2026, Number 2
Tibial nerve compression by a ganglion of the proximal tibiofibular joint. Exceptional diagnosis
Full text
10.35366/122626
Language: English/Spanish [Versión en español]
References: 5
Page: 163-164
PDF size: 723.72 Kb.
ABSTRACT
Ganglion cysts are fluid-filled structures that develop near joints and tendons. They are usually asymptomatic and rarely require treatment. Neural compression can be especially problematic, resulting in paralysis, paresthesia, or loss of function depending on the degree of compression and the nerve involved. The proximal tibiofibular joint is a rare site of ganglion cyst development, and therefore, peroneal nerve compression due to a ganglion cyst is uncommon; tibial nerve compression from this cause is exceptional. Prompt recognition and treatment are crucial for managing this condition and its complications.INTRODUCTION
Ganglion cysts are fluid-filled structures that develop near joints and tendons. Neural compression can cause paralysis, paresthesia, and loss of function depending on the degree of compression and the affected nerve.1 The proximal tibiofibular joint is an uncommon site for the development of ganglions; compression of the peroneal nerve due to a ganglion cyst at the proximal tibiofibular joint is rare,2 while compression of the tibial nerve due to this cause is exceptional. Prompt recognition and treatment are essential to prevent complications.
CLINICAL CASE
A 21-year-old male, a semi-professional soccer player, was referred to rehabilitation with a three-month history of symptoms characterized by difficulty standing on his tiptoes on the right foot, as well as paresthesias in the heel and the lateral plantar aspect of the right foot; he presented with a normal lumbosacral spine magnetic resonance imaging study.
On targeted examination: full range of motion in the right lower limb; muscle strength clinical examination using the Daniels scale showed gluteus maximus, medius, and minimus, semimembranosus, semitendinosus, biceps femoris, tibialis anterior, peroneals, and extensor digitorum longus at 5/5; triceps surae, plantaris, tibialis posterior, and flexor digitorum at 3/5; hypoesthesia in the plantar territory of the heel and the lateral plantar nerve, including the lateral half of the fourth toe. Patellar reflex was normal, Achilles reflex was diminished. With a diagnosis of tibial nerve compression at the lower apex of the popliteal fossa, a magnetic resonance imaging study was performed, revealing a ganglion arising from the proximal tibiofibular joint. The patient was referred to joint surgery for surgical management.
COMMENTS
Ganglions are cystic-appearing pseudotumor lesions with regular, well-defined walls, presenting as soft tissue masses in juxta-articular tissues. They can intermittently increase or decrease in size spontaneously, and can be uni- or multilobulated, with thick, gelatinous, or mucoid content; they arise from the degeneration of a synovial cyst or from mucoid degeneration of juxta-articular connective tissue secondary to a post-traumatic injury.1 They are more frequent in young people between 20 and 40 years of age, with a female predominance in a 3:1 ratio; their incidence varies depending on location. Regarding their presence in the proximal tibiofibular joint,2 Ilahi and collaborators3 report it in 0.76%. When found in this location, reports indicate that compression of the common peroneal nerve and/or peroneal nerve may occur,2-4 making compression of the tibial nerve extraordinary.
Magnetic resonance imaging is the method of choice5 for its study, determining its anatomical localization and extension into deep planes (Figure 1). Surgical treatment is used when the ganglion is symptomatic,1 as there is a high recurrence rate with conservative management such as puncture, aspiration, or injection of steroids, lidocaine, or other substances.
REFERENCES
Gonzalez M, Castillo-Flores S, Portmann-Baracco A, Pretell-Mazzini J. Ganglion cysts arising from the proximal tibiofibular joint: treatment approach and associated outcomes-A systematic review. HSS Journal. The Musculoskeletal Journal of Hospital for Special Surgery. 2023; 20 (4): 556-566. doi: 10.1177/15563316231172510.
AFFILIATIONS
1 Hospital Angeles León. León, Guanajuato. México.
2 Radiólogo. Radiología e Imagenología. Gestalt Imagen. León, Guanajuato. México. ORCID: 0000-0001-5068-5958.
3 Especialista en Medicina de Rehabilitación. División de Medicina. ORCID: 0000-0002-1985-4837.
4 Ortopedista. Cirugía articular. División de Cirugía. ORCID: 0000-0002-4773-2140.
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CORRESPONDENCE
Dr. Luis Gerardo Domínguez Carrillo. Correo electrónico: lgdominguez@hotmail.comReceived: 2024-08-01. Accepted: 2024-08-22.