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[Compression of the peroneal nerve by a synovial cyst in a 7-year-old child]
L E Gayet1, F Morand, J M Goujon
1Service d'Orthopédie-Traumatologie adulte et infantile, Hôpital Jean Bernard, C.H.U. de la Milétrie, Poitiers.
Purpose Of The Study:
Compressions of the peroneal nerve by synovial cysts are rare. Sixty cases have been described since 1921.
Materials And Methods:
It concerns extrinsic compression of the peroneal nerve by a synovial cyst, developed from the upper tibiofibular joint, in a seven years old child. As far as we know, this is the youngest age found in the relevant literature. Because of a swiftly appearing painful swelling, along with complete paralysis of the peroneal nerve, an electromyogram and a magnetic resonance imaging were performed, in view to confirm the diagnosis and to clarify cyst topography.
Results:
Removal of the cyst led to healing with complete recovery of the peroneal nerve within three months.
Discussion:
Both intraneural and extraneural cysts exist. Most authors agree that their source is the upper tibiofibular joint. In case of intraneural cysts, complete removal is sometimes impossible. It seems preferable to make a longitudinal incision in the nerve to lay the tumor flat. Indeed, everything possible should be done to find, then ligature, the pedicle which passes by the articular nerve ending of the peroneal nerve in order to avoid recurrence. Extraneural cysts are sometimes intra- or inter-muscular and create a swelling which is often palpable. It is necessary to remove the cyst carefully and to dissociate it from the nerve endings.
Conclusion:
In all cases, recurrence is not infrequent. Longer the delay before intervention is less satisfactory the recovery will be.