Giant Ganglion Cyst of the Proximal Tibiofibular Joint with Peroneal Nerve Palsy: A Case Report

Introduction: Ganglion cysts are benign cystic tumors of musculoskeletal structures which have variable clinical presentations, however, compression neuropathies due to ganglion cyst are much less common in the lower extremity and only a couple of cases have been described in the literature. Hence, in the current case report, we describe a patient with a giant ganglion cyst causing peroneal nerve palsy which was managed surgically.

Case Report: A 50-year-old female presented with a 2-month history of progressive left foot drop with a gradual development of swelling over the left fibular head. Imaging suggested ganglion cyst-induced peroneal nerve palsy. Initial conservative treatment failure warranted surgical excision which confirmed extraneural origin on histopathological examination. An immediate clinical improvement was observed postoperatively and full recovery occurred within 6 months. There was no recurrence at 2 years follow up.

Conclusion: The ganglion cyst-induced compression neuropathies are uncommon in lower limbs, especially in a skeletally mature person. Our case was an extraneural cyst which is the rare comparatively. The possibilities of other differentials should be excluded through imaging due to non-specific presentations. Surgical management is the preferred mode of treatment with 10% recurrences which can be reduced by complete excision including stalk.