Common peroneal nerve ganglion following trauma

The current trend of proximal tibiofibular ganglion cyst: A summary of 7 case series and 61 case reports

Purpose

To review the different types of ganglion cysts surrounding the proximal tibio-fibular joint, their management options, outcomes, and recurrence.

Design

Descriptive analytical review.

Results

7 case series consisting of a total of 159 patients and 61 case reports consisting of 80 patients (with three patients having bilateral pathology) were included in this review. (Total cysts 159 + 83 = 242). The mean age was 41 years, and 71 % of the patients were males. 96.5 % of the cases were managed operatively, out of which 98 % of patients felt improvement in local symptoms and 71.5 % had improvement in neurological symptoms. Complete excision of the cyst is the primary mode of operative management. Many added procedures with complete excision are to mitigate the risk of recurrence. The recurrence rate of aspiration, simple excision alone, simple excision with recurrent articular branch neurectomy, and simple excision with PTFJ procedures were 77 %, 56 %, 11.5 %, and 0 %, respectively. Outcomes beyond recurrence were poorly reported.

Conclusion

There is not enough literature regarding the topic from which any formal systematic review can be done. Our summary suggests that aspiration alone or with steroid injection is associated with the highest recurrence rates among all the procedures. Complete excision with recurrent articular branch neurectomy should be the primary management. Revision cyst excision in isolation is an inadequate treatment option, therefore should be done in conjunction with PTFJ arthrodesis, which reduces the recurrence rates. Better quality studies are needed that report patient-centered outcomes and morbidities following PTFJ procedures.

Treatment approach to isolated common peroneal nerve palsy by mechanism of injury: Systematic review and meta-analysis of individual participants' data

BACKGROUND

We reviewed the individual participant data of patients who sustained isolated common peroneal nerve (CPN) injuries resulting in foot drop. Functional results were compared between eight interventions for CPN palsies to determine step-wise treatment approaches for the underlying mechanisms of nerve injury.

METHODS

PubMed, Embase, Cochrane Library, Web of Science, Scopus, and CINAHL databases were searched. PRISMA-IPD and Cochrane guidelines were followed in the data search. Eligible patients sustained isolated CPN injuries resulting in their foot drop. Patients were stratified by mechanisms of nerve injury, ages, duration of motor symptoms, and nerve defect/zone of injury sizes, and were compared by functional results (poor = 0, fair = 1, good = 2, excellent = 3), using meta-regression between interventions. Interventions evaluated were primary neurorrhaphy, neurolysis, nerve grafts, partial nerve transfer, neuromusculotendinous transfer, tendon transfer, ankle-foot orthosis (AFO), and arthrodesis.

RESULTS

One hundred and forty-four studies included 1284 patients published from 1985 through 2020. Transection/Cut: Excellent functional results following tendon transfer (OR: 126, 95%CI: 6.9, 2279.7, p=0.001), compared to AFO. Rupture/Avulsion: Excellent functional results following tendon transfer (OR: 73985359, 95%CI: 73985359, 73985359, p<0.001), nerve graft (OR: 4465917, 95%CI: 1288542, 15478276, p<0.001), and neuromusculotendinous transfer (OR: 42277348, 95%CI: 3001397, 595514030, p<0.001), compared to AFO. Traction/Stretch: Good functional results following tendon transfer (OR: 4.1, 95%CI: 1.17, 14.38, p=0.028), compared to AFO. Entrapment: Excellent functional results following neurolysis (OR: 4.6, 95%CI: 1.3, 16.6, p=0.019), compared to AFO.

CONCLUSIONS

Functional results may be optimized for treatments by the mechanism of nerve injury. Transection/Cut and Traction/Stretch had the best functional results following tendon transfer. Rupture/Avulsion had the best functional results following tendon transfer, nerve graft, or neuromusculotendinous transfer. Entrapment had the best functional results following neurolysis.

Compression of common peroneal nerve caused by an extraneural ganglion cyst mimicking intermittent claudication

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.

An unusual cause of paralysis of the peroneal nerve-a case report

A 12-year-old boy was referred to our clinic because of progressive paresis of left peroneal nerve. Ultrasound showed a cystic mass close to the proximity of the fibula neck. Puncture revealed jelly-like fluid, but that could not relieve symptoms. Six weeks after onset of symptoms, the boy had complete paresis. Peroneal intraneural ganglia are a rare entity of paralysis of the lower limb in children; more often these symptoms occur because of exostosis. Surgical exploration showed a cystic formation involving the common peroneal nerve. Total recovery of nerve function was seen two years later. Patients with exostosis showed varying outcomes. In children with symptoms suspicious of nerve compression, fast diagnosis and immediate treatment are mandatory to regain best possible recovery.

A posttraumatic, joint-connected sural intraneural ganglion cyst-with a new mechanism of intraneural recurrence: a case report

Intraneural ganglion cysts are rare in occurrence and most commonly involve the peroneal nerve at the fibular neck. We present a case of a traumatically induced intraneural ganglion cyst of the sural nerve that developed after a nondisplaced posterior malleolus ankle fracture. The intraneural ganglion cyst was connected to the subtalar joint by its articular branch and ascended several centimeters into the distal fourth of the leg. It was resected from the sural nerve proper and the posterior branch of the lateral calcaneal nerve, and the articular trunk was ligated. The patient developed subclinical intraneural recurrence, which was detected on a postoperative magnetic resonance imaging (MRI). Retrospective reinterpretation of the preoperative and postoperative MRIs revealed that ligation of the articular trunk proximal to a major branch (ie, the anterior branch of the lateral calcaneal nerve) led to increased intraneural cyst propagation distally: within the blind stump of the articular trunk and within several anterior branches of the lateral calcaneal nerve but not within the parent sural nerve or its continuation, the lateral dorsal cutaneous nerve. This mode of intraneural, but extraparental nerve recurrence can be easily understood by considering the altered fluid dynamics, particularly the increased resistance. This case report provides further evidence not only supporting the articular theory of intraneural ganglion formation but also highlighting the importance of searching for, identifying, and treating the pathologic articular branch connection near its joint connection in all cases.

LEVEL OF CLINICAL EVIDENCE

4.

Intraneural ganglion cyst of the peroneal nerve in a four-year-old girl: a case report

Intraneural ganglion cysts of the peroneal nerve are rare, usually occurring in adult men with a typical presentation of knee or proximal leg pain preceding motor weakness and/or sensory disturbances in the peroneal nervous distribution. A history of knee trauma and a palpable mass of the lateral knee in the region of the peroneal nerve are common. We present the unusual case of an intraneural ganglion cyst of the peroneal nerve in a 4-year-old girl. Although extremely rare in the pediatric population, the condition should be considered in the differential diagnosis of children presenting with new-onset foot deformities, foot drop, or clinical examinations consistent with a peroneal nerve lesion. Surgical treatment consisting of ganglion decompression with exploration and ligation of the articular branch of the peroneal nerve may result in improved functional recovery in the pediatric population compared with the adult population. Greater access to magnetic resonance imaging may allow diagnosis of cases that were not previously identified.

MR Imaging of Cysts, Ganglia, and Bursae About the Knee

Cystic lesions around the knee comprise a diverse group of entities, ranging from benign cysts to complications of underlying diseases such as infection, arthritis, and malignancy. Their diverse causes result in varied prognoses and therapeutic options. Although the presentation of cystic masses may be similar, their management may differ, thus highlighting the importance of appropriate categorization. MR aids in the characterization of lesions by first localizing them, and then defining their relationship with adjacent structures and identifying any additional abnormalities. For the purpose of this article, the authors limit the scope of their discussion to benign cysts, ganglia, and bursae about the knee.

A behavioral model of neuropathic pain induced by ligation of the common peroneal nerve in mice

Different laboratory animal models of neuropathic pain that replicate pathophysiological changes in patients have been developed. In most animal models of neuropathic pain, both sensory and motor nerves are injured. Thus, animals usually show both abnormal sensory and motor responses. Assessment of the sensory system is likely to be affected by the motor defects, although motor functions have not been evaluated in previous neuropathic pain models. An ideal neuropathic pain model to assess behavioral nociceptive responses in animals is one without affecting motor function and without muscle injury. Here, we report a novel mouse model of neuropathic pain with normal motor functions. Ligation of the common peroneal nerve near the head of fibula was performed by a less invasive procedure. Long-lasting behavioral allodynia and thermal hyperalgesia was observed in mice after the ligation. Furthermore, behavioral allodynia is resistant to morphine treatment at 5 mg/kg body weight, as reported in some cases of neuropathic pain. Standard rotarod test analysis confirmed intact motor functions. Our results show that ligation of the common peroneal nerve can be used as an efficacious mouse model for assessing behavioral nociceptive responses in neuropathic pain.

PERSPECTIVE

Tests to assess behavioral responses in a neuropathic pain model depend on intact motor functions. Here we report a less invasive procedure to ligate common peroneal nerve of leg to induce neuropathic pain with least motor defects.