Peroneal Nerve Branching Suggests Compression Palsy in CMT Deformities

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Clin Orthop Relat Res. 2006 Jul 10

Peroneal Nerve Branching Suggests Compression Palsy in the

Deformities of Charcot-Marie Tooth Disease.

Guyton GP.

From the Department of Orthopaedic Surgery, The Union Memorial

Hospital, Baltimore, MD.

Altered expression of the PMP-22 protein may be implicated in Charcot-

Marie-Tooth disease and the much rarer disease, hereditary liability

to pressure palsy. An element of chronic pressure palsy may explain

the unique distribution of motor imbalance in patients with Charcot-

Marie-Tooth disease. If this is the case, innervation of the lateral

leg motor units should show sufficient anatomic segregation to

explain the variable disease patterns. Twelve fresh cadaver specimens

were dissected to examine the innervation of the anterior and lateral

compartment muscles from the peroneal nerve. Nine specimens had a

branch to the peroneus longus at or proximal to nerve passage of the

posterior fibular neck. The first branch to the peroneus longus was

2.1 +/- 6.7 mm proximal, and the first branch to the peroneus brevis

was 110.9 +/- 19 mm distal. The nerve to the tibialis anterior

originated within 5 mm of the reference point and wrapped

transversely along the fibular neck for 17.2 +/- 1.4 mm. These

discrete pathways to the individual motor units in the anterolateral

leg were consistent with the possible implication of chronic pressure

palsy in the patterns of atrophy in Charcot-Marie-Tooth disease.