 17%, with no sex nor side difference. Recognition of ADPN is essential for proper interpretation of lower limbs electrophysiological data.

References

  1. Preston D, Shapiro B. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. 3rd ed. Pennsylvania, PA: Elsevier Saunders; 2013.

    Google Scholar 

  2. Tomaszewski KA, Roy J, Vikse J, Pekala PA, Kopacz P, Henry BM. Prevalence of the accessory deep peroneal nerve: a cadaveric study and meta-analysis. Clin Neurol Neurosurg 2016; 144:105–111.

    Article  Google Scholar 

  3. Dessi F, Durand G, Hoffmann JJ. The accessory deep peroneal nerve: a pitfall for the electromyographer. J Neurol Neurosurg Psychiatry 1992; 55:214–215.

    Article  CAS  Google Scholar 

  4. Kuruvilla A. Accessory deep peroneal nerve. Neurol India 2004; 52:135.

    CAS  PubMed  Google Scholar 

  5. Neundörfer B, Seiberth R. The accessory deep peroneal nerve. J Neurol 1975; 209:125–129.

    Article  Google Scholar 

  6. Masakado Y, Kawakami M, Suzuki K, Abe L, Ota T, Kimura A. Clinical neurophysiology in the diagnosis of peroneal nerve palsy. Keio J Med 2008; 57:84–89.

    Article  Google Scholar 

  7. Baima J, Krivickas L. Evaluation and treatment of peroneal neuropathy. Curr Rev Musculoskelet Med 2008; 1:147–153.

    Article  Google Scholar 

  8. Owsiak S, Kostera-Pruszczyk A, Rowinska-Marcinska K. Accessory deep peroneal nerve - a clinically significant anomaly? Neurol Neurochir Pol 2008; 42:112–115.

    PubMed  Google Scholar 

  9. Infante E, Kennedy WR. Anomalous branch of the peroneal nerve detected by electromyography. Arch Neurol 1970; 22:162–165.

    Article  CAS  Google Scholar 

  10. Tzika M, Paraskevas GK, Kitsoulis P. The accessory deep peroneal nerve: a review of the literature. Foot (Edinb) 2012; 22:232–234.

    Article  CAS  Google Scholar 

  11. Murad H, Neal P, Katirji B. Total innervation of the extensor digitorum brevis by the accessory deep peroneal nerve. Eur J Neurol 1999; 6:371–373.

    Article  CAS  Google Scholar 

  12. Mathis S, Ciron J, du Boisguéheneuc F, Godenèche G, Hobeika L, Larrieu D, et al. Study of accessory deep peroneal nerve motor conduction in a population of healthy subjects. Neurophysiol Clin 2011; 41:29–33.

    Article  CAS  Google Scholar 

  13. Rayegani SM, Daneshtalab E, Bahrami MH, Eliaspour D, Raeissadat SA, Rezaei S, et al. Prevalence of accessory deep peroneal nerve in referred patients to an electrodiagnostic medicine clinic. J Brachial Plex Peripher Nerve Inj 2011; 6:3.

    PubMed  PubMed Central  Google Scholar 

  14. Statistical Package of Social Science, version 17 London: University of Cambridge computing service. Documentation: 2007.

  15. Kudoh H, Sakai T, Horiguchi M. The consistent presence of the human accessory deep peroneal nerve. J Anat 1999; 194:101–108.

    Article  Google Scholar 

  16. Kayal R, Katirji B. Atypical deep peroneal neuropathy in the setting of an accessory deep peroneal nerve. Muscle Nerve 2009; 40:313–315.

    Article  Google Scholar 

  17. Ubogu EE. Complete innervation of extensor digitorum brevis byaccessory peroneal nerve. Neuromuscul Disord 2005; 15:562–564.

    Article  Google Scholar 

  18. Saba EK. Electrophysiological study of Martin-Gruber anastomosis in a sample of Egyptians. Egypt Rheumatol Rehabil 2017; 44:153–158.

    Article  Google Scholar 

  19. Gutmann L. AAEM mini-monograph #2: important anomalous innervations of the extremities. Muscle Nerve 1993; 16:339–347.

    Article  CAS  Google Scholar 

  20. Crutchfield CA, Gutmann L. Hereditary aspects of accessory deep peroneal nerve. J Neurol Neurosurg Psychiatry 1973; 36:989–990.

    Article  CAS  Google Scholar 

  21. Budak F, Gönenc Z. Innervation anomalies in upper and lower extremities (an electrophysiological study). Electromyogr Clin Neurophysiol 1999; 39:231–234.

    CAS  Google Scholar 

  22. Sinanovic O, Zukic S, Sakic A, Muftic M. The accessory deep peroneal nerve and anterior tarsal tunnel syndrome: case report. Acta Myol 2013; 32:110–112.

    PubMed  PubMed Central  Google Scholar 

  23. Koo YS, Cho CC, Kim BJ. Pitfalls in using electrophysiological studies to diagnose neuromuscular disorders. J Clin Neurol 2012; 8:1–14.

    Article  Google Scholar 

  24. Sander HW, Quinto C, Chokroverty S. Accessory deep peroneal neuropathy: collision technique diagnosis. Muscle Nerve 1998; 21:121–123.

    Article  CAS  Google Scholar 

  25. Clarkson MJ, Fox JN, Atsas S, Daney BT, Dodson SC, Lambert HW. Clinical implications of novel variants of the fibularis (peroneus) quartus muscle inserting onto the cuboid bone: peroneocuboideus and peroneocalcaneocuboideus. J Foot Ankle Surg 2013; 52:118–121.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emmanuel K. A. Saba MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saba, E.K.A. Electrophysiological study of accessory deep peroneal nerve in a sample of Egyptian subjects. Egypt Rheumatol Rehabil 46, 251–256 (2019). https://doi.org/10.4103/err.err_19_19

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/err.err_19_19

Keywords