Common Peroneal Nerve Ganglion Cyst

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Common Peroneal Nerve Ganglion Cyst

Authors, Editors, Case Information Author: Kyle Samyn, DO, MS Affiliation: Ascension Providence Sports Medicine Fellowship Co Author(s): Nicholas Moore, MD Senior Editor: Laura Mattson, DO Clinical Vignette: A 59-year-old male presents with the complaint of left lower leg pain located at the proximal fibula. The pain started insidiously roughly a year prior and has gradually worsened over that time. The pain radiates down the lateral leg to just above the lateral malleolus. Pain worsened with applied pressure/contact to the proximal fibula and was described as "sharp." The pain has been keeping him from walking or exercising for a period of 2 weeks. Patient rated the pain a 10/10. The patient denied weakness in dorsiflexion of the left foot On examination, there is no weakness of ankle dorsiflexion or great toe extension. Neither restriction of lumbosacral range of motion nor complaints of low back pain was observed. Although tenderness without swelling was present around the left fibular head, Tinel's sign was not evoked along the course of the peroneal nerve. There was no pain, spontaneously or evoked, in association with the passive movement of the knee or ankle. There was no abnormality in sensory examinations. Sciatic root stretch signs were negative. Type of Probe Used: 15-6 MHz linear array probe Long axis view comparison A long axis view of the common peroneal nerve at the level of the fibular neck with a hypoechoic intraneural ganglion cyst disrupting the normal striated pattern of the nerve. Comparison views of the right, normal appearing common peroneal nerve of uniform thickness and showing internal striations due to the interface between the perineurium and the individual fascicles that comprise the nerve. Long Axis view of Peroneal Nerve Cyst comparison A long axis view of the common peroneal nerve at the level of the fibular neck with a hypoechoic intraneural ganglion cyst disrupting the normal striated pattern of the nerve. Comparison views of the right, normal appearing common peroneal nerve of uniform thickness and showing internal striations due to the interface between the perineurium and the individual fascicles that comprise the nerve. Short Axis view of Peroneal Nerve Cyst Short axis view of the hypoechoic intraneural ganglion cyst at the fibular neck with crowding of the common peroneal nerve Long Axis view of Peroneal Nerve Cyst A long axis view of the common peroneal nerve at the level of the fibular neck with a hypoechoic intraneural ganglion cyst disrupting the normal striated pattern of the nerve. Long Axis view of Peroneal Nerve Cyst A long axis view of the common peroneal nerve at the level of the fibular neck with a hypoechoic intraneural ganglion cyst disrupting the normal striated pattern of the nerve. Interpretation Image Interpretation: At the level of the fibular head there is a well-circumscribed hypoechoic mass resulting in loss of the normal striation pattern of the common fibular nerve. The mass measured roughly 0.95 x 0.8 x 0.5 cm and was not compressible. There was no doppler signal or acoustic shadow. This was seen in both sagittal and transverse planes. Teaching Pearl: Peroneal neuropathy is the most common lower extremity peripheral neuropathy. Most cases are caused by external compression or direct trauma to the nerve. Rarely, peripheral neuropathy can be caused by intraneural ganglia. An intraneural ganglion cyst is a benign mucinous cyst originating from the epineurium of a peripheral nerve. These cysts have been documented in several peripheral nerves but are most found at the common peroneal nerve. Symptoms range from burning pain, tingling or numbness of the anterolateral leg from just below the fibular head to the dorsal aspect of the foot, to sensory loss to the dorsum of the foot and, in prolonged or severe cases, weakness in ankle dorsiflexion, foot eversion, and great toe extension. Diagnosis is typically based on MRI. Surgical treatment is the first-choice treatment for a peroneal intraneural ganglion. Conservative treatment is not recommended because, when performed early, surgical treatment is highly successful. Ultrasound offers a less expensive and non-invasive option to guide treatment.
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Authors, Editors, Case Information

Long axis view comparison

Long Axis view of Peroneal Nerve Cyst comparison

Short Axis view of Peroneal Nerve Cyst

Long Axis view of Peroneal Nerve Cyst

Long Axis view of Peroneal Nerve Cyst

Interpretation

UPCOMING EVENTS

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