Intraneural Ganglion of the Superficial Peroneal Nerve: A Case Report

Ganglia affecting the peripheral nerves of the foot and ankle are rare. The most frequent location of occurrence is the common peroneal nerve at the level of the fibular neck. We report the case of an intraneural ganglion of the superficial peroneal nerve and its branches. Although there have been many previous reports of intraneural ganglion involvement with the common peroneal nerve, deep peroneal nerve, sural nerve, and the posterior tibial nerve, to our knowledge, this is the first reported occurrence of an intraneural ganglion distinctly localized to the superficial peroneal nerve and its branches. The presumptive diagnosis was made preoperatively using magnetic resonance imaging, and then confirmed postoperatively by pathologic examination. Despite the use of operative magnification, it was impossible to remove all of the cyst elements within the nerve trunk, because the nerve fascicles were intimately intertwined. Therefore, complete resection of the common trunk of the superficial peroneal nerve and its terminal branches was performed, and the proximal stump was buried in a hole in the distal fibula. Two years after the surgery, the patient was pain free and asymptomatic except for cutaneous anesthesia in the distribution of the superficial peroneal nerve.     

腓总神经嵌压综合征

报告腓总神经嵌压综合征９例，用保守疗法治疗３例，手术治疗６例，获满意疗效。该症的发生与腓总神经在窝至腓骨颈的解剖特点密切相关。主要病因为膝关节急剧屈曲下蹲位劳动使腓总神经反复损伤和局部赘生物压迫。临床表现为胫前肌、腓骨长肌、长伸肌、趾长伸肌等肌力减退或麻痹，小腿外侧及足背皮肤麻木或感觉缺失。电生理检查对诊断有一定价值。早期可保守治疗，３个月无效者，即应手术探查。局部赘生物嵌压者，应将其切除，进行彻底的神经松解术。     

Lateral Meniscal Cyst Causing Irreversible Peroneal Nerve Palsy

We report an unusual case of irreversible foot drop occurring secondary to a large lateral meniscal cyst. We discuss the presentation and management of this rare case and highlight some of the less common causes of foot drop.     

腓总神经卡压的应用解剖学研究

目的：为腓总神经卡压综合征的诊治提供解剖学资料。方法：在７０侧成人整尸上对窝外侧沟、腓管等结构做了观测。结果：腓总神经在入腓管之前走行在致密的窝外侧沟内，在腓管内与腓骨骨膜紧密相贴，长度约为２７．０±１．４ｍｍ。腓管顶为腓骨长肌纤维拱，长约２７．５±１．７ｍｍ，其构成为全腱性者占７．１％，混合性者占９０％，全肌性占２．９％。腓总神经在窝外侧沟起始部横径为４．４±０．８ｍｍ，在腓骨颈横径为６．１±０．７ｍｍ，在腓管上端有１～２支恒定的膝返神经。结论：致密的窝外侧沟及腓管的解剖形态、腓管内腓总神经与腓骨骨膜紧贴等是腓总神经易卡压的解剖学基础，过度非正常姿势或病理状态是卡压发生的诱因。膝返神经卡压可能是膝外侧痛的原因之一。     

A Case Report and Literature Review: Intraneural Ganglion Cyst Causing Tarsal Tunnel Syndrome

Intraneural ganglion cysts are benign mucinous lesions that form within joints and enter adjacent nerves via an articular branch. Despite being morphologically characterized as benign, they can demonstrate considerable intrafascicular destruction and expansion, resulting in worsening compressive neuropathies or nerve injury. There have been several suggested theories of pathogenesis, but the most widely accepted articular (synovial) theory describes a capsular defect in a neighboring joint that allows joint fluid to egress and track along the epineurium of the innervating articular branch. In this case report, we describe an intraneural ganglionic cyst located in the tarsal tunnel with extensive involvement of the tibial nerve. We describe the symptoms, diagnosis, and treatment as well as review the current literature on intraneural ganglionic cysts.     

合并膝关节韧带损伤的腓总神经损伤

目的分析合并膝关节韧带损伤的腓总神经损伤特点,探讨腓总神经损伤的治疗措施。方法回顾该类型损伤11例,保守治疗10例,早期探查1例。对3个月无恢复的8例行手术探查。结果保守治疗3例有不同程度恢复,手术8例仅2例部分恢复。结论该类损伤神经恢复不满意,膝外翻型损伤预后较好,伤后3个月无恢复者再作手术探查。术后神经仍不恢复者,可作肌腱移位或三关节融合补救。     

Occupational Compression of the Common Peroneal Nerve at the Neck of the Fibula

Seven cases of common peroneal nerve compression were seen among farm workers. The symptoms followed working in a sitting position with forward advancement, a position commonly adopted in India for harvesting a crop and hoeing. Motor and sensory impairment was seen in the distribution of the common peroneal nerve, more marked in the distribution of the deep peroneal branch. Motor conduction time, estimated in two cases, was delayed. At exploration, the cause of the compression was found to be a tendinous arch extending along the posterior border of the peroneus longus, and curving backwards and upwards along the lateral border of the soleus. Excision of this arch, with elimination of the origin of the upper part of the peroneus longus, led to disappearance of the neurological deficits.     

Common Peroneal Nerve Palsy Due to Giant Fabella After Total Knee Arthroplasty

BackgroundCommon peroneal nerve palsy (CPNP) is a rare but serious complication following primary total knee arthroplasty (TKA). The common peroneal nerve is one of the main molecules of the sciatic nerve. CPNP is a series of symptoms caused by common peroneal nerve injury due to paralysis and atrophy of the fibula and tibia muscles. The main clinical symptoms are: ankle joint unable to extend back, toe unable to extend back, foot droop, walking in a steppage gait, and foot dorsal skin sensation having decreased or disappeared. If treatment is not timely, severe cases may result in atrophy of the anterior tibia and lateral calf muscles. The risk factors for CPNP include mechanical stretching of the nerve, disruption of the blood supply to the nerve, and compression of the nerve. The CPNP should be treated in a timely manner and according to the cause. Its function should be restored as soon as possible to avoid serious adverse consequences. It has negative effects on patients’ life and physical and mental health. To our knowledge, this is the first study to describe CPNP due to a giant fabella after TKA.Case presentationThe present study reported on a 70‐year‐old female patient. The patient underwent a primary TKA of the right knee for osteoarthritis. Relevant examinations were conducted and the operation went smoothly. Three hours postoperation, a right partial CPNP was observed, with progressive aggravation over time. On palpation, there was a 2 × 2‐cm fixed hard mass in the posterolateral aspect of the right knee, with mild tenderness to deep palpation. Radiographs demonstrated that a giant fabella was located at the posterolateral condyle of the right femur. Fabellectomy and neurolysis of the common peroneal nerve were performed. The peroneal nerve palsy resolved gradually after the operation. At 8‐month follow up after fabellectomy and neurolysis, the function of the common peroneal nerve had fully recovered.ConclusionsThe presence of giant feballa pressing on the common peroneal nerve should be considered when common peroneal nerve palsy occurs after TKA. Surgical exploration and release compression should be performed in a timely manner.     

Proximity of the Common Peroneal Nerve to the Tibial Nerve Entering the Gastrocnemius Muscle: The Implications for Calf Reduction

This article describes the precise anatomic relation and close proximity of the common peroneal nerve (PN) to the tibial nerve branch entering the gastrocnemius muscle (NLG) in the popliteal region. For the study, 22 legs from 13 Korean fresh cadavers (5 men and 8 women ranging in age from 50 to 80 years) were dissected. An x-axis was set as a transverse line crossing the lateral and medial epicondyle of the femur. A longitudinal y-axis accorded with a perpendicular midline between the medial malleoulus of the tibia and the lateral malleolus of the fibula. The PN diverged from the sciatic nerve above the interepicondylar line (−0.4 cm, +10.3 cm) and ran inferolaterally at 20.2° ± 2.4°. The PN crossed the midpoint of the x-axis (+3.4 cm, 0 cm). The NLG diverged from the tibial nerve above the interepicondylar (transverse) line (0 cm, 2.3 cm) and ran inferiorly and laterally at 17.7° ± 4.3°. The distance from the diverging point of the NLG from the tibial nerve to the nearest point of the PN was 2.5 ± 0.5 cm. The distance from the point at which the PN crossed the x-axis to the nearest point of the NLG was 2.7 ± 0.3 cm. In procedures that involve handling of the lateral gastrocnemius muscle itself or the nerves to the lateral gastrocnemius, surgeons should be aware of the close proximity of the PN to the NLG in the popliteal region.     

Ultrasound-Guided Therapy for Knee and Foot Ganglion Cysts

The present study evaluated the effectiveness of ultrasound-guided aspiration/injection of ganglion cysts in the lower extremities (knee and foot) that required referral to the radiology department for precise localization. The present study is the first series to describe such results. The study population consisted of 15 patients who had undergone treatment from April 2012 to January 2015. Follow-up was by telephone survey, which was performed at a mean of 15 ± 6 months after treatment. Almost 90% of patients experienced immediate improvement in symptoms (mostly pain), and 77% of these patients had not experienced a recurrence of symptoms at a mean follow-up time of 14 ± 6 months. In conclusion, ultrasound-guided therapy is a safe and potentially effective treatment for most cases of symptomatic lower extremity ganglion cysts.