title: Peripheral neuropathy caused by joint-related cysts: a review of 17 cases.
abstract: BACKGROUND
  Clinical compression neuropathy caused by para-articular cysts is rare. Only recently, the unifying articular theory was proposed to clarify its true etiologic nature. The authors attribute 17 cases to this theory in order to illustrate the shift in the diagnostic and treatment protocol, and the possible impact on patient outcome.
  
  
  METHODS
  Eight intraneural and nine extraneural cysts were included. The proposed diagnostic protocol includes electromyography and ultrasound, followed by magnetic resonance imaging to characterize the cyst. The proposed treatment protocol consists of (1) ligation of the pedicle connecting the cyst with the afflicted joint, (2) decompression of the nerve and, when needed and (3) disarticulation of the superior tibiofibular joint (in case of peroneal nerve involvement).
  
  
  RESULTS
  Outcome was good to excellent in all patients, with recovery of sensory and motor function. Cyst recurrence was observed in three intraneural cases (18 %). Analysis of our own diagnostic protocol showed that atypical compression neuropathies should follow a strict diagnostic protocol to exclude missing the presence of a cyst. Ultrasound needs to play a crucial role, with MRI for cyst characterization and pedicle identification.
  
  
  CONCLUSIONS
  Retrospective proof in favor of the articular theory was found in all cases. An explanation for the cyst recurrences was formed based on the articular theory. In addition, a diagnostic and therapeutic protocol is proposed for all atypical peripheral compression neuropathies with the ultimate goal to achieve optimal patient outcome.
authors.affiliation: Department of Neurosurgery, Ziekenhuis Oost-Limburg, Schepersweg 3, 3600, Genk, Belgium frank.weyns@skynet.be
authors.forename: F
authors.initials: F
authors.lastname: Weyns
authors.forename: T
authors.initials: T
authors.lastname: Bringmans
authors.forename: J
authors.initials: J
authors.lastname: Vandevenne
authors.forename: T
authors.initials: T
authors.lastname: Daenekindt
authors.forename: A
authors.initials: A
authors.lastname: Van Goethem
authors.forename: J
authors.initials: J
authors.lastname: Wuyts
authors.forename: L
authors.initials: L
authors.lastname: Vanormelingen
authors.forename: M
authors.initials: M
authors.lastname: Vandersteen
mesh_terms: D000328:Adult; D000368:Aged; D003560:Cysts / Q000150:complications* / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000150:complications* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome