Excursion and strain of the superficial peroneal nerve during inversion ankle sprain

Patrick J. O'Neill, Brent G. Parks, Russell Walsh, Lucia M. Simmons, Stuart Miller

Research output: Contribution to journalArticle

Abstract

Background: Traction is presumed to be the mechanism of injury to the superficial peroneal nerve in an inversion ankle sprain, but it is not known whether the amount of strain caused by nerve traction is sufficient to cause nerve injury. We hypothesized that the superficial peroneal nerve would experience significant excursion and strain during a simulated inversion sprain, that sectioning of the anterior talofibular ligament would increase excursion and strain, and that an impact force would produce strain in a range that can structurally alter the nerve. Methods: Differential reluctance transducers were placed in the superficial peroneal nerve in sixteen lower-extremity cadaver specimens to measure excursion and strain in situ. Static weight was applied to the foot in increments starting at 0.454 kg and ending at 4.54 kg. The anterior talofibular ligament was sectioned, and the measurements were repeated. A final impact force of 4.54 kg was applied to each specimen. Two-way repeated-measures analysis of variance was used to evaluate differences in excursion and strain. Results: The mean excursion and strain of the superficial peroneal nerve increased with increases in the applied weight in both the group with the intact anterior talofibular ligament and the group in which it had been sectioned. Nerve excursion was greater in the sectioned-ligament group than in the intact-ligament group with all applied weights (p < 0.05). The mean nerve strain was greater in the sectioned-ligament group (range, 5.5% to 12.9%) than in the intact-ligament group (range, 3.0% to 11.6%) with application of the 0.454, 0.908, 1.362, and 1.816-kg weights (p < 0.05). With the ligament sectioned, the 4.54-kg impact force produced significantly higher mean nerve excursion and strain than did the 4.54-kg static weight (p < 0.05). Conclusions: The magnitude of strain with the impact force was in the lower range of values that have been shown to structurally alter peripheral nerves. The superficial peroneal nerve is at risk for traction injury during an ankle inversion sprain and is at additional risk with more severe sprains or with an insufficient anterior talofibular ligament. Clinical Relevance: Nerve injury may contribute to the high rate of residual morbidity after inversion ankle sprains.

Original languageEnglish (US)
Pages (from-to)979-986
Number of pages8
JournalJournal of Bone and Joint Surgery - Series A
Volume89
Issue number5
DOIs
StatePublished - Jan 1 2007
Externally publishedYes

Fingerprint

Ankle Injuries
Peroneal Nerve
Ligaments
Traction
Weights and Measures
Sprains and Strains
Wounds and Injuries
Transducers
Peripheral Nerves
Cadaver
Foot
Lower Extremity
Analysis of Variance
Morbidity

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Excursion and strain of the superficial peroneal nerve during inversion ankle sprain. / O'Neill, Patrick J.; Parks, Brent G.; Walsh, Russell; Simmons, Lucia M.; Miller, Stuart.

In: Journal of Bone and Joint Surgery - Series A, Vol. 89, No. 5, 01.01.2007, p. 979-986.

Research output: Contribution to journalArticle

O'Neill, Patrick J. ; Parks, Brent G. ; Walsh, Russell ; Simmons, Lucia M. ; Miller, Stuart. / Excursion and strain of the superficial peroneal nerve during inversion ankle sprain. In: Journal of Bone and Joint Surgery - Series A. 2007 ; Vol. 89, No. 5. pp. 979-986.
@article{c568dd8cdfbe4dc8b6fab3f2d7c7c742,
title = "Excursion and strain of the superficial peroneal nerve during inversion ankle sprain",
abstract = "Background: Traction is presumed to be the mechanism of injury to the superficial peroneal nerve in an inversion ankle sprain, but it is not known whether the amount of strain caused by nerve traction is sufficient to cause nerve injury. We hypothesized that the superficial peroneal nerve would experience significant excursion and strain during a simulated inversion sprain, that sectioning of the anterior talofibular ligament would increase excursion and strain, and that an impact force would produce strain in a range that can structurally alter the nerve. Methods: Differential reluctance transducers were placed in the superficial peroneal nerve in sixteen lower-extremity cadaver specimens to measure excursion and strain in situ. Static weight was applied to the foot in increments starting at 0.454 kg and ending at 4.54 kg. The anterior talofibular ligament was sectioned, and the measurements were repeated. A final impact force of 4.54 kg was applied to each specimen. Two-way repeated-measures analysis of variance was used to evaluate differences in excursion and strain. Results: The mean excursion and strain of the superficial peroneal nerve increased with increases in the applied weight in both the group with the intact anterior talofibular ligament and the group in which it had been sectioned. Nerve excursion was greater in the sectioned-ligament group than in the intact-ligament group with all applied weights (p < 0.05). The mean nerve strain was greater in the sectioned-ligament group (range, 5.5{\%} to 12.9{\%}) than in the intact-ligament group (range, 3.0{\%} to 11.6{\%}) with application of the 0.454, 0.908, 1.362, and 1.816-kg weights (p < 0.05). With the ligament sectioned, the 4.54-kg impact force produced significantly higher mean nerve excursion and strain than did the 4.54-kg static weight (p < 0.05). Conclusions: The magnitude of strain with the impact force was in the lower range of values that have been shown to structurally alter peripheral nerves. The superficial peroneal nerve is at risk for traction injury during an ankle inversion sprain and is at additional risk with more severe sprains or with an insufficient anterior talofibular ligament. Clinical Relevance: Nerve injury may contribute to the high rate of residual morbidity after inversion ankle sprains.",
author = "O'Neill, {Patrick J.} and Parks, {Brent G.} and Russell Walsh and Simmons, {Lucia M.} and Stuart Miller",
year = "2007",
month = "1",
day = "1",
doi = "10.2106/JBJS.F.00440",
language = "English (US)",
volume = "89",
pages = "979--986",
journal = "Journal of Bone and Joint Surgery - Series A",
issn = "0021-9355",
publisher = "Journal of Bone and Joint Surgery Inc.",
number = "5",

}

TY - JOUR

T1 - Excursion and strain of the superficial peroneal nerve during inversion ankle sprain

AU - O'Neill, Patrick J.

AU - Parks, Brent G.

AU - Walsh, Russell

AU - Simmons, Lucia M.

AU - Miller, Stuart

PY - 2007/1/1

Y1 - 2007/1/1

N2 - Background: Traction is presumed to be the mechanism of injury to the superficial peroneal nerve in an inversion ankle sprain, but it is not known whether the amount of strain caused by nerve traction is sufficient to cause nerve injury. We hypothesized that the superficial peroneal nerve would experience significant excursion and strain during a simulated inversion sprain, that sectioning of the anterior talofibular ligament would increase excursion and strain, and that an impact force would produce strain in a range that can structurally alter the nerve. Methods: Differential reluctance transducers were placed in the superficial peroneal nerve in sixteen lower-extremity cadaver specimens to measure excursion and strain in situ. Static weight was applied to the foot in increments starting at 0.454 kg and ending at 4.54 kg. The anterior talofibular ligament was sectioned, and the measurements were repeated. A final impact force of 4.54 kg was applied to each specimen. Two-way repeated-measures analysis of variance was used to evaluate differences in excursion and strain. Results: The mean excursion and strain of the superficial peroneal nerve increased with increases in the applied weight in both the group with the intact anterior talofibular ligament and the group in which it had been sectioned. Nerve excursion was greater in the sectioned-ligament group than in the intact-ligament group with all applied weights (p < 0.05). The mean nerve strain was greater in the sectioned-ligament group (range, 5.5% to 12.9%) than in the intact-ligament group (range, 3.0% to 11.6%) with application of the 0.454, 0.908, 1.362, and 1.816-kg weights (p < 0.05). With the ligament sectioned, the 4.54-kg impact force produced significantly higher mean nerve excursion and strain than did the 4.54-kg static weight (p < 0.05). Conclusions: The magnitude of strain with the impact force was in the lower range of values that have been shown to structurally alter peripheral nerves. The superficial peroneal nerve is at risk for traction injury during an ankle inversion sprain and is at additional risk with more severe sprains or with an insufficient anterior talofibular ligament. Clinical Relevance: Nerve injury may contribute to the high rate of residual morbidity after inversion ankle sprains.

AB - Background: Traction is presumed to be the mechanism of injury to the superficial peroneal nerve in an inversion ankle sprain, but it is not known whether the amount of strain caused by nerve traction is sufficient to cause nerve injury. We hypothesized that the superficial peroneal nerve would experience significant excursion and strain during a simulated inversion sprain, that sectioning of the anterior talofibular ligament would increase excursion and strain, and that an impact force would produce strain in a range that can structurally alter the nerve. Methods: Differential reluctance transducers were placed in the superficial peroneal nerve in sixteen lower-extremity cadaver specimens to measure excursion and strain in situ. Static weight was applied to the foot in increments starting at 0.454 kg and ending at 4.54 kg. The anterior talofibular ligament was sectioned, and the measurements were repeated. A final impact force of 4.54 kg was applied to each specimen. Two-way repeated-measures analysis of variance was used to evaluate differences in excursion and strain. Results: The mean excursion and strain of the superficial peroneal nerve increased with increases in the applied weight in both the group with the intact anterior talofibular ligament and the group in which it had been sectioned. Nerve excursion was greater in the sectioned-ligament group than in the intact-ligament group with all applied weights (p < 0.05). The mean nerve strain was greater in the sectioned-ligament group (range, 5.5% to 12.9%) than in the intact-ligament group (range, 3.0% to 11.6%) with application of the 0.454, 0.908, 1.362, and 1.816-kg weights (p < 0.05). With the ligament sectioned, the 4.54-kg impact force produced significantly higher mean nerve excursion and strain than did the 4.54-kg static weight (p < 0.05). Conclusions: The magnitude of strain with the impact force was in the lower range of values that have been shown to structurally alter peripheral nerves. The superficial peroneal nerve is at risk for traction injury during an ankle inversion sprain and is at additional risk with more severe sprains or with an insufficient anterior talofibular ligament. Clinical Relevance: Nerve injury may contribute to the high rate of residual morbidity after inversion ankle sprains.

UR - http://www.scopus.com/inward/record.url?scp=34248195901&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34248195901&partnerID=8YFLogxK

U2 - 10.2106/JBJS.F.00440

DO - 10.2106/JBJS.F.00440

M3 - Article

C2 - 17473134

AN - SCOPUS:34248195901

VL - 89

SP - 979

EP - 986

JO - Journal of Bone and Joint Surgery - Series A

JF - Journal of Bone and Joint Surgery - Series A

SN - 0021-9355

IS - 5

ER -