The successful arthroscopic treatment of suprascapular intraneural ganglion cysts

OBJECT High-resolution magnetic resonance imaging (MRI) can distinguish between intraneural ganglion cysts and paralabral (extraneural) cysts at the glenohumeral joint. Suprascapular intraneural ganglion cysts share the same pathomechanism as their paralabral counterparts, emanating from a tear in the glenoid labrum. The authors present 2 cases to demonstrate that the identification and arthroscopic repair of labral tears form the cornerstone of treatment for intraneural ganglion cysts of the suprascapular nerve. METHODS Two patients with suprascapular intraneural ganglion cysts were identified: 1 was recognized and treated prospectively, and the other, previously reported as a paralabral cyst, was identified retrospectively through the reinter-pretation of high-resolution MR images. RESULTS Both patients achieved full functional recovery and had complete radiological involution of the intraneural ganglion cysts at the 3-month and 12-month follow-ups, respectively. CONCLUSIONS Previous reports of suprascapular intraneural ganglion cysts described treatment by an open approach to decompress the cysts and resect the articular nerve branch to the glenohumeral joint. The 2 cases in this report demonstrate that intraneural ganglion cysts, similar to paralabral cysts, can be treated with arthroscopic repair of the glenoid labrum without resection of the articular branch. This approach minimizes surgical morbidity and directly addresses the primary etiology of intraneural and extraneural ganglion cysts.

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Ulnar Neuropathy due to Intraneural Ganglion Cyst of the Ulnar Nerve at the Elbow

Indian Journal of Neurosurgery ◽

10.1055/s-0038-1639385 ◽

2018 ◽

Vol 07 (03) ◽

pp. 260-264 ◽

Cited By ~ 1

Author(s):

Byung-chul Son ◽

Jin-gyu Choi ◽

Hak-cheol Ko

Keyword(s):

Ulnar Nerve ◽

Elbow Joint ◽

Glenohumeral Joint ◽

Ganglion Cyst ◽

Ulnar Neuropathy ◽

Intraneural Ganglion ◽

Intraneural Ganglion Cyst ◽

Articular Branch ◽

Right Hand ◽

Ganglion Cysts

AbstractIntraneural ganglion cysts are rare mucinous cyst originating within the epineurium of peripheral nerves. They occur most commonly in the peroneal nerve. However, they have also been described in many nerves in the vicinity of synovial joints. Intraneural ganglion cysts in the upper extremity are rare. Those at the elbow joint comprise only 9% of intraneural ganglion ever reported.A 66-year-old and right-handed male patient presented with a sudden onset of right-hand weakness. He initially noticed paresthesia with decreased sensation in the lateral two digits and radial palm in his right hand. Physical examination showed thenar muscle atrophy and muscle weakness of the abductor pollicis brevis in the right hand. Preoperative diagnosis of intraneural ganglion cyst was made on the basis of characteristic magnetic resonance imaging (MRI) findings. On exploration, the ulnar nerve was identified proximal to the elbow joint. Its articular branch was addressed and divided from the elbow joint.To the best of our knowledge, addressing the articular branch connecting the glenohumeral joint for the treatment of intraneural ganglion at the elbow has only been reported twice. We experienced a rare occurrence of intraneural ganglion cyst at the elbow manifesting an ulnar neuropathy. Here, we report intraoperative findings for the articular branch-connected to intraneural ganglion of the ulnar nerve at the elbow. Early diagnosis of intraneural ganglion with precise identification of the pathology and addressing the articular branch with atraumatic dissection of ganglion cyst are essential to achieve successful treatment for this rare lesion.

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Two different pathways for suprascapular intraneural ganglion cysts along two distinct articular branches from the glenohumeral joint

Clinical Anatomy ◽

10.1002/ca.20966 ◽

2010 ◽

Vol 23 (4) ◽

pp. 462-465 ◽

Cited By ~ 5

Author(s):

Robert J. Spinner ◽

Marie-Noëlle Hébert-Blouin ◽

Diane L. Dahm ◽

Kimberly K. Amrami

Keyword(s):

Glenohumeral Joint ◽

Intraneural Ganglion ◽

Ganglion Cysts

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Outcomes of Arthroscopic Repair of Panlabral Tears of the Glenohumeral Joint

The American Journal of Sports Medicine ◽

10.1177/0363546512460834 ◽

2012 ◽

Vol 40 (11) ◽

pp. 2561-2568 ◽

Cited By ~ 17

Author(s):

Eric T. Ricchetti ◽

Michael C. Ciccotti ◽

Daniel F. O’Brien ◽

Matthew J. DiPaola ◽

Peter F. DeLuca ◽

...

Keyword(s):

Revision Surgery ◽

Glenohumeral Joint ◽

Case Series ◽

Arthroscopic Repair ◽

Labral Repair ◽

Glenoid Labrum ◽

Superior Labrum ◽

Shoulder Score ◽

Anterior Posterior

Background: Combined lesions of the glenoid labrum involving tears of the anterior, posterior, and superior labrum have been infrequently reported in the literature. Purpose: To evaluate the clinical outcomes of arthroscopic repair of these lesions in a general population using validated scoring instruments, presence of complications, and need for revision surgery. Study Design: Case series; Level of evidence, 4. Methods: Fifty-eight patients who had arthroscopic labral repair of tears involving the anterior, posterior, and superior labrum (defined as a panlabral repair) were identified at our institution by retrospective review. All patients underwent arthroscopic labral repair with suture anchor fixation by a uniform approach and with a standardized postoperative protocol. Forty-four patients had a minimum 16-month postoperative follow-up. Outcomes were assessed postoperatively by the American Shoulder and Elbow Surgeons (ASES) score and the Penn Shoulder score. Complications were also documented, including need for revision surgery. Results: The mean age at the time of surgery was 32 years (range, 15-55 years) in the 44 patients. Presenting shoulder complaints included pain alone (40%), instability alone (14%), or pain and instability (45%). Mean number of anchors per repair was 7.9 (range, 5-12). Mean follow-up was 42 months (range, 16-78 months). Mean ± standard deviation ASES score at final follow-up was 90.1 ± 17.7 (range, 22-100), and mean Penn Shoulder score was 90.2 ± 15.3 (range, 38-100). Three of the 4 patients with outcome scores of 70 or less at final follow-up had undergone prior surgery. Thirteen postoperative complications (30%) occurred, with 3 (7%) requiring a second surgery. Five patients (11%) had an instability event following panlabral repair, but only 1 of these patients (2%) required revision surgery for a recurrent labral tear. Conclusion: Combined tears of the anterior, posterior, and superior glenoid labrum represent a small but significant portion of labral injuries. Arthroscopic repair of these injuries can be performed with good postoperative outcomes and a low rate of recurrent labral injury.

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High-resolution MRI of a peroneal intraneural ganglion cyst arising from the knee joint: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21130 ◽

2021 ◽

Vol 1 (21) ◽

Author(s):

Brandon W. Smith ◽

Megan M. Jack ◽

Garret M. Powell ◽

Matthew A. Frick ◽

Kimberly K. Amrami ◽

...

Keyword(s):

High Resolution ◽

Knee Joint ◽

Ganglion Cyst ◽

High Resolution Imaging ◽

Synovial Joint ◽

Intraneural Ganglion ◽

Intraneural Ganglion Cyst ◽

Articular Branch ◽

Ganglion Cysts ◽

Resolution Imaging

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 cyst on follow-up imaging. LESSONS This case adds to the mounting evidence that intraneural cyst pathology is dependent on a connection to a synovial joint as stated in the unifying theory of intraneural cyst development.

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Intraneural ganglion cysts of the lower limb

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-0777-2525 ◽

2018 ◽

Vol 191 (08) ◽

pp. 732-738

Author(s):

Tobias Fricke ◽

Anne Dorothée Schmitt ◽

Olav Jansen

Keyword(s):

Case Studies ◽

Lower Limb ◽

Peripheral Nerves ◽

Intraneural Ganglion ◽

Nerve Branch ◽

Ganglion Cysts ◽

Key Points ◽

Mri Scans ◽

Capsular Defect

Background Intraneural ganglion cysts are rare. They affect the peripheral nerves. According to the most widely accepted theory (articular/synovial theory), the cysts are formed from a capsular defect of an adjacent joint, so that synovial fluid spreads along the epineurium of a nerve branch. This leads to diverse neurological symptoms. We will illustrate this disease based on three of our own cases. Methods Patients were examined between 2011 and 2018 using lower limb MRI. MRI scans were also performed for the follow-up examinations. Case studies and Discussion The patients had many symptoms. We were able to accurately detect the intraneural ganglion cysts on MRI and provide the treating surgeons with the basis for the operation to be performed. The success of surgical therapy depends on the resection of the nerve endings supplying the joint as the only way to treat the origin of the disease and prevent recurrence. Based on our case studies, we can support the commonly favored articular/synovial theory. Key Points: Citation Format

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