대한근골격영상의학회

Title : Case 88

Age / Sex : 70 / M Age / Sex : 70/M Chief complaint : Paresthesia and numbness of Lt. foot 1) What is your impression? Two weeks later, you can see the final diagnosis with a brief discussion of this case. * Send Application Answers to Ja-Young Choi, MD (drchoi01@gmail.com) Courtesy : Na Ra Kim, MD., Boramae Hospital Diagnosis: tarsal tunnel syndrome with ganglion cyst Discussion Findings: Transverse US scan of posteroinferior aspect of medial malleolus shows an ganglion cyst adjacent medial plantar nerve and tibial vessels. The medial plantar nerve is swollen. Axial FS T2-weighted image demonstrate a ganglion cyst in the tarsal tunnel. The cyst is responsible for compression of medial plantar nerve branch. Coronal FS T2-weighted image shows diffuse high SI of abductoe hallucis m., flexor hallucis brevis m., and flexor digitorum brevis m. by denervation injury. Differential Diagnosis: Diagnosis: Tarsal tunnel syndrome by ganglion cyst Discussion: Proximal tarsal tunnel syndrome consists of entrapment of the tibial nerve in the retromalleolar region, whereas distal tarsal tunnel syndrome involves the divisions of the tibial nerve.In cases of standard tarsal tunnel syndrome, it should be assumed that the pathologic condition exists in both these zones; however,localized nerve disease involving only one of these nerves may occur. External compression resulting from ill-fitting footwear or tight plaster casts is probably the most common cause. However,space-occupying lesions of the medial ankle, such as flexor tenosynovitis, ganglia related to the talocalcaneal joint, fascial septa, an anomalous tendon or muscle (flexor digitorum accessorius longus), or fracture residuals, may also constrict the nerve. Although typical symptoms include numbness or pain in the foot and ankle and paresthesia in the sole of the foot, the clinical and electromyographic diagnosis of tarsal tunnel syndrome is often not straight forward, especially when a soft-tissue swelling on the medial ankle is absent. References: 1. Emmanuelle M. Delfaut, MD, Xavier Demondion, MD, et alRadiographics. 2003;23:613-623. Imaging of Foot and Ankle Nerve Entrapment Syndromes: From Well-demonstrated to Unfamiliar Sites 2. Carlo Martinoli, MD, Stefano Bianchi, MD, Nicola Gandolfo, MD, et alRadiographics. 2000;20:S199-S217. US of Nerve Entrapments in Osteofibrous Tunnels of the Upper and Lower Limbs

Title : Case 88

Age / Sex : 70 / M

Age / Sex : 70/M
Chief complaint : Paresthesia and numbness of Lt. foot

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

* Send Application Answers to Ja-Young Choi, MD (drchoi01@gmail.com)

Courtesy : Na Ra Kim, MD., Boramae Hospital

Diagnosis:

tarsal tunnel syndrome with ganglion cyst

Discussion

Findings:
Transverse US scan of posteroinferior aspect of medial malleolus shows an ganglion cyst adjacent medial plantar nerve and tibial vessels. The medial plantar nerve is swollen. Axial FS T2-weighted image demonstrate a ganglion cyst in the tarsal tunnel. The cyst is responsible for compression of medial plantar nerve branch. Coronal FS T2-weighted image shows diffuse high SI of abductoe hallucis m., flexor hallucis brevis m., and flexor digitorum brevis m. by denervation injury.

Differential Diagnosis:

Diagnosis: Tarsal tunnel syndrome by ganglion cyst

Discussion:

Proximal tarsal tunnel syndrome consists of entrapment of the tibial nerve in the retromalleolar region, whereas distal tarsal tunnel syndrome involves the divisions of the tibial nerve.In cases of standard tarsal tunnel syndrome, it should be assumed that the pathologic condition exists in both these zones; however,localized nerve disease involving only one of these nerves may occur. External compression resulting from ill-fitting footwear or tight plaster casts is probably the most common cause. However,space-occupying lesions of the medial ankle, such as flexor tenosynovitis, ganglia related to the talocalcaneal joint, fascial septa, an anomalous tendon or muscle (flexor digitorum accessorius longus), or fracture residuals, may also constrict the nerve. Although typical symptoms include numbness or pain in the foot and ankle and paresthesia in the sole of the foot, the clinical and electromyographic diagnosis of tarsal tunnel syndrome is often not straight forward, especially when a soft-tissue swelling on the medial ankle is absent.

References:

1. Emmanuelle M. Delfaut, MD, Xavier Demondion, MD, et alRadiographics. 2003;23:613-623. Imaging of Foot and Ankle Nerve Entrapment Syndromes: From Well-demonstrated to Unfamiliar Sites

2. Carlo Martinoli, MD, Stefano Bianchi, MD, Nicola Gandolfo, MD, et alRadiographics. 2000;20:S199-S217. US of Nerve Entrapments in Osteofibrous Tunnels of the Upper and Lower Limbs

Correct Answer
Name	Institution
Total Applicants (7)

Correct Answer (7)

김완태: 서울보훈병원
김권형: 한마음 병원
김성준: 영동세브란스병원
박상현: 순천향대학천안병원
박소영: 분당서울대병원
정혜원: 서울아산병원
채지원: 서울대병원

Comment

- Weekly Cases
- Case 718
  
  Seung Hyun Lee
- Case 677
  
  Yun Sun Choi
- 관련 동영상
- Ankle and Foot Imaging
  
  하두회
- Forefoot and midfoot diseases
  
  김성준
- 집담회 증례
- Sesamoiditis?
- Tarsal tunnel syndrome

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