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Ultrasound facilitates the diagnosis of tarsal tunnel syndrome: intraneural ganglion cyst of the tibial nerve

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Abstract

The tibial nerve intraneural ganglion cyst—which presents with fluid accumulated inside the nerve epineurium—is a rare etiology of tarsal tunnel syndrome. We report a case with insidious onset of numbness over his left medial ankle. Ultrasound imaging revealed that the tibial nerve was encircled by crescent-shaped anechoic substances, spanning from the distal leg to the sole. Magnetic resonance imaging disclosed a thickened tibial nerve wrapped by hyperintense materials in the tarsal tunnel. Some effusion was observed besides the tibialis posterior and flexor digitorum tendons as well. The patient underwent a surgical treatment and an intraneural ganglion cyst was confirmed. This report elaborated the clinical and imaging presentations of a tibial nerve intraneural ganglion cyst and highlighted the usefulness of ultrasound in exploring the cause of compressive neuropathy at the ankle region.

Sommario

La cisti del ganglio intraneurale del nervo tibiale—che si presenta con presenza di liquido all’interno del nervo epineurico—è una rara causa di sindrome del tunnel tarsale. Segnaliamo un caso con insidiosa insorgenza di intorpidimento a livello della caviglia mediale sinistra. L’ecografia ha rivelato che il nervo tibiale era circondato da sostanze anecoiche a forma di mezzaluna, che si estendevano dalla gamba distalmente fino in zona plantare. La risonanza magnetica ha rivelato un nervo tibiale ispessito ed avvolto da materiali iperintensi nel tunnel tarsale. È stato osservato un certo versamento perifericamente ai tendini del tibiale posteriore e del flessore delle dita. La paziente è stata sottoposta a un trattamento chirurgico ed è stata confermata una cisti gangliare intraneurale. Questo caso clinico ha valutato le presentazioni cliniche e di imaging di una cisti del ganglio intraneurale del nervo tibiale e ha evidenziato l’utilità degli ultrasuoni nella valutazione della causa della neuropatia compressiva nella regione della caviglia.

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References

  1. Ahmad M, Tsang K, Mackenney PJ, Adedapo AO (2012) Tarsal tunnel syndrome: a literature review. Foot Ankle Surg 18(3):149–152

    Article  CAS  PubMed  Google Scholar 

  2. Zheng C, Zhu Y, Jiang J et al (2016) The prevalence of tarsal tunnel syndrome in patients with lumbosacral radiculopathy. Eur Spine J 25(3):895–905

    Article  PubMed  Google Scholar 

  3. Alan U, Sendromu H (2007) Tarsal tunnel syndrome in a patient on long-term peritoneal dialysis: case report. Turk Neurosurg 17(4):283–285

    Google Scholar 

  4. Moholkar S, Sawhney JS, Bhatt R (2009) Imaging benign soft tissue lesions of the foot. Appl Radiol 38(10):10

    Google Scholar 

  5. Hung CY, Hsiao MY, Ozcakar L et al (2016) Sonographic tracking of the lower limb peripheral nerves: a pictorial essay and video demonstration. Am J Phys Med Rehabil 95(9):698–708

    Article  PubMed  Google Scholar 

  6. Kara M, Özçakar L, De Muynck M, Tok F, Vanderstraeten G (2012) Musculoskeletal ultrasound for peripheral nerve lesions. Eur J Phys Rehabil Med 48(4):665–674

    CAS  PubMed  Google Scholar 

  7. Özçakar L, Kara M, Chang K et al (2015) EURO-MUSCULUS/USPRM basic scanning protocols for ankle and foot. Eur J Phys Rehabil Med 51(5):647–653

    PubMed  Google Scholar 

  8. Patel P, Schucany WG (2012) A rare case of intraneural ganglion cyst involving the tibial nerve. In: Baylor University Medical Center Proceedings 2012 Apr 1, vol 25, No. 2, p 132

  9. Chalian M, Soldatos T, Faridian-Aragh N et al (2013) 3T magnetic resonance neurography of tibial nerve pathologies. J Neuroimaging 23(2):296–310

    Article  PubMed  Google Scholar 

  10. Kim DH, Cho Y-J, Ryu S, Tiel RL, Kline DG (2003) Surgical management and results of 135 tibial nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery 53(5):1114–1125

    Article  PubMed  Google Scholar 

  11. Fantino O (2014) Role of ultrasound in posteromedial tarsal tunnel syndrome: 81 cases. J Ultrasound 17(2):99–112

    Article  PubMed  PubMed Central  Google Scholar 

  12. Takakura Y, Kitada C, Sugimoto K, Tanaka Y, Tamai S (1991) Tarsal tunnel syndrome. Causes and results of operative treatment. Bone Joint J 73(1):125–128

    CAS  Google Scholar 

  13. Judd T, Jones T, Thornberry L (2014) Schwannoma of the posterior tibial nerve: case study. J Am Podiatr Med Assoc 104(5):539–543

    Article  PubMed  Google Scholar 

  14. Silveira CRS, Vieira CGM, Pereira BM, Pinto Neto LH, Chhabra A (2017) Cystic degeneration of the tibial nerve: magnetic resonance neurography and sonography appearances of an intraneural ganglion cyst. Skelet Radiol 46(12):1763–1767

    Article  Google Scholar 

  15. Desy NM, Wang H, Elshiekh MAI et al (2016) Intraneural ganglion cysts: a systematic review and reinterpretation of the world’s literature. J Neurosurg 125(3):615–630

    Article  PubMed  Google Scholar 

  16. Spinner RJ, Mokhtarzadeh A, Schiefer TK, Krishnan KG, Kliot M, Amrami KK (2007) The clinico-anatomic explanation for tibial intraneural ganglion cysts arising from the superior tibiofibular joint. Skelet Radiol 36(4):281–292

    Article  Google Scholar 

  17. Kannus P, Jozsa L (1991) Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. JBJS 73(10):1507–1525

    Article  CAS  Google Scholar 

  18. Spinner RJ, Hébert-Blouin M-N, Maniker AH, Amrami KK (2009) Clock face model applied to tibial intraneural ganglia in the popliteal fossa. Skelet Radiol 38(7):691–696

    Article  Google Scholar 

  19. Spinner RJ, Atkinson JL, Tiel RL (2003) Peroneal intraneural ganglia: the importance of the articular branch. A unifying theory. J Neurosurg 99(2):330–343

    Article  PubMed  Google Scholar 

  20. Spinner RJ, Amrami KK, Wolanskyj AP et al (2007) Dynamic phases of peroneal and tibial intraneural ganglia formation: a new dimension added to the unifying articular theory. J Neurosurg 107:296–307

    Article  PubMed  Google Scholar 

  21. Spinner RJ, Luthra G, Desy NM, Anderson ML, Amrami KK (2008) The clock face guide to peroneal intraneural ganglia: critical “times” and sites for accurate diagnosis. Skelet Radiol 37(12):1091–1099

    Article  Google Scholar 

  22. Jacobson JA, Wilson TJ, Yang LJS (2016) Sonography of common peripheral nerve disorders with clinical correlation. J Ultrasound Med 35(4):683–693

    Article  PubMed  Google Scholar 

  23. Spinner RJ, Dellon AL, Rosson GD, Anderson SR, Amrami KK (2007) Tibial intraneural ganglia in the tarsal tunnel: is there a joint connection? J Foot Ankle Surg 46(1):27–31

    Article  PubMed  Google Scholar 

  24. Chung W, Chung H, Shin M et al (1018) MRI to differentiate benign from malignant soft-tissue tumours of the extremities: a simplified systematic imaging approach using depth, size and heterogeneity of signal intensity. Br J Radiol 2012(85):e831–e836

    Google Scholar 

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, No. 87 Neijiang St, Wanhua District, Taipei, 108, Taiwan

    Wei-Ting Wu & Ke-Vin Chang

  2. Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey

    Levent Özçakar

Authors
  1. Wei-Ting Wu
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  2. Ke-Vin Chang
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  3. Levent Özçakar
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Correspondence to Ke-Vin Chang.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

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This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from the patient for being included in the study.

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Wu, WT., Chang, KV. & Özçakar, L. Ultrasound facilitates the diagnosis of tarsal tunnel syndrome: intraneural ganglion cyst of the tibial nerve. J Ultrasound 22, 95–98 (2019). https://doi.org/10.1007/s40477-018-0314-5

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  • DOI: https://doi.org/10.1007/s40477-018-0314-5

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