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Acute Common Peroneal Neuropathy Due to Hand Positioning in Normal Labor and Delivery

Radawski, Melissa M. MD; Strakowski, Jeffrey A. MD; Johnson, Ernest W. MD

doi: 10.1097/AOG.0b013e31821dac98
Case Reports
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BACKGROUND: Foot drop has been described as an infrequent complication from common peroneal nerve injury related to external compression and forceful knee flexion while pushing during vaginal delivery. Past recommendations include placing the hands at the posterior thighs rather than the legs to avoid this complication.

CASE: A 32-year-old woman developed unilateral foot drop after vaginal delivery. Electromyography was diagnostic for an acute compression neuropathy of the common peroneal nerve above the knee.

CONCLUSION: The patient's likely mechanism of injury occurred during delivery from external compression by the patient's dominant hand to the distal posterior thigh while under epidural anesthesia. Labor and delivery teams should be aware that nerve injury is also possible at the distal thigh with excessive external pressure.

Patients can develop a common peroneal neuropathy during vaginal birth due to hand positioning by following current recommendations to grasp at their posterior thighs.

From the Departments of Physical Medicine and Rehabilitation, The Ohio State University Medical Center and Riverside Methodist Hospital, Columbus, Ohio.

See related editorial on page 413.

Corresponding author: Melissa M. Radawski, MD, 1028 Dodd Rehab Hospital, 480 Medical Center Drive, Columbus, OH 43210; e-mail: melissa.radawski@gmail.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 The American College of Obstetricians and Gynecologists