[Peroneal nerve palsy caused by a recurrent proximal tibiofibular joint ganglion--a case report and review of the literature].
OBJECTIVE
Compression of peripheral nerves is a well known complication of articular synovial cysts. The peroneal nerve is the most common site of intraneural ganglia (pseudocysts) originating from the proximal tibiofibular joint. The neurological deficit associated with these cysts is often severe due to delayed diagnostic and surgical treatment. Therefore, recurrence is very often seen and recovery is incomplete.


METHODS
We report a case of a 60-year-old man with peroneal nerve palsy caused by recurrent proximal tibiofibular joint ganglion.


RESULTS
Within the context of the current literature, clinical symptoms, diagnostics, differential diagnosis with regard to imaging methods, neurology, pathology and the broader spectrum of operative and non-operative treatment are discussed. The cyst was completely resected, but a recurrent cyst developed eight years later. At reoperation, a communication of the cyst with the tibiofibular joint was demonstrated. Despite complete resection of the cyst and ligation of the ganglion stem, a routine postoperative MRI disclosed a second recurrence of the cyst nine months later. On the last clinical examination, twelve years after onset of the symptoms, a complete paresis of the peroneal nerve was seen.


CONCLUSIONS
This entity needs careful, prompt preoperative evaluation to avoid neurological damage. Surgical treatment includes microsurgical decompression and complete resection of the cyst and also ligation of the ganglion stem. Early diagnosis and treatment is required to ensure recovery.
Rein
S
S
Berufsgenossenschaftliche Unfallklinik, Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Tübingen. susanne.rein@web.de
Weindel
S
S
Schaller
H-E
HE
Mittelbronn
M
M
Schmidt
G
G
D003937:Diagnosis, Differential; D045888:Ganglion Cysts / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007719:Knee Joint; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020427:Peroneal Neuropathies / Q000175:diagnosis / Q000209:etiology*; D026741:Physical Therapy Modalities; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D013997:Time Factors; D014463:Ultrasonography