Optimal stimulation site for deep peroneal motor nerve conduction study around the ankle: cadaveric study

Area of Science:

• Anatomy
• Neurophysiology
• Clinical Electrophysiology

Background:

• Deep peroneal nerve (DPN) conduction studies are crucial for diagnosing neurological conditions affecting the lower limb.
• Identifying the optimal stimulation point is essential for accurate and reliable electrodiagnostic assessments.

Purpose of the Study:

• To determine the precise anatomical location for optimal distal stimulation of the deep peroneal nerve (DPN).
• To enhance the accuracy and consistency of DPN motor nerve conduction studies.

Main Methods:

• A cadaveric dissection study was conducted on 30 ankles from 20 human cadavers.
• The deep peroneal nerve (DPN) was examined 8 cm proximal to the extensor digitorum brevis (EDB) muscle.
• The distance and relationship of the DPN to the tibialis anterior (TA), extensor hallucis longus (EHL), and extensor digitorum longus (EDL) tendons were documented.

Main Results:

• The median distance from the DPN to the tibialis anterior (TA) tendon was 10 mm (range, 1-21 mm).
• The DPN was located between the EHL and EDL tendons in 60% of cases.
• Varied anatomical relationships were observed between the DPN and surrounding tendons.

Conclusions:

• The optimal distal stimulation point for DPN conduction studies is approximately 1 cm lateral to the TA tendon, 8 cm proximal to the active electrode.
• Reconsideration of the stimulation site is advised for cases with weak distal responses without accessory peroneal nerves.