Double synovial cyst of the proximal tibiofibular joint confirmed by MRI as a cause of the peroneal tunnel syndrome (original) (raw)
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Pan African Medical Journal, 2019
Synovial cyst of the proximal tibiofibular joint is a very rare condition, for which there is no consensus regarding treatment. Two macroscopic forms may be encountered: extraneural cysts and intraneural cysts. We present the cases of two patients who had synovial cysts of proximal tibiofibular joint that caused peroneal nerve palsy. We discussed the special features of synovial cysts and reviewed the literature. We considered the best treatment of synovial cysts originating from proximal tibiofibular joint and causing peroneal nerve palsy to be a total surgi cal removal as soon as possible after the diagnosis is made. However, follow-up is needed because recurrence is possible. It should be kept in mind that despite surgical treatment the neurological symptoms may not recover.
Archives of Orthopaedic and Trauma Surgery, 2004
Introduction Synovial cyst of the proximal tibiofibular joint is a very rare condition, for which there is no consensus regarding treatment. Case presentation We present three patients who had synovial cysts of proximal tibiofibular joint that caused peroneal nerve palsy. We discuss the special features of synovial cysts and review the literature. Conclusion We consider the best treatment of synovial cysts originating from proximal tibiofibular joint and causing peroneal nerve palsy to be total surgical removal as soon as possible after the diagnosis is made. It should be kept in mind that despite surgical treatment the neurological symptoms may not recover.
Giant Ganglion Cyst of the Proximal Tibiofibular Joint with Peroneal Nerve Palsy: A Case Report
Journal of Orthopaedic Case Reports, 2020
Introduction: Ganglion cysts are benign cystic tumors of musculoskeletal structures which have variable clinical presentations, however, compression neuropathies due to ganglion cyst are much less common in the lower extremity and only a couple of cases have been described in the literature. Hence, in the current case report, we describe a patient with a giant ganglion cyst causing peroneal nerve palsy which was managed surgically. Case Report: A 50-year-old female presented with a 2-month history of progressive left foot drop with a gradual development of swelling over the left fibular head. Imaging suggested ganglion cyst-induced peroneal nerve palsy. Initial conservative treatment failure warranted surgical excision which confirmed extraneural origin on histopathological examination. An immediate clinical improvement was observed postoperatively and full recovery occurred within 6 months. There was no recurrence at 2 years follow up Conclusion: The ganglion cyst-induced compressi...
Journal of Neurosurgery: Case Lessons
BACKGROUND The articular (synovial) theory describes the formation of intraneural ganglion cysts through defects in the capsule of synovial joints. While the articular theory is gaining significant traction in the literature, it is not universally accepted. Therefore, the authors present a case of a plainly visible peroneal intraneural cyst, although the subtle joint connection was not identified specifically at the time of surgery, with subsequent rapid extraneural cyst recurrence. The joint connection was not immediately evident on review of the magnetic resonance imaging, even to the authors who have a large experience with this clinical entity. The authors report this case to demonstrate that all intraneural ganglion cysts have joint connections, although they may be difficult to identify. OBSERVATIONS An occult joint connection in the intraneural ganglion poses a unique diagnostic and management dilemma. High-resolution imaging is a valuable tool used to identify the articular ...
Journal of Neurosurgery: Case Lessons, 2021
BACKGROUND The advancement of high-resolution imaging and increased clinical experience have led to an increased understanding of the formation and treatment of intraneural ganglion cysts. Nearly all intraneural ganglion cysts in the common peroneal nerve have been reported to arise from a joint connection to the superior tibiofibular joint. The authors have identified four cases of intraneural ganglion cysts arising from the knee joint itself; however, none of these reported cases were well described, documented, or illustrated with high-resolution imaging. OBSERVATIONS Here the authors present the case of an intraneural ganglion cyst arising from the knee joint and causing intermittent weakness and pain. The articular branch to the knee joint was clearly demonstrated on high-resolution magnetic resonance imaging and confirmed at surgical exploration. The patient was treated with articular branch ligation and has had complete resolution of his symptoms without recurrence of the cys...
The Journal of Foot and Ankle Surgery, 2009
A deep peroneal intraneural cyst of the first web space of the foot is presented. Analysis of the magnetic resonance image scans revealed not only a connection with the medial aspect of the second metatarsophalangeal joint, but also the presence of an interconnected cyst within the lateral digital branch of the hallux. These characteristic magnetic resonance image findings are consistent with those previously described for a peroneal intraneural ganglion cyst that arose from the superior tibiofibular joint, and include (1) origin (ascent) from the second metatarsophalangeal joint with propagation along the articular branch and into the dorsal digital branch of the second toe, (2) cross-over within the shared epineurial sheath of the deep peroneal nerve, and (3) further propagation (descent) within the dorsal digital branch of the hallux. The analogous features between intraneural ganglion cysts affecting small and large-caliber nerves support the fundamental principles of the unified articular (synovial) theory for the formation of intraneural ganglia, including (1) a connection to a synovial joint, (2) dissection of joint fluid through a capsular rent along the articular branch into the parent nerve, and (3) intra-epineurial, pressure-dependent propagation of cyst fluid along paths of least resistance.
Journal of Brachial Plexus and Peripheral Nerve Injury, 2013
Peripheral neuropathies caused by ganglion cysts are rare. They seldom cause serious complications especially in the lower extremities. The case was a 51-year-old woman referred by her physician to the vascular surgeon with diagnosis including intermittent (vascular) claudication and deep venous thrombosis. Primarily vascular surgeon performed a doppler ultrasound of the lower extremity and calculation of the ankle-brachial index. There were no abnormal pathological findings. Careful physical examination revealed soft swelling and tenderness around the fibular head and neck. Weakness was observed in foot eversion and dorsiflexion. There was pain and tingling in the distribution of the peroneal nerve. and referring the patient to orthopedic surgeon owing to concern for a potential compressive lesion at the right proximal tibiofibular region. Electromyogram studies and physical examination confirmed a diagnosis of compression neuropathy of common peroneal nerve. Magnetic resonance imaging revealed a fluid-filled, lobulated mass indicating a ganglion cyst. One months after decompression, the patient had no complaint. Fast diagnosis and immediate management are essential to regain best possible recovery.