A rare case of an intraneural ganglion cyst of the median nerve

,; Ariyaratne, Sisith; Pathak, Gora; ,; Iyengar, Karthikeyan; ,; Botchu, Rajesh; ,; Shah, Amit; ,

doi:10.15557/jou.2023.0025

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Compression neuropathies caused by ganglion cysts are much less common. Most frequently, ganglion cysts involve the common peroneal nerve (CPN) and, less commonly, the ulnar and radial nerves [ 5 , 6 ]. In the upper extremities, ganglia have been reported to compress the ulnar nerve in Guyon’s canal, in the cubital tunnel, or the median nerve at the carpal tunnel [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Most frequently, ganglion cysts involve the common peroneal nerve (CPN) and, less commonly, the ulnar and radial nerves [ 5 , 6 ]. In the upper extremities, ganglia have been reported to compress the ulnar nerve in Guyon’s canal, in the cubital tunnel, or the median nerve at the carpal tunnel [ 6 ]. The involvement of the lower extremities is significantly less common than the upper extremities.…”

Section: Introductionmentioning

confidence: 99%

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

Lee,

Kim,

Kim

et al. 2024

Medicina

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Lee,

Kim,

Kim

et al. 2024

Medicina

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Cubital tunnel syndrome: anatomy, pathology, and imaging

Hussein,

Hanumanthu,

Shirodkar

et al. 2024

Skeletal Radiol

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Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of tarsal tunnel syndrome caused by an intraneural ganglion cyst

Phadke,

Dalal,

Seetharaman

et al. 2024

Diagnosis

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Objectives Intraneural ganglionic cysts are non-neoplastic cysts that can cause signs and symptoms of peripheral neuropathy. However, the scarcity of such cases can lead to cognitive biases. Early surgical exploration of space occupying lesions plays an important role in identification and improving the outcomes for intraneural ganglionic cysts. Case presentation This patient presented with loss of sensation on the right sole with tingling numbness for six months. A diagnosis of tarsal tunnel syndrome was made. Nerve conduction study revealed that the mixed nerve action potential (NAP) was absent in the right medial and lateral plantar nerves. The magnetic resonance imaging (MRI) found a cystic lesion measuring 1.4×1.8×3.8 cm as the presumed cause of the neuropathy. Surgical exploration revealed a ganglionic cyst traversing towards the flexor retinaculum with baby cysts. The latter finding came as a surprise to the treating surgeon and was confirmed to be an intraneural ganglionic cyst based on the histopathology report. Conclusions Through integrated commentary by a case discussant and reflection by an orthopedician, this case highlights the significance of the availability heuristic, confirmation bias, and anchoring bias in a case of rare disease. Despite diagnostic delays, a medically knowledgeable patient’s involvement in their own care lead to a more positive outcome. A fish-bone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic delay. Finally, this case provides clinical teaching points in addition to a pitfall, myth, and pearl related to availability heuristic and the sunk cost fallacy.

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A rare case of an intraneural ganglion cyst of the median nerve

Cited by 3 publications

References 8 publications

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

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

Cubital tunnel syndrome: anatomy, pathology, and imaging

Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of tarsal tunnel syndrome caused by an intraneural ganglion cyst

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