M.

Shuja Tahir
Faisalabad, Pakistan
Clinical Skills
EXAMINATION OF COMMON
PERONEAL NERVE
Anatomy
The root value of lateral popliteal
nerve is lumbar 4,5 - sacral1,2. It is
lateral branch of sciatic nerve at
superior angle of popliteal fossa. It
winds around the fibular neck
where it is susceptible to injury. It
gives following branches;
! Communicating sural nerve.
! Lateral cutaneous nerve of the
calf.
! Extensors and abductors of leg.
! Evertors of foot.
! Skin over peroneal and
extensor compartment of the
leg
! Knee joint and superior tibio
fibular joint.
It is injured due to injury just below
the knee joint. It is associated with
fracture neck of fibula or in tight
fitting plasters.
It may also be injured accidently
during surgery for varicose veins.
Its injury leads to loss of function of
muscles of anterior and lateral
compartments of the leg below
knee and short extensor muscles of
the toes.
SPECIAL INTERVIEW
Questions should be asked to find
out difficulty in walking and history
of injury or plaster application.
IR-038
CLINICAL ASSESSMENT
LOOK
Look for abnormalities;
Foot drop is seen.
Equino varus deformity is seen.
Check gait;
It is slapping and excess pressure is
seen on outer side of the foot. The
toe of shoe is scuffed.
FEEL
Check sensations;
fine touch, pin prick and
temperature sensations are
checked.
There is loss of sensations over the
lateral and anterior aspect of leg
along with medial aspect of the
dorsum of the foot.
MOVE
Check for eversion of foot against
resistance;
Failure to do so is due to paralysis of
everters such as;
Peroneus longus and peroneus
brevis
Examine extension / dorsiflexion at
the ankle and other joints of the foot
and toes.

Failure to do so is due to paralysis of

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the muscles of extensor performed and its record is kept for
compartment. future reference and comparison.

REFLEXES Motor function grading is described

Ankle jerk is absent on the affected as below ;
side. Grade Power
Testing fine touch sensation
0 No contraction
GRADING 1 Flicker or trace of contraction
2 Active movement in a plane perpendicular to
Sensory, motor and vasomotor gravity
changes are examined to have 3 Active movement against gravity
adequate assessment of the 4 Active movement against gravity and resistance
(weaker than normal)
neuronal injury. The grading of
5 Normal power
muscle power (motor function) is

CHECK LIST
SPECIAL INTERVIEW
LOOK
for Foot drop
Equinovarus deformity
High stepping gait
Ankle jerk
FEEL
Sensation at lateral and anterior aspect
of leg with medial part of dorsum of foot

MOVE
Eversion of foot
Dorsiflexion of toes and ankle
Ankle reflex

The author :
Muhammad Shuja Tahir
FRCS (Ed), FCPS (Hon)
is professor and head of the
department of Surgery at
Independent Medical
College Faisalabad.
shuja@iu-hospital.com

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