Tibial Intraneural Ganglia in the Tarsal Tunnel: Is There a Joint Connection?

Robert J. Spinner, A. Lee Dellon, Gedge David Rosson, Sharon R. Anderson, Kimberly K. Amrami

Research output: Contribution to journalArticle

Abstract

Intraneural ganglia are rare entities, and, as such, their pathogenesis has been extremely controversial. Recent evidence from intraneural ganglia occurring at more proximal sites-the peroneal nerve at the fibular neck (the most common site) and the tibial nerve at the knee-has suggested an articular origin rather than de novo formation. To our knowledge, of the 10 previous reports of tibial intraneural ganglia within the tarsal tunnel by others, a joint connection to the ankle joint was only identified in 2 cases. To support a hypothesis that tibial intraneural ganglia occurring within the tarsal tunnel region arise from neighboring joints, we analyzed 3 patients retrospectively, all of whom had magnetic resonance (MR) imaging and operative intervention. One of these patients was treated by a peripheral nerve surgeon specializing in foot and ankle surgery. The other 2 patients were the only ones previously published in the literature who had MR images available for reinterpretation. In none of these cases was a joint communication appreciated by radiologists interpreting the MR images preoperatively or by surgeons intraoperatively. Our review of these same cases demonstrated radiographic evidence of joint communications with the subtalar joints. Based on our findings in this article and our knowledge of intraneural ganglia occurring at more proximal sites, we believe that tibial intraneural ganglia within the tarsal tunnel originate from neighboring joints and that their connections to the joints (pedicles) are through articular branches. The importance of these connections is 2-fold: first, for their role in the pathogenesis of this entity, and second, for their potential therapeutic implications. As is highlighted by the clinical and radiographic follow-up in the 1 patient in this article and in many previously reported at other sites, intraneural cyst recurrence can occur if surgeons do not specifically address the articular connection.

Original languageEnglish (US)
Pages (from-to)27-31
Number of pages5
JournalJournal of Foot and Ankle Surgery
Volume46
Issue number1
DOIs
StatePublished - Jan 2007
Externally publishedYes

Fingerprint

Ganglia
Joints
Magnetic Resonance Spectroscopy
Communication
Subtalar Joint
Tibial Nerve
Peroneal Nerve
Ankle Joint
Peripheral Nerves
Ankle
Cysts
Foot
Knee
Neck
Magnetic Resonance Imaging
Recurrence
Surgeons

Keywords

  • ganglion
  • intraneural cyst
  • synovial cyst
  • tarsal tunnel
  • tibial nerve

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Tibial Intraneural Ganglia in the Tarsal Tunnel : Is There a Joint Connection? / Spinner, Robert J.; Dellon, A. Lee; Rosson, Gedge David; Anderson, Sharon R.; Amrami, Kimberly K.

In: Journal of Foot and Ankle Surgery, Vol. 46, No. 1, 01.2007, p. 27-31.

Research output: Contribution to journalArticle

Spinner, Robert J. ; Dellon, A. Lee ; Rosson, Gedge David ; Anderson, Sharon R. ; Amrami, Kimberly K. / Tibial Intraneural Ganglia in the Tarsal Tunnel : Is There a Joint Connection?. In: Journal of Foot and Ankle Surgery. 2007 ; Vol. 46, No. 1. pp. 27-31.
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