Acute Onset of Deep Peroneal Neuropathy During a Golf Game Resulting From a Ganglion Cyst
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Abstract:
We report a case of sudden onset of deep peroneal neuropathy resulting from a ganglion cyst. Electrophysiology demonstrated a severe deep peroneal neuropathy with axonal loss and probably proximal conduction block. Magnetic resonance imaging demonstrated a mass arising from the proximal tibiofibular joint extending along the peroneal nerve. Surgical resection of the ganglion resulted in gradual improvement of strength. Peroneal nerve ganglia should be considered in the evaluation of patients with sudden painless foot drop.Keywords:
Foot drop
Ganglion cyst
Superficial peroneal nerve
Common peroneal nerve
Entrapment Neuropathy
Extraneural ganglion cysts of the peroneal nerve have rarely been reported in the literature. This paper reports a large extraneural ganglion cyst compressing the peroneal nerve and causing pain in the leg, and foot drop. Electromyographic study revealed a deep peroneal nerve lesion, but the superficial branch was spared. Magnetic resonance imaging showed a cystic tumor located below the superior tibiofibular joint. A complete surgical resection was undertaken. During surgery multimodal intraoperative neurophysiological monitoring was performed. An extraneural ganglion cyst should be considered in the differential diagnosis of painful foot drop. Electrophysiological and radiological studies should be carried to rule out other causes of foot drop.
Foot drop
Ganglion cyst
Superficial peroneal nerve
Common peroneal nerve
Tibial nerve
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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.
Ganglion cyst
Foot drop
Common peroneal nerve
Presentation (obstetrics)
Superficial peroneal nerve
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Introduction: Intraneural ganglion cysts can arise from the peroneal nerve at the lateral knee secondary to synovial fluid tracking along the articular branch and transforming within the nerve into a mucinous cyst, resulting in nerve compression.
Case Report: A 17-year-old right-handed male presented with a four-month history of right foot drop. He is physically active and attributed the foot drop to a sprained ankle. EMG/NCS showed a right common peroneal neuropathy distal to the innervation of the biceps femoris short head with active denervation. MRI showed an intraneural ganglion cyst in the common peroneal nerve starting at the level of biceps femoris. On exam, he had right foot drop and sensory deficits referable to the peroneal distribution, along with a right steppage gait. He had successful decompression of the ganglion cyst, excision of the articular branch and resection of the proximal tibiofibular joint, with clinical improvement.
Conclusion: Early recognition and surgical treatment leads to better outcomes for patients when an intraneural ganglion cyst results in neurologic deficits. Physical activities and trauma, which increase stress on the knee joints, may predispose ganglion cyst formation within peroneal nerves. Fibers of the deep peroneal nerve may be preferentially affected when compared to the superficial peroneal nerve. Disconnection of the articular branch and proximal tibiofibular joint resection may decrease risk of recurrence.
Ganglion cyst
Foot drop
Common peroneal nerve
Superficial peroneal nerve
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Intraneural ganglion cysts, which occur within the common peroneal nerve, are a rare cause of foot drop. The current standard of treatment for intraneural ganglion cysts involving the common peroneal nerve involves (1) cyst decompression and (2) ligation of the articular nerve branch to prevent recurrence. Nerve transfers are a time-dependent strategy for recovering ankle dorsiflexion in cases of high peroneal nerve palsy; however, this modality has not been performed for intraneural ganglion cysts involving the common peroneal nerve. We present a case of common peroneal nerve palsy secondary to an intraneural ganglion cyst occurring in a 74-year-old female. The patient presented with a 5-month history of pain in the right common peroneal nerve distribution and foot drop. The patient underwent simultaneous cyst decompression, articular nerve branch ligation, and nerve transfer of the motor branch to flexor hallucis longus to a motor branch of anterior tibialis muscle. At final follow-up, the patient demonstrated complete (M4+) return of ankle dorsiflexion, no pain, no evidence of recurrence and was able to bear weight without the need for orthotic support. Given the minimal donor site morbidity and recovery of ankle dorsiflexion, this report underscores the importance of considering early nerve transfers in cases of high peroneal neuropathy due to an intraneural ganglion cyst.
Foot drop
Ganglion cyst
Common peroneal nerve
Superficial peroneal nerve
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Proximal tibiofibular joint ganglion cyst is a rare disorder. It may develop along the peroneal musclesand nerve and cause compressive neuropathy. This is the case report of 37 year-old male that presented with mass at lateral aspect of right knee leading to progressive foot drop. His physical findings and investigations corresponded with proximal tibiofibular ganglion cyst and the cyst was excised. His foot drop returned to fully recovery and he could go back to the same level of previous activities. We reported one case and reviewed the literature about diagnostic tools and treatment modalities.
Foot drop
Ganglion cyst
Common peroneal nerve
Tibial nerve
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Common peroneal nerve
Superficial peroneal nerve
Foot drop
Entrapment
Etiology
Presentation (obstetrics)
Entrapment Neuropathy
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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.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.Precise diagnosis and immediate treatment are important in cases of compressive common peroneal neuropathy caused by an extraneural cyst.
Foot drop
Ganglion cyst
Common peroneal nerve
Superficial peroneal nerve
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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.
Ganglion cyst
Foot drop
Superficial peroneal nerve
Common peroneal nerve
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Traumatic damage to the common peroneal nerve due to sharp injury, gunshot wound, sciatic nerve tumor, radiculopathy, or hip replacement surgery may result in foot drop. We present an alternative strategy for reanimation of foot drop following deep peroneal nerve palsy, successfully restoring voluntary movement. Fourteen consecutive patients with deep peroneal nerve injuries resulting in foot drop underwent nerve transfer of functional fascicles of either the superficial peroneal nerve or of the tibial nerve as donor for deep peroneal-innervated muscle groups. Eleven cases had successful restoration of British motor grade 3+ to 4+/5 ankle dorsiflexion, one case had restoration of grade 3 ankle dorsiflexion, and two cases had no restoration of dorsiflexion. Nerve transfer to the deep peroneal nerve is a feasible and effective method of treating deep peroneal nerve injuries of less than 1-year duration.
Foot drop
Common peroneal nerve
Superficial peroneal nerve
Ankle dorsiflexion
Foot (prosody)
Motor nerve
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