Obturator Intraneural Ganglion Cysts: Joint Connected and Underdiagnosed

Jitpun, Ekkapot; Howe, Benjamin M.; Amrami, Kimberly K.; Trousdale, Robert T.; Spinner, Robert J.

doi:10.1016/j.wneu.2019.02.029

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…Alternatively, if a labral tear is observed, the nerve affected can be predicted. Articular branch connections occur near labral tears (labral tears are well known in extraneural cysts) 15 . Besides labrocapsular pathology (eg, laxity, tears), joint pathology was frequently identified, including degenerative changes, femoroacetabular impingement, and joint dysplasia 2,12–14 .…”

Section: Journeying To Other Planets: Applying the Articular Theory T...mentioning

confidence: 99%

“…Our group first described the articular joint connections to the hip in sciatic, obturator, superior gluteal, and femoral IGCs [13][14][15][16] ; retrospective reviews of other cases revealed an unrecognized joint connection. [13][14][15] In all, hip joint connections have now been identified or demonstrated upon reinterpretation in 89% of cases (the few examples without joint connections have typically either lacked imaging or involved lowresolution imaging). In fact, the hip has the highest percentage of joint connections compared with other joints.…”

Section: Journeying To Other Planets: Applying the Articular Theory T...mentioning

confidence: 99%

“…Articular branch connections occur near labral tears (labral tears are well known in extraneural cysts). 15 Besides labrocapsular pathology (eg, laxity, tears), joint pathology was frequently identified, including degenerative changes, femoroacetabular impingement, and joint dysplasia. 2,[12][13][14] These IGCs propagate proximally with balloon-like expansion in the pelvis 18 and extensions, at times, to the neural foramina.…”

Section: Journeying To Other Planets: Applying the Articular Theory T...mentioning

confidence: 99%

“…Importantly, they tap into potential opportunities afforded by the hip joint---a more complex (with richer articular anatomy and a labrocapsular complex), larger, and better-understood joint compared with the simpler, smaller, and more mysterious STFJ. Our group first described the articular joint connections to the hip in sciatic, obturator, superior gluteal, and femoral IGCs [13][14][15][16] ; retrospective reviews of other cases revealed an unrecognized joint connection. [13][14][15] In all, hip joint connections have now been identified or demonstrated upon reinterpretation in 89% of cases (the few examples without joint connections have typically either lacked imaging or involved lowresolution imaging).…”

Section: Journeying To Other Planets: Applying the Articular Theory T...mentioning

confidence: 99%

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Intraneural ganglion cysts at the hip: The next celestial frontier

2022

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Shin et al 2 in Skeletal Radiology provided us with a glimpse into the next frontier in our celestial-inspired, unchartered journey to understand intraneural ganglion cysts (IGCs). In the grand scheme, these experiences with hip-related IGCs are more than just case series; they represent further evidence that, when it comes to IGCs, there is much more deep space in need of exploration.IGCs are mucinous cysts within the epineurium of peripheral nerves. Once thought to be exceedingly rare, they are being described more frequently due to advances in imaging of nerve-related disorders. 3 Approximately 1000 patients with IGCs have been reported, most commonly in the peroneal nerve at the fibular neck, although they may occur at many other sites, including the hip region. IGCs often cause neuropathy (pain, motor, and sensory symptoms/findings), but may occasionally be asymptomatic or minimally symptomatic. Neurological outcomes after surgical procedures (including cyst decompression and cyst/nerve resection) tend to be suboptimal, with high recurrence rates. 4 This editorial takes us on a cosmic journey through the discovery and exploration of IGCs: from the first description of an intraneural cyst (looking to the stars) to solidifying the articular theory (an accomplishment akin to landing on the Moon), investigating rare occurrences in the hip/pelvic region (journeying to other planets), and envisioning new frontiers for IGC research (discovering other galaxies).

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Section: Journeying To Other Planets: Applying the Articular Theory T...mentioning

confidence: 99%

Section: Journeying To Other Planets: Applying the Articular Theory T...mentioning

confidence: 99%

Section: Journeying To Other Planets: Applying the Articular Theory T...mentioning

confidence: 99%

Section: Journeying To Other Planets: Applying the Articular Theory T...mentioning

confidence: 99%

See 2 more Smart Citations

Intraneural ganglion cysts at the hip: The next celestial frontier

2022

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“…In one case the stalk of the cyst could be followed to the anterior labrum [16], whereas in another case the stalk was following the obturator externus muscle [15]. Ganglion cysts arising from the transverse ligament have been described in 3 cases [3] [19], although reviews have shown, that they might as well originate from articular branches of the obturator nerve, proceeding an intraneural path [21].…”

Section: Pathophysiologymentioning

confidence: 99%

Intra- and Periarticular Ganglia (Synovial Cysts) of the Hip with Compression of the Obturator Nerve, Concomitant with Lesions of the Ligamentum Teres—A Report of 3 Cases

Haug¹,

Herzog²

2021

OJO

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Background: Synovial cysts of the hip are commonly found in patients with intra-or extraarticular pathologies of the joint. Symptoms are mostly unspecific. To date there are no guidelines for a gold standard of treatment. Aim of this article is to show up how lesions of the ligamentum teres (LT) might possibly lead to a specific formation of synovial cysts of the hip joint and how this can be treated arthroscopically. Methods: This case series included 3 patients with ganglia of the hip. All patients had impingement symptoms, combined with untypical location of pain. All patients qualified for joint preserving surgery and underwent hip arthroscopy with pre-and postoperative MRI imaging. The mean follow-up time was 22 months. Results: MRI imaging showed extensive ganglia, presumably originating from the pelvic root of LT, extending to the obturator lodge. In 2 of 3 cases MRI showed lesions of the LT. Hip arthroscopy revealed damage of the LT in all cases, caused by chronic instability of the joint. The postoperative MRI showed a complete regression of the ganglia in all patients after offset correction. After follow-up, 2 of 3 patients were mostly symptom free. One patient was still suffering from a chronic weakness of the gluteus medius muscle. Conclusion: Whenever unspecific radiating pain of surrounding areas of the hip is encountered and cannot be explained by common pathologies of the hip, possible compression of nerves by ganglion cysts should be excluded. This should be done by MRI arthrography. A partial rupture of the LT can occur during FAI with consecutive formation of ganglia in the obturator canal, compressing the obturator nerve. Primarily the articular pathology needs to be repaired. In our cases,

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