scholarly journals Intraneural Synovial Cyst of the Common Peroneal Nerve: An Unusual Cause of Foot Drop with Four-Year Follow-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Abrar Adil ◽  
Clint Basener ◽  
Jake Checketts
Keyword(s):  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Synovial Cyst ◽  
Foot Drop ◽  
Proximal Tibiofibular Joint ◽  
Cystic Fluid ◽  
Articular Branch ◽  
Tibiofibular Joint ◽  
The Common ◽  
Simple Decompression

In our case report, we describe a 55-year-old male patient with isolated foot drop due to an intraneural synovial ganglion. We successfully treated the lesion with decompression via epineurotomy combined with primary division of the recurrent articular branch of the common peroneal nerve (CPN). Compression neuropathies of the common peroneal nerve arise from a variety of causes. Intrinsic compression due to intraneural ganglion cysts of the CPN is rare. Previous reports of simple decompression of the cystic fluid have resulted in recurrence. The unified articular theory describes a pathway for fluid to fill from the proximal tibiofibular joint into the CPN via a recurrent articular branch. In our case, we divide this articular branch which we feel prevents recurrence.

scholarly journals Drop Foot Secondary to a Peroneal Intraneural Ganglion Connected to the Superior Tibiofibular Joint: A Case Report

2020 ◽  
Author(s):  
Kenan Kıbıcı ◽  
Berrin Erok ◽  
Akın Onat
Keyword(s):  
Peroneal Nerve ◽  
Imaging Modality ◽  
Axonal Neuropathy ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Intraneural Ganglion ◽  
Articular Branch ◽  
Ankle Eversion ◽  
Adjacent Structures ◽  
Tibiofibular Joint

AbstractPeroneal neuropathy is the most frequent mononeuropathy of the lower extremity. Intraneural ganglion cysts (INGCs) are among rare causes of peroneal nerve palsy. According to the articular (synovial) theory, the articular branch plays the key role in the pathogenesis. Patients present with pain around the fibular head and neck, motor weakness resulting in foot drop and paresthesia in the anterolateral calf and foot. Ultrasonography (US) and MRI are both useful in the diagnosis, but MRI is the best imaging modality in the demonstration of the articular connection and the relation of the cyst with adjacent structures, even without special neurography sequences. We present a 32-year-old male patient referred to our neurosurgery clinic with suspicion of lumbar radiculopathy. He presented with right foot drop which began 3 weeks prior. On examination, there was 90% loss in the ankle dorsiflexion and finger extension. Ankle eversion was also weakened. There was no low back or posterolateral thigh pain to suggest L5 radiculopathy and sciatic neuropathy. Following negative lumbar spine MRI, peripheral neuropathy was concerned. Electrodiagnostic evaluations findings were consistent with acute/subacute common peroneal nerve (CPN) axonal neuropathy. Subsequent MRI of knee showed a homogeneous, thin-walled tubular cystic lesion, extending along the course of the CPN and its articular branch. Full recovery of the neuropathy was achieved with early diagnosis and decompression via microsurgical epineurotomy. The diagnosis of INGC was confirmed by histopathologic examination. INGCs, although rare, should also be considered in the differential diagnosis of peripheral mononeuropathies.

scholarly journals Spontaneous intraneural hematoma of the common fibular nerve due to oral anticoagulation

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Stephanie Schwab ◽  
Christoph Kabbasch ◽  
Stefan J Grau
Keyword(s):  
Peroneal Nerve ◽  
Oral Anticoagulants ◽  
Factor V Leiden ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Nerve Lesion ◽  
Mri Findings ◽  
The Common ◽  
Fibular Nerve ◽  
Common Fibular Nerve

Abstract Compression syndromes affecting the common fibular nerve are common and frequently caused by direct pressure upon the fibular tip region. Here, we describe a case of a 50-year-old male presenting with sudden foot drop, which had developed spontaneously. He was on oral anticoagulants due to hereditary thrombophilia (factor-V-Leiden). Neurophysiology examination revealed a common peroneal nerve lesion at the fibular tip. T1-weighted magnetic resonance imaging (MRI) showed a not further classifiable hyperintensity within the common peroneal nerve. Surgical exploration revealed a diffuse intraneural hematoma, which was not evacuated. During follow-up, the nerve function recovered almost completely. In retrospect, MRI findings indicated a hematoma supported by the history of anticoagulant medication.

Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory

2003 ◽  
Vol 99 (2) ◽  
pp. 330-343 ◽  
Author(s):  
Robert J. Spinner ◽  
John L. D. Atkinson ◽  
Robert L. Tiel
Keyword(s):  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Clinical Results ◽  
Articular Branch ◽  
Content Type ◽  
Superior Tibiofibular Joint ◽  
Imaging Characteristics ◽  
Objective Evidence ◽  
Tibiofibular Joint ◽  
Fine Print

Object. Based on a large multicenter experience and a review of the literature, the authors propose a unifying theory to explain an articular origin of peroneal intraneural ganglia. They believe that this unifying theory explains certain intriguing, but poorly understood findings in the literature, including the proximity of the cyst to the joint, the unusual preferential deep peroneal nerve (DPN) deficit, the absence of a pure superficial peroneal nerve (SPN) involvement, the finding of a pedicle in 40% of cases, and the high (10–20%) recurrence rate. Methods. The authors believe that peroneal intraneural lesions are derived from the superior tibiofibular joint and communicate from it via a one-way valve. Given access to the articular branch, the cyst typically dissects proximally by the path of least resistance within the epineurium and up the DPN and the DPN component of the common peroneal nerve (CPN) before compressing nearby SPN fascicles. The authors present objective evidence based on anatomical, clinical, imaging, operative, and histological data that support this unifying theory. Conclusions. The predictable clinical presentation, electrical studies, imaging characteristics, operative observations, and histological findings regarding peroneal intraneural ganglia can be understood in terms of their origin from the superior tibiofibular joint, the anatomy of the articular branch, and the internal topography of the peroneal nerve that the cyst invades. Understanding the controversial pathogenesis of these cysts will enable surgeons to perform operations based on the pathoanatomy of the articular branch of the CPN and the superior tibiofibular joint, which will ultimately improve clinical results.

scholarly journals Peroneal nerve palsy caused by a synovial cyst of the proximal tibiofibular joint: A case report

2018 ◽  
Vol 4 (2) ◽  
pp. 11
Author(s):  
Swantje M. Kruspi ◽  
Michael Dietrich
Keyword(s):  
Lower Limb ◽  
Peroneal Nerve ◽  
Nerve Palsy ◽  
Rare Condition ◽  
Synovial Cyst ◽  
Sudden Onset ◽  
Proximal Tibiofibular Joint ◽  
Peroneal Nerve Palsy ◽  
Fast Recovery ◽  
Tibiofibular Joint

Peroneal nerve entrapment is the most common entrapment found in the lower limb, even though nerve palsy caused by a synovial cyst of the proximal tibiofibular joint (PTFJ) is a very rare condition. We report the case of a 54-year-old man who developed sudden onset of an incomplete foot droop and therefore presented himself to the emergency room. Further examination showed a compression of the peroneal nerve provoked by a synovial cyst of the PTFJ. Treatment involved puncture of the cyst. The patient showed a complete and fast recovery. We discuss our case with regards to the recent literatures.

Peroneal intraneural ganglia: the importance of the articular branch. Clinical series

2003 ◽  
Vol 99 (2) ◽  
pp. 319-329 ◽  
Author(s):  
Robert J. Spinner ◽  
John L. D. Atkinson ◽  
Bernd W. Scheithauer ◽  
Michael G. Rock ◽  
Rolfe Birch ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Articular Branch ◽  
Content Type ◽  
Superior Tibiofibular Joint ◽  
Imaging Characteristics ◽  
Clinical Series ◽  
Tibiofibular Joint ◽  
Fine Print

Object. The peroneal nerve is the most common site of intraneural ganglia. The neurological deficit associated with these cysts is often severe and the operation to eradicate them is difficult. The aims of this multicenter study were to collate the authors' experience with a relatively rare lesion and to improve clinical outcomes by better understanding its controversial pathogenesis. Methods. Part I of this paper offers a description of 24 patients with peroneal intraneural ganglia who were treated by surgeons aware of the importance of the peroneal nerve's articular branch. Part II offers a description of three more patients who were seen after earlier operations in which the ganglion was excised, but the articular branch was not identified (all reportedly gross-total resections). Twenty-six of the 27 patients presented with clinical, electrophysiological, and imaging evidence of a common peroneal nerve (CPN) lesion, predominantly affecting the deep peroneal nerve (DPN) division, and one patient presented with a painful mass of the CPN that was not accompanied by a neurological deficit. In all 24 patients in Part I there was magnetic resonance (MR) imaging evidence of a connection between the cyst and the superior tibiofibular joint, including one patient in whom high-resolution (3-tesla) MR neurography demonstrated the pathological articular branch itself. At the operation, the communication proved to extend through the articular branch of the CPN in all cases. The operation consisted of drainage of the cyst and ligation of the articular branch. At a minimum follow-up period of 1 year, these patients experienced significant improvements in their neuropathic pain, but only mild improvements in their functional deficits. In none of the 24 patients was there evidence of an intraneural recurrence. In three patients, however, extraneural ganglia developed: two patients with symptoms subsequently underwent resection of the superior tibiofibular joint without further recurrence and one patient with no symptoms was followed clinically after the recurrence was detected incidentally on 1-year postoperative imaging. As predicted, in Part II all three patients in whom the articular branch had not been ligated experienced early intraneural recurrence; both postoperative MR images and original studies, which were retrospectively examined, demonstrated a connection with the superior tibiofibular joint. Conclusions. The clinical presentation, electrical studies, imaging characteristics, and operative observations regarding peroneal intraneural ganglia are predictable. Treatment must address the underlying pathoanatomy and should include decompression of the cyst and ligation of the articular branch of the nerve. To avoid extraneural recurrence, resection of the superior tibiofibular joint may also be necessary, but indications for this additional procedure need to be defined. These recommendations are based on the authors' belief that intraneural peroneal ganglia arise from the superior tibiofibular joint and are connected to it by the articular branch.

scholarly journals A CADAVERIC STUDY OF COMMON PERONEAL NERVE IN RELATION TO FIBULAR TUNNEL

2021 ◽  
pp. 1-4
Author(s):  
Jaskaran Singh ◽  
Bhawani Shankar Modi ◽  
Kavita Pahuja ◽  
Tejendra Singh
Keyword(s):  
Peroneal Nerve ◽  
Close Contact ◽  
Average Distance ◽  
Common Peroneal Nerve ◽  
Lower Limbs ◽  
Foot Drop ◽  
Sensory Loss ◽  
Nerve Injuries ◽  
Muscle Nerve ◽  
The Common

INTRODUCTION: The common peroneal nerve is major lateral division of the sciatic nerve supplies lateral and anterior compartment of leg, when injured may leads to debilitating conditions such as foot drop and sensory loss or numbness in its supplied area. Common peroneal nerve's position subjects it to nerve injuries at two places one behind the knee joint where the nerve is superficial and other being the course of nerve through the fibular tunnel where its being tugged between musculo-aponeurotic fibers of peroneus longus muscle. Nerve injuries to common peroneal nerve has been attributed to several factors depending upon its anatomical position such as this may be due to sudden weight loss, prolonged sitting in squatting position, meniscus injuries in athletes or whether it is any surgical procedures involving the upper part of tibia and fibula. MATERIAL & METHODS: In present study we examine 70 lower limbs equally of right and left sides, the course, branching pattern and other reference point distances were measured with the help of metallic scale and dissections were photograph. RESULT: In 60% cases nerve separate from sciatic at the apex of popliteal fossa and in 80% cases it passes through the groove and then in about 70% specimen it passes through fibular tunnel, where it remains on an average 1.33 cm below the fibular head. The average distance of the nerve division was found 2.73 cm and just below that at a distance of 4.29 cm the nerve is in close contact with the bone. CONCLUSION: In present study we have observed average 7 muscular branches with variable origin from the common peroneal nerve in fibular tunnel which are likely to be damaged during surgical incision at this site.

Sign in / Sign up

Export Citation Format

Share Document