Role of sonography in the diagnosis and treatment of a ganglion cyst compressing the lateral branch of deep peroneal nerve

Abstract

Selective compression neuropathy of the lateral branch of the deep peroneal nerve is rare. A 55-year-old woman with ankle instability and mild weakness of extension of the toes was examined with sonography (US), which revealed the presence of a ganglion cyst compressing selectively the lateral branch of the deep peroneal nerve. US-guided aspiration of the cyst resulted in nerve decompression and progressive resolution of symptoms. This case demonstrates the importance of examining the deep peroneal nerve and its branches when performing US in the clinical setting of ankle instability. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:108-111, 2017.

Neuropatía peronea secundaria a ganglión extraneural: revisión de literatura y propuesta de tratamiento. Caso no positivo.

“…Los gangliones son tumoraciones benignas habitualmente asintomáticos que no precisan tratamiento más allá de actitud expectante (1), excepto en situaciones como la de nuestro paciente, en la que existe una compresión nerviosa y existe clínica neurológica secundaria. En estas situaciones la aspiración del ganglión es la primera línea de tratamiento (1,3). El inconveniente principal de este abordaje terapéutico es la existencia de una mayor tasa de recurrencias en comparación con la escisión quirúrgica.…”

“…Un ganglión se define ecográficamente como una estructura bien definida, anecoica, compresible, con refuerzo acústico posterior, sin vascularización interna (9). Una vez identificado puede ser evacuado en consulta, siendo la guía ecográfica la mejor modalidad para realizar una aspiración segura (3).…”

An Update on Peroneal Nerve Entrapment and Neuropathy

“…In these cases, DPN entrapment was due to ganglion cysts in 2 cases and bony overgrowth of the navicular bone in 1 case. [62][63][64] One of the ganglion cysts was treated with CT-guided fenestration, pulsed radiofrequency modulation, and steroid injection into the cyst. In contrast, the other ganglion cyst case was treated with ultrasoundguided aspiration.…”

“…Both patients reported successful nerve decompression and return of motor function. 62,64 The case of DPN entrapment due to navicular bone overgrowth was treated successfully with surgical nerve decompression. 63…”

Ultrasound Imaging of the Deep Peroneal Nerve

“…Nerve compression may be the result of direct trauma, repetitive microtrauma (eg, related to tight ski boots or, in soccer players, related to frequent kicking, with trauma to the dorsum of the ankle and foot), 12 previous fractures (Figure 12) or recurrent ankle sprains, 41 and joint arthritis or osteoarthrosis, with prominent osteophytes near the DPN (or its branches), in which the nerve may be stretched by the contiguous dorsal joint capsule. Other causes of DPN disorders include iatrogenic damage: eg, during surgery, in which the nerve may be directly damaged or encased in scar tissue (Figure 13), or during the anterior approach to talonavicular or tarsal joint injections, a ganglion cyst (Figure 14), or other masses that compress the nerve 42,43 . Thrombosis of the dorsal pedis artery has also been reported as a possible cause of ATTS 44 ; similarly, a rare cause of entrapment, which has not been described to the best of our knowledge, is the compression exerted by foot vein thrombosis (Figure 15).…”