Disclosures: Bo Song, MD: No financial relationships or conflicts of interest

Case Description: The patient reported burning pain in the left patellar tendon and fibular head area worse with exercise and ankle dorsiflexion. Initial MRI of the left leg revealed possible fat pad impingement, and he underwent 12 weeks of physical therapy without relief. Subsequently, he was diagnosed with L5 radiculopathy, undergoing 3 L5 epidural steroid injections without relief. He was then referred to Sports Medicine clinic for evaluation. Physical examination revealed 4/5 Extensor Hallicus Longus strength and tenderness over the fibular head concerning for peroneal nerve involvement.

Setting: Outpatient Sports Medicine Clinic

Patient: 15 year-old male with 9-month history of left knee pain after falling off bicycle Assessment/

Results: He underwent an ultrasound-guided hydrodissection of the left peroneal nerve with 5 mL of saline and 1 mL of corticosteroid with immediate pain relief for 3 days. Follow-up electromyelogram was negative for any focal neuropathy or lumbar radiculopathy. A repeat hydrodissection was performed at a more proximal location 2 weeks later with temporary improvement. A final hydrodissection along the course of the entire peroneal nerve was performed, eliciting an area 0.55 cm posterior to the fibular head where the nerve was entrapped and unable to be hydrodissected. He was referred to plastic surgery where he underwent a left common peroneal nerve release with symptom resolution.

Discussion: Peroneal nerve entrapment, commonly at the fibular neck, often presents with foot drop and sensory deficits. MRI is the standard for diagnosis but EMG/NCS can also be beneficial. Treatment typically involves surgical decompression however has high recurrence rates. Hydrodissection has traditionally been used for several medical utilities including adhesiolysis however has been described as successful in other musculoskeletal conditions and neuropathies.

Conclusion: In this case, ultrasound-guided hydrodissection provided symptomatic benefit while delineating the area of compression, allowing for surgical resolution of symptoms not visualized on MRI or ultrasound.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/hydrodissection-as-a-therapeutic-and-diagnostic-modality-in-treating-peroneal-nerve-compression-a-case-report/