Compression neuropathy of the peroneal nerve secondary to a ganglion cyst

Palsy of Both the Tibial Nerve and Common Peroneal Nerve Caused by a Ganglion Cyst in the Popliteal Area

A ganglion cyst is a benign mass consisting of high-viscosity mucinous fluid. It can originate from the sheath of a tendon, peripheral nerve, or joint capsule. Compressive neuropathy caused by a ganglion cyst is rarely reported, with the majority of documented cases involving peroneal nerve palsy. To date, cases demonstrating both peroneal and tibial nerve palsies resulting from a ganglion cyst forming on a branch of the sciatic nerve have not been reported. In this paper, we present the case of a 74-year-old man visiting an outpatient clinic complaining of left-sided foot drop and sensory loss in the lower extremity, a lack of strength in his left leg, and a decrease in sensation in the leg for the past month without any history of trauma. Ankle dorsiflexion and great toe extension strength on the left side were Grade I. Ankle plantar flexion and great toe flexion were Grade II. We suspected peroneal and tibial nerve palsy and performed a screening ultrasound, which is inexpensive and rapid. In the operative field, several cysts were discovered, originating at the site where the sciatic nerve splits into peroneal and tibial nerves. After successful surgical decompression and a series of rehabilitation procedures, the patient's neurological symptoms improved. There was no recurrence.

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.

Common Peroneal Nerve Compression Neuropathy Due to a Large Synovial Cyst From the Proximal Tibiofibular Joint in a Teenager

Ganglion cysts are very rare in the lower limb and when present, ganglion cysts rarely cause compression neuropathy at any site. Peripheral nerve sheath tumors as a whole, are also very rare and mostly presented as a painful lump along the nerve path. Ganglion cysts are non-neoplastic gelatinous cysts, which lack true synovial lining. They can be divided into intraneural cysts which can be found within the epineurium of a peripheral nerve and lead to signs and symptoms of peripheral neuropathy or extraneural cysts which can develop from surrounding joints or tendon sheaths causing gradual nerve compression. Intraneural tumors of common peroneal nerve (CPN) are widely reported in the literature with varying degrees of symptoms; however, there are only a few case reports describing CPN palsy due to extraneural cysts. We are reporting a rare case of atraumatic CPN palsy, which resulted in irreversible foot drop in a teenage boy who presented with right leg radiating calf and foot pain. We recommend prompt investigation and excision of the cyst to decompress the nerve to increase the chances of early recovery and favorable outcomes.

Proximal Tibiofibular Joint Arthrodesis Due to Recurrent Giant Ganglion Cyst Causing Peroneal Nerve Palsy

Ganglion cysts are masses that we encounter frequently in our daily practice, usually in the upper extremity, less frequently in the lower extremities, and rarely cause compression symptoms. We present a case of a massive ganglion cyst of the lower limb causing peroneal nerve compression, managed with excision and proximal tibiofibular joint arthrodesis to prevent recurrence. Examination and radiological imaging of a 45-year-old female patient who was admitted to our clinic showed new-onset weakness in right foot movements and numbness on the dorsum of the foot and lateral cruris, a mass consistent with a ganglion cyst expanding the muscle was detected in the peroneus longus muscle. In the first surgery, the cyst was carefully resected. After three months, the patient came with a repeated mass on the lateral side of the knee. After confirmation of the ganglion cyst with clinical examination and MRI, a second surgery was planned for the patient. In this stage, we performed a proximal tibiofibular arthrodesis for the patient. Her symptoms recovered during the early follow-up period and no recurrence occurred during the two years of the follow-up period. Although the treatment of ganglion cysts seems easy, it can sometimes be challenging. We think that arthrodesis may be a good treatment option in recurrent cases.

Differential diagnosis and treatment of foot drop caused by an extraneural ganglion cyst above the knee: A case report

BACKGROUND

One of the causes of foot drop is compression of the common peroneal nerve caused by space-occupying lesions such as a synovial cyst or a ganglion cyst. Most previous reports have involved compressive common peroneal neuropathy by intraneural ganglion cysts and synovial cysts. Compression of the peroneal nerve by extraneural ganglion cysts is rare. We report a rare case of compressive common peroneal neuropathy by an extraneural ganglion cyst.

CASE SUMMARY

A 46-year-old man was hospitalized after he reported a right foot drop for 1 mo. Manual muscle testing revealed scores of 1/5 on dorsiflexion of the right ankle. Hypoesthesia and paresthesia on the right lateral leg and foot dorsum were noted. He was diagnosed with a popliteal cyst by using electrophysiologic study and popliteal ultrasound (US). To facilitate common peroneal nerve (CPN) decompression, 2 cc of sticky gelatinous material was aspirated from the cyst under US guidance. Electrical stimulation and passive and assisted active ROM exercises of the right ankle and strengthening exercises for weak muscles using elastic band were prescribed based on the change of muscle power. A posterior leaf spring ankle-foot orthosis was prescribed to assist the weak dorsiflexion of the ankle. Follow-up US revealed that the cystic lesion was growing and magnetic resonance imaging demonstrated compression of the CPN by the cystic mass. The cyst was resected to prevent impending compression of the CPN.

CONCLUSION

Precise diagnosis and immediate treatment are important in cases of compressive common peroneal neuropathy caused by an extraneural cyst.

Ganglion cyst at the proximal tibiofibular joint - A rare cause of compression neuropathy of the peroneal nerve

Ganglion cysts are fluid filled sacs which develop near joints and tendons and are usually asymptomatic. Lower limb ganglion cysts are rare occurrences especially those situated around joint spaces causing nerve compression. We present the case of a 68 year-old female with history of progressive swelling in the left antero-lateral leg, associated with pain, and neurological symptoms of peroneal nerve compression. Magnetic resonance imaging (MRI) revealed a large proximal tibiofibular joint ganglion cyst causing peroneal nerve compression. One year following the left sided presentation, the patient presented with similar but less severe symptoms in her right antero-lateral leg. MRI revealed a small juxta-articular ganglion cyst in the right proximal tibiofibular joint space. We discuss etiology, symptoms, and management of lower limb ganglion cysts.

Intraneural Peroneal Ganglion Cyst Excision in a Pediatric Patient: A Case Report

CASE

A 14-year-old female presented with a profound foot drop after trauma to the right leg. Clinical examination and electrodiagnostic studies demonstrated a dense palsy of the common peroneal nerve. Magnetic resonance imaging revealed an intraneural peroneal ganglion cyst at the fibular neck. Surgical treatment included decompression and transection of the articular branch to the proximal tibiofibular joint. At the 1-year follow-up, the patient demonstrated complete recovery of peroneal nerve function.

CONCLUSIONS

This case demonstrates a rare finding of a pediatric intraneural peroneal ganglion cyst. The presentation and treatment is well-documented and adds depth to the literature on a sparsely reported condition.

Peroneal neuropathy caused by an extraneural ganglion cyst in the supracondylar area of the femur: A case report

RATIONALE

Peroneal neuropathy is the most common type of peripheral neuropathy in the lower extremities. The peroneal nerve is usually compressed at the lateral aspect of the fibular head. Compression by ganglion cysts are one of the numerous underlying etiologies for peroneal nerve neuropathy and are most frequently located around the fibular neck and proximal tibiofibular joint. To the best of our knowledge, this is the first report of an extraneural ganglion cyst located at the level of the distal thigh that resulted in compressive peroneal neuropathy.

PATIENT CONCERNS

We report a case of a 56-year-old man with sudden onset of left foot drop and gait disturbance caused by an extraneural ganglion cyst located in the popliteal fossa.

DIAGNOSIS

Electrodiagnosis (EDX) suggested a peroneal nerve lesion. Subsequently, diagnostic ultrasonography (USG) revealed a cystic mass located within the left side of the supracondylar area of femur. Further magnetic resonance imaging confirmed that the mass was located at the proximal of popliteal fossa.

INTERVENTIONS

Surgical excision was performed using a direct posterior approach. The cystic mass was compressing the common peroneal nerve, and was carefully and completely removed ensuring that all nerve branches were protected.

OUTCOMES

A histopathologic evaluation confirmed the diagnosis of a ganglion cyst. There were no postoperative complications. Two months after the surgery, follow-up USG revealed no evidence of cyst recurrence or residual lesions. Six months after the surgery, the ankle dorsiflexor motor power improved and he experienced less pain and hypoesthesia.

LESSONS

Physicians should bear in mind that the peroneal neuropathy can occur because of the ganglion cyst in the distal thigh. The thorough evaluation of EDX and USG is crucial for the early diagnosis and surgical intervention, although there is no abnormal finding around the fibular neck.

Isolated medial plantar neuropathy caused by a large ganglion cyst diagnosed with MRI: A case report

•

Compression neuropathy caused by a ganglion cyst is a rare entity.

•

MRI remains an excellent diagnostic modality to evaluate the masses in the foot.

•

This is a very rare report of isolated medial plantar neuropathy by a ganglion cyst.

Introduction

Although ganglion cysts are common soft tissue tumors, nerve compression syndrome caused by a ganglion cyst in the lower extremities is very rare. Herein, we report a 57-year-old man who presented with hypoesthesia in the sole of his right foot for 6 months. We believe that reporting this rare case will help clinicians update their knowledge on possible causes of the plantar neuropathy, and avoid diagnostic delay.

Presentation of case

The patient had pain and numbness in the inner right sole, as well as a tingling and dull sensation. Tenderness around the area of abnormal sensation was not evident. Percussion at the abductor tunnel gave a positive Tinel’s sign in the medial plantar nerve. No mass was palpable in the right foot. Based on the electrophysiological findings, we diagnosed medial plantar nerve entrapment in the right foot. Magnetic resonance imaging (MRI) was conducted to identify a 5.5-cm long elongated cystic lesion as the cause of entrapment. The patient underwent surgical removal of the cystic mass, with histologic examination confirming the diagnosis of a large ganglion cyst.

Discussion

The feasibility of nerve conduction studies and electromyography for detection of nerve entrapment is still controversial. MRI is considered the best diagnostic modality, if biopsy is not feasible.

Conclusion

We suggest that foot imaging and electrophysiological studies should be considered for patients with isolated median plantar neuropathy to exclude the presence of space-occupying lesions, especially when conservative treatment is not effective.

An Unusual Cause of Foot Drop: Peroneal Extraneural Ganglion Cyst

Peripheral neuropathies caused by ganglion cysts are quite rare, especially in the lower extremities. The case of a 64-year-old male with a 2-day history of foot drop and tenderness in the region of the left fibular neck is presented. Physical examination and electromyogram findings verified peroneal nerve palsy. Ultrasonography showed cystic mass localized proximal of the peroneal muscle structures. Magnetic resonance imaging revealed a cystic-appearing mass around the fibular neck that compressed the common peroneal nerve. Surgical excision and ligation of the cyst pedicle were performed. The pathology reports confirmed the diagnosis of a ganglion cyst. The patient regained full function within two months of the surgery. Early sensory symptoms before foot drop should be considered as an indication of surgical excision to prevent delayed damage. Ligation or electrocoagulation of the cyst pedicle should be a part of surgical procedure to avoid recurrences.

Deep peroneal nerve palsy caused by an extraneural ganglion cyst: a rare case

Lower extremities peripheral neuropathies caused by ganglion cysts are rare. The most frequent location of occurrence is the common peroneal nerve and its branches, at the level of the fibular neck. We report the case of a 57-year-old patient admitted with foot drop, due to an extraneural ganglion of the upper tibiofibular syndesmosis, compressing the deep branch of the peroneal nerve. Although there have been many previous reports of intraneural ganglion involvement with the lower limb nerves, to our knowledge, this is the second reported occurrence of an extraneural ganglion distinctly localized to the upper tibiofibular syndesmosis and palsying deep peroneal nerve. The diagnosis was made preoperatively using MRI. The common peroneal nerve and its branches were recognized and traced to its bifurcation during the operation, and the ganglion cyst was removed. Two months after surgery, the patient was pain-free and asymptomatic except for cutaneous anesthesia in the distribution of the deep peroneal nerve.

Compression neuropathy of the common peroneal nerve by the fabella

The fabella is a normal anatomical variant and has been found in up to 30% of the general population. We present the case of a 67-year-old man with pain down the lateral aspect of the left lower limb of 18 months duration. A clinical examination revealed a palpable fabella and nerve conduction studies confirmed a common peroneal nerve neuropathy at its level. Dynamic ultrasound scan and MRI of the knee showed the fabella to be impinging on the common peroneal nerve. Operative excision of the fabella was performed with significant improvement at 3 months and full recovery at 1 year. A literature review has shown that the last reported case of a compression neuropathy of the common peroneal nerve was in 1976. Anatomical considerations need to be taken into account and operative treatment has been recommended due to the favourable outcome in this case.

Foot drop secondary to peroneal intraneural cyst arising from tibiofibular joint

An 11-year-old boy presented to our outpatient clinic with a three-month history of pain over the fibular head area and gait difficulty. Surgical exploration revealed a mass arising from the superior tibiofibular joint invading the peroneal nerve along the articular branch of the common peroneal nerve. The pathogenesis of the intraneural ganglion of the peroneal nerve may be an articular origin and superior tibiofibular joint is the central point.

LEVEL OF EVIDENCE

V.

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.

Peroneal neuropathy misdiagnosed as L5 radiculopathy: a case report

Objective

The purpose of this case report is to describe a patient who presented with a case of peroneal neuropathy that was originally diagnosed and treated as a L5 radiculopathy.

Clinical features

A 53-year old female registered nurse presented to a private chiropractic practice with complaints of left lateral leg pain. Three months earlier she underwent elective left L5 decompression surgery without relief of symptoms.

Intervention and outcome

Lumbar spine MRI seven months prior to lumbar decompression surgery revealed left neural foraminal stenosis at L5-S1. The patient symptoms resolved after she stopped crossing her legs.

Conclusion

This report discusses a case of undiagnosed peroneal neuropathy that underwent lumbar decompression surgery for a L5 radiculopathy. This case study demonstrates the importance of a thorough clinical examination and decision making that ensures proper patient diagnosis and management.

Verification of nerve integrity after surgical intervention using quantitative sensory testing

PURPOSE

The aim of this study was to apply a standardized Quantitative Sensory Testing (QST) approach in patients to investigate whether oral surgery can lead to sensory changes, even if the patients do not report any sensory disturbances. Furthermore, this study determines the degree and duration of possible neuronal hyperexcitability due to local inflammatory trauma after oral surgery.

PATIENTS AND METHODS

Orofacial sensory functions were investigated by psychophysical means in 60 patients (30 male, 30 female) in innervation areas of infraorbital nerves, mental nerves and lingual nerves after different interventions in oral surgery. The patients were tested 1 week, 4 weeks, 7 weeks, and 10 weeks postoperatively. As controls for bilateral sensory changes after unilateral surgery, tests were additionally performed in 20 volunteers who did not have any dental restorations.

RESULTS

No differences were found between the control group and the control side of the patients. Although not 1 of the patients reported paresthesia or other sensory changes postoperatively, QST detected significant differences between the control and the test side in the mental and lingual regions. Test sides were significantly less sensitive for thermal parameters (cold, warm, and heat). No differences were found in the infraorbital region. Patients showed significantly decreased pain pressure thresholds on the operated side. QST monitored recovery over time in all patients.

CONCLUSIONS

The results show that oral surgery can lead to sensory deficits in the mental and lingual region, even if the patients do not notice any sensory disturbances. The applied QST battery is a useful tool to investigate trigeminal nerve function in the early postoperative period. In light of the increasing forensic implication, this tool can serve to objectify clinical findings.

Common peroneal neuropathy related to cryotherapy and compression in a footballer

This report describes the effect of excessive cooling with ice, and compression with a plastic wrap on the common peroneal nerve (CPN) for 90 minutes in a professional footballer, which led to a common peroneal nerve palsy and a resulting footdrop. It highlights the need to be cautious with regards to the duration and frequency of icing as well as the choice of anchoring material when applying ice to injured areas that have superficial nerves passing nearby. Full recovery of the CPN function occurred in this athlete after five weeks. The major causes of footdrop and common causes of common peroneal neuropathy are discussed.