Case Study: Peroneal Nerve Entrapment

Our Patient

Our female patient came to us after unsuccessful treatment at another clinic. She presented with painful hip snapping, leg paresthesia (tingling/numbness), low back pain, sacroiliac(SI) joint pain, and gluteal pain. She had previously been treated with epidural steroid injections, piriformis steroid injections, and hip steroid injection, without long-term results.

The Challenge

Navigating the complexities of this case posed significant challenges. Distinguishing between peripheral nerve entrapment and spinal pathologies was difficult due to the diversity of symptoms. Interpreting the ultrasound images demanded a nuanced understanding of the body’s structures and systems.

Our Diagnosis

Our clinical exam revealed severe pelvic torsion and SI instability. We used high resolution diagnostic ultrasonography to examine our patient, and discovered fraying of the SI ligaments on the painful side, and thickening of the common peroneal nerve – a branch of the sciatic nerve that enables movement and sensation in the lower leg, foot and toes. Comprehensive ultrasonography enabled precise identification of multiple sites of peroneal nerve compression.

Our Conclusion

The sciatic nerve and its peroneal branch affect multiple structures along their path, from the lumbar spine to the feet and toes. Entrapment of the nerve in multiple places caused the patient to experience diverse symptoms that had previously been misdiagnosed and maltreated. In such cases, experience and expertise are crucial for identifying the underlying cause of symptoms. High resolution ultrasonography, when conducted by a skilled and knowledgeable practitioner, is an invaluable diagnostic tool.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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