J Korean Soc Surg Hand.  2017 Jun;22(2):132-136. 10.12790/jkssh.2017.22.2.132.

Radial Nerve Compression Caused by a Ganglion Cyst at the Elbow

• Kim DH
• Ko HS
• Jun YJ

• KMID: 2383807
• DOI: http://doi.org/10.12790/jkssh.2017.22.2.132

Abstract

Although ganglion cyst is a relatively common benign mass in soft tissues, there have been very few reports of intramuscular ganglion cyst. We encountered such a case located in the antecubital fossa originating from the supinator muscle. A 61-year-old woman presented with a painless mass in the antecubital fossa. However, the patient complained of a significant sensory deficit in the radial side of the thumb, index, and middle finger. She also had extensor weakness at the metacarpophalangeal joint. The mass was excised completely, with no post-surgical complications. Pathologic results revealed the ganglion cyst. The patient showed improvements in sensory dysfunction and extensor weakness. Intramuscular ganglion cyst can be misdiagnosed. This report might be useful for making an accurate diagnosis and rapidly initiating treatment for an intramuscular mass.

Keyword

Elbow joint; Radial nerve; Ganglion cysts

MeSH Terms

Diagnosis
Elbow Joint
Elbow*
Female
Fingers
Ganglion Cysts*
Humans
Metacarpophalangeal Joint
Middle Aged
Radial Nerve*
Thumb

Figure

• 

  Fig. 1 Preoperative gross clinical photo. The mass is palpable to about 2×2 cm2 sized firmly in the antecubital fossa.

• 

  Fig. 2 Preoperative computed tomography shows a lobulated cystic lesion (arrows) arising from a voloradial aspect of the proximal radius. (A) Axial view. (B) Sagittal view.

• 

  Fig. 3 Intraoperative gross clinical photo. (A) A mass was located where the radial nerve is a bifurcation to the deep branch and superficial branch. (B) Well-preserved nerve was visible after removing the mass.

• 

  Fig. 4 Intraoperative gross clinical photo of the excised mass.

• 

  Fig. 5 Pathologic finding shows a lack of a cyst lining and a muscular tissue on the tissue surface consistent with intramuscular ganglion cyst. Hematoxylin and eosin stain, examined at magnification of ×100 (A), ×200 (B), and ×400 (C).

Reference

1. Loh YC, Lam WL, Stanley JK, Soames RW. A new clinical test for radial tunnel syndrome: the Rule-of-Nine test: a cadaveric study. J Orthop Surg (Hong Kong). 2004; 12:83–86.

2. Ogino T, Minami A, Kato H. Diagnosis of radial nerve palsy caused by ganglion with use of different imaging techniques. J Hand Surg Am. 1991; 16:230–235.

3. Vaishya R, Kapoor C, Agarwal AK, Vijay V. A rare presentation of ganglion cyst of the elbow. Cureus. 2016; 8:e665.

4. Mileti J, Largacha M, O’Driscoll SW. Radial tunnel syndrome caused by ganglion cyst: treatment by arthroscopic cyst decompression. Arthroscopy. 2004; 20:e39–e44.

5. Kim YJ, Chae SU, Choi BS, Kim JY, Jo HJ. Intramuscular ganglion of the quadriceps femoris. Knee Surg Relat Res. 2013; 25:40–42.

6. Jou IM, Wang HN, Wang PH, Yong IS, Su WR. Compression of the radial nerve at the elbow by a ganglion: two case reports. J Med Case Rep. 2009; 3:7258.

7. McFarlane J, Trehan R, Olivera M, Jones C, Blease S, Davey P. A ganglion cyst at the elbow causing superficial radial nerve compression: a case report. J Med Case Rep. 2008; 2:122.

8. Datir A, James SL, Ali K, Lee J, Ahmad M, Saifuddin A. MRI of soft-tissue masses: the relationship between lesion size, depth, and diagnosis. Clin Radiol. 2008; 63:373–378.

9. Persson BM, Rydholm A. Soft-tissue masses of the locomotor system: a guide to the clinical diagnosis of malignancy. Acta Orthop Scand. 1986; 57:216–219.

10. Feldman F, Singson RD, Staron RB. Magnetic resonance imaging of para-articular and ectopic ganglia. Skeletal Radiol. 1989; 18:353–358.