TY - JOUR
T1 - Magnetic Resonance Imaging of a Deep Peroneal Intraneural Ganglion Cyst Originating from the Second Metatarsophalangeal Joint
T2 - A Pattern of Propagation Supporting the Unified Articular (Synovial) Theory for the Formation of Intraneural Ganglia
AU - Blitz, Neal M.
AU - Amrami, Kimberly K.
AU - Spinner, Robert J.
PY - 2009/1
Y1 - 2009/1
N2 - A deep peroneal intraneural cyst of the first web space of the foot is presented. Analysis of the magnetic resonance image scans revealed not only a connection with the medial aspect of the second metatarsophalangeal joint, but also the presence of an interconnected cyst within the lateral digital branch of the hallux. These characteristic magnetic resonance image findings are consistent with those previously described for a peroneal intraneural ganglion cyst that arose from the superior tibiofibular joint, and include (1) origin (ascent) from the second metatarsophalangeal joint with propagation along the articular branch and into the dorsal digital branch of the second toe, (2) cross-over within the shared epineurial sheath of the deep peroneal nerve, and (3) further propagation (descent) within the dorsal digital branch of the hallux. The analogous features between intraneural ganglion cysts affecting small and large-caliber nerves support the fundamental principles of the unified articular (synovial) theory for the formation of intraneural ganglia, including (1) a connection to a synovial joint, (2) dissection of joint fluid through a capsular rent along the articular branch into the parent nerve, and (3) intra-epineurial, pressure-dependent propagation of cyst fluid along paths of least resistance. Level of Clinical Evidence: 4.
AB - A deep peroneal intraneural cyst of the first web space of the foot is presented. Analysis of the magnetic resonance image scans revealed not only a connection with the medial aspect of the second metatarsophalangeal joint, but also the presence of an interconnected cyst within the lateral digital branch of the hallux. These characteristic magnetic resonance image findings are consistent with those previously described for a peroneal intraneural ganglion cyst that arose from the superior tibiofibular joint, and include (1) origin (ascent) from the second metatarsophalangeal joint with propagation along the articular branch and into the dorsal digital branch of the second toe, (2) cross-over within the shared epineurial sheath of the deep peroneal nerve, and (3) further propagation (descent) within the dorsal digital branch of the hallux. The analogous features between intraneural ganglion cysts affecting small and large-caliber nerves support the fundamental principles of the unified articular (synovial) theory for the formation of intraneural ganglia, including (1) a connection to a synovial joint, (2) dissection of joint fluid through a capsular rent along the articular branch into the parent nerve, and (3) intra-epineurial, pressure-dependent propagation of cyst fluid along paths of least resistance. Level of Clinical Evidence: 4.
KW - articular (synovial) theory
KW - deep peroneal nerve
KW - ganglia
KW - intermetatarsal space
KW - intraneural ganglion cyst
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U2 - 10.1053/j.jfas.2008.09.002
DO - 10.1053/j.jfas.2008.09.002
M3 - Article
C2 - 19110165
AN - SCOPUS:57749116116
VL - 48
SP - 80
EP - 84
JO - Journal of Foot and Ankle Surgery
JF - Journal of Foot and Ankle Surgery
SN - 1067-2516
IS - 1
ER -