Effects of Ultrasound-Guided Percutaneous Neuromodulation on Cutaneous Hyperalgesia and Hypoesthesia After Distal Fibular Fracture: A Clinical Case Report
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Abstract
Introduction: Neuropathic pain and sensory disturbances frequently follow surgical fixation of distal fibular fractures, largely due to the proximity of the superficial peroneal nerve (SPN) and common peroneal nerve (CPN). Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is a minimally invasive approach aiming to modulate peripheral nerve excitability and facilitate sensorimotor recovery. This case report describes the clinical effects of US-guided PNM applied to the SPN and CPN in a patient with chronic cutaneous hyperalgesia and hypoesthesia years after surgery.
Case Presentation: A 44-year-old woman presented with chronic postoperative burning pain, paresthesia, cutaneous hypoesthesia, and reduced limb control several years after open reduction and internal fixation, followed by hardware removal. At baseline, pain intensity (numerical rating scale, NRS) was 6/10; Douleur Neuropathique 4 (DN4) score was 5/10; sensory testing revealed hypoesthesia and mechanical hyperalgesia in the SPN dermatome; tibialis anterior and fibular muscle strength ranged 3–4/5 on the Medical Research Council (MRC) scale; ankle dorsiflexion was 15°, eversion 10°, knee-to-wall distance 5 cm, and single-leg stance 32 seconds.
Intervention: Two US-guided PNM sessions were performed: first targeting the SPN for sensory modulation (2–100 Hz, 400 µs, 30 min) and subsequently the CPN for sensorimotor facilitation (2 Hz, 240 µs, 30 min).
Results: Two US-guided PNM sessions were delivered within one week. After intervention, pain decreased to 2/10; DN4 score normalized to 0/10; sensory thresholds returned to normal; ankle dorsiflexion increased to 20°; eversion to 16°; knee-to-wall to 9 cm; single-leg stance to 43 seconds; tibialis anterior and fibular muscles improved to 5/5.
Conclusions: US-guided PNM may be a promising therapeutic option for chronic postoperative neuropathic symptoms involving the peroneal nerves. Controlled studies are warranted.
Keywords
- percutaneous neuromodulation
- peroneal nerve
- neuropathic pain
- postoperative complications
- ultrasound guidance
- invasive physiotherapy
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