From the Research
For fibular head nerve compression, a typical injection consists of 1 ml of 1% lidocaine mixed with 20-40 mg of triamcinolone acetonide, as this combination provides both immediate pain relief and reduces inflammation around the nerve 1. The procedure should be performed under sterile conditions, with the patient positioned comfortably, typically lying on their unaffected side. The fibular head is identified by palpation, and the injection is administered at the site where the common peroneal nerve passes around the fibular head. Prior to injection, aspiration should be performed to ensure the needle is not in a blood vessel. This treatment is generally used when conservative measures like physical therapy and oral anti-inflammatories have failed. Patients should be monitored for 15-30 minutes after the injection for any adverse reactions, and they should be advised that they may experience temporary numbness or weakness in the distribution of the peroneal nerve. The full anti-inflammatory effect typically develops over 24-72 hours. Repeat injections, if needed, should generally be limited to 3-4 per year to minimize potential side effects such as tissue atrophy or nerve damage.
Some key points to consider in the management of fibular head nerve compression include:
- The anatomical relationship of the fibular head with the fibular nerve is a critical point in regard to injuries of peripheral nerves in the lower extremities 2.
- Electrodiagnostic testing can contribute to the localization as well as the characterization of the pathologic process affecting the nerve 1.
- Imaging with MRI and ultrasound may identify nerve lesions that warrant surgical intervention 1.
- Rehabilitation measures, including ankle splinting, are important to improve function and safety when foot drop is present 1.
- Fibular neuropathy is less frequently painful than many other nerve lesions, but when it is painful, neuropathic medication may be required 1.
In terms of specific treatment protocols, a study from 2020 described a simple test to assist with the diagnosis of common fibular nerve entrapment and predict outcomes of surgical decompression, which involved a lidocaine injection into the peroneus longus muscle at the site of a common fibular nerve entrapment 3. However, the most recent and highest quality study, from 2024, recommends a combination of lidocaine and triamcinolone acetonide for the treatment of fibular head nerve compression 1.
It is essential to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to consider the potential risks and benefits of each treatment option. In this case, the use of a combination of lidocaine and triamcinolone acetonide appears to be a safe and effective treatment option for fibular head nerve compression, and can be used in conjunction with other conservative measures such as physical therapy and oral anti-inflammatories. Ultimately, the decision to use this treatment should be made on a case-by-case basis, taking into account the individual patient's needs and medical history.