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Shields LB, Iyer VG, Zhang YP, Shields CB. Unilateral Calf Atrophy: A Case Series of Clinical and Electrodiagnostic Findings With a Review of the Literature. Cureus 2024; 16:e54710. [PMID: 38524090 PMCID: PMC10960639 DOI: 10.7759/cureus.54710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Unilateral calf atrophy may result from several medical conditions, such as lumbar radiculopathy, asymmetric myopathy/dystrophy, a Baker's (popliteal) cyst leading to tibial nerve compression, and disuse atrophy. We present a case series of four patients with unilateral calf atrophy, including chronic neurogenic atrophy (benign focal amyotrophy, one patient), tibial nerve compression at the popliteal fossa by a Baker's cyst (one patient), and disuse atrophy (two patients). All four patients underwent electrodiagnostic (EDX) studies, and two of them had denervation changes of the gastrocnemius. One patient underwent an ultrasound (US), which revealed a large cyst in the popliteal fossa causing compression of the tibial nerve. The differential diagnosis of unilateral calf atrophy as well as diagnostic techniques to confirm the underlying pathology are described. EDX and US studies are useful in differentiating between the varied conditions that may cause asymmetric calf muscle wasting.
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Affiliation(s)
- Lisa B Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, USA
| | - Vasudeva G Iyer
- Neurology/Clinical Neurophysiology, Neurodiagnostic Center of Louisville, Louisville, USA
| | - Yi Ping Zhang
- Norton Neuroscience Institute, Norton Healthcare, Louisville, USA
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2
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Stefanou N, Kalifis G, Marin Fermin T, Koutalos A, Akrivos V, Dailiana Z, Varitimidis S. Tibial Nerve Palsy: An Atypical Presentation of a Popliteal Cyst. Cureus 2022; 14:e27984. [PMID: 36120222 PMCID: PMC9468759 DOI: 10.7759/cureus.27984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2022] [Indexed: 11/05/2022] Open
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Yang JH, Kwon HH, Lee JK, Bang SY, Lee HS. Successful arthroscopic treatment of refractory and complicated popliteal cyst associated with rheumatoid arthritis in combination with osteoarthritis: case series and literature review. Rheumatol Int 2019; 39:2177-2183. [PMID: 30976834 DOI: 10.1007/s00296-019-04278-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 03/08/2019] [Indexed: 11/29/2022]
Abstract
Although popliteal cysts are most frequently identified in patients with osteoarthritis (OA), they may occur in patients with rheumatoid arthritis (RA), in which serious complicated cases such as cyst rupture can be developed. The objective of this study was to report four patients with RA (six knees) in combination with OA with a brief review of literature of previous similar published cases. This is a retrospective review of case records of patients with refractory and/or complicated popliteal cysts, who have successfully treated with arthroscopic intervention. We suggest that arthroscopic interventions such as radical debridement, synovectomy, biomechanical valve excision, and/or cystectomy should be considered in patients with refractory and complicated popliteal cysts associated with RA or RA in combination with OA.
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Affiliation(s)
- Jae-Hyuk Yang
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Hyuk-Hee Kwon
- Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, 153, Gyeongchunro, Guri, Gyeonggi-do, 11923, South Korea
| | - Jin Kyu Lee
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - So Young Bang
- Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, 153, Gyeongchunro, Guri, Gyeonggi-do, 11923, South Korea
| | - Hye-Soon Lee
- Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, 153, Gyeongchunro, Guri, Gyeonggi-do, 11923, South Korea.
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4
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Liebensteiner MC, Thaler M, Putzer D, Wurm A, Nogler M. [Arthroscopic procedure for Baker's cysts : surgical technique. Video article]. DER ORTHOPADE 2015; 44:803-5. [PMID: 26306606 DOI: 10.1007/s00132-015-3155-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Baker's cysts are related to increased intra-articular pressure. The causes may be inflammatory, degenerative or traumatic disorders. Owing to the increased intra-articular pressure a cyst protrudes between the semimembranosus and the medial gastrocnemius tendons. The traditional treatment for a Baker's cyst is open resection. As an alternative, an arthroscopic procedure can be performed, which is demonstrated by the video on surgical technique that accompanies this short report. SURGICAL TECHNIQUE From the anterolateral portal the arthroscope is advanced through the intercondylar notch (below the posterior cruciate ligament) to the posteromedial recess. Under visual control, a posteromedial portal is created followed by identification of the capsular fold separating the cyst from the joint cavity. This fold (valvular mechanism) is resected with a shaver from the posteromedial portal until a large enough connection exists between the joint and the cyst (cyst decompression). After the decompression, the arthroscope is inserted from the posteromedial portal directly into the cyst cavity. Subsequently, the inner wall of the cyst is removed with the shaver via an additional far posterior cystic portal. It is obligatory to treat the associated intra-articular pathological condition. In our video a medial meniscal lesion is treated with partial meniscectomy.
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Affiliation(s)
- M C Liebensteiner
- Universitätsklinik für Orthopädie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - M Thaler
- Universitätsklinik für Orthopädie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - D Putzer
- Universitätsklinik für Orthopädie, Experimentelle Orthopädie, Medizinische Universität Innsbruck, Innsbruck, Österreich.
| | - A Wurm
- Universitätsklinik für Orthopädie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - M Nogler
- Universitätsklinik für Orthopädie, Experimentelle Orthopädie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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Yoo MJ, Yoo JS, Jang HS, Hwang CH. Baker's Cyst Filled with Hematoma at the Lower Calf. Knee Surg Relat Res 2014; 26:253-6. [PMID: 25505709 PMCID: PMC4258494 DOI: 10.5792/ksrr.2014.26.4.253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/17/2014] [Accepted: 08/25/2014] [Indexed: 10/26/2022] Open
Abstract
Baker's cyst is a distension of the gastrocnemius-semimembranosus bursa of the knee, which communicates with the posterior portion of the joint capsule. Baker's cyst is commonly located in the inferomedial or superficial layers of the knee joint and rarely extends laterally or proximally. Complications of Baker's cysts are dissection, rupture, pseudothrombophlebitis, leg ischemia, nerve entrapment, and compartment syndrome. However, hematomas in the Baker's cyst have not been reported in Korea. We report a rare case of hematoma in the Baker's cyst with subfascial extension into the calf. The hematoma was demonstrated by magnetic resonance imaging and removed by mass excision.
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Affiliation(s)
- Moon-Jib Yoo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jae-Sung Yoo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Ho-Seong Jang
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Chang-Hwan Hwang
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
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Moon SH, Im S, Park GY, Moon SJ, Park HJ, Choi HS, Jo YR. Compressive neuropathy of the posterior tibial nerve at the lower calf caused by a ruptured intramuscular baker cyst. Ann Rehabil Med 2013; 37:577-81. [PMID: 24020041 PMCID: PMC3764355 DOI: 10.5535/arm.2013.37.4.577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/17/2012] [Indexed: 11/05/2022] Open
Abstract
Baker cyst is an enlargement of the gastrocnemius-semimembranosus bursa. Neuropathy can occur due to either direct compression from the cyst itself or indirectly after cyst rupture. We report a unique case of a 49-year-old man with left sole pain and paresthesia who was diagnosed with posterior tibial neuropathy at the lower calf area, which was found to be caused by a ruptured Baker cyst. The patient's symptoms resembled those of lumbosacral radiculopathy and tarsal tunnel syndrome. Posterior tibial neuropathy from direct pressure of ruptured Baker cyst at the calf level has not been previously reported. Ruptured Baker cyst with resultant compression of the posterior tibial nerve at the lower leg should be included in the differential diagnosis of patients who complain of calf and sole pain. Electrodiagnostic examination and imaging studies such as ultrasonography or magnetic resonance imaging should be considered in the differential diagnosis of isolated paresthesia of the lower leg.
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Affiliation(s)
- Seock Ho Moon
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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Abstract
Peripheral nerve entrapments are frequent. They usually appear in anatomical tunnels such as the carpal tunnel. Nerve compressions may be due to external pressure such as the fibular nerve at the fibular head. Malignant or benign tumors may also damage the nerve. For each nerve from the upper and lower limbs, detailed clinical, electrophysiological, imaging, and therapeutic aspects are described. In the upper limbs, carpal tunnel syndrome and ulnar neuropathy at the elbow are the most frequent manifestations; the radial nerve is less frequently involved. Other nerves may occasionally be damaged and these are described also. In the lower limbs, the fibular nerve is most frequently involved, usually at the fibular head by external compression. Other nerves may also be involved and are therefore described. The clinical and electrophysiological examination are very important for the diagnosis, but imaging is also of great use. Treatments available for each nerve disease are discussed.
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Affiliation(s)
- P Bouche
- Department of Clinical Neurophysiology Salpêtrière Hospital, Paris, France.
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Marchalik D, Lipsky A, Petrov D, Harvell JD, Milgraum SS. Dermatologic Presentations of Orthopedic Pathologies. Am J Clin Dermatol 2012; 13:293-310. [DOI: 10.2165/11595880-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Compression syndromes of the popliteal neurovascular bundle due to Baker cyst. J Vasc Surg 2011; 54:1821-9. [PMID: 21958564 DOI: 10.1016/j.jvs.2011.07.079] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 07/08/2011] [Accepted: 07/20/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this study was to perform a comprehensive search of the literature for all studies, case reports, and series describing Baker cyst compression of the neurovascular bundle in the popliteal fossa and index their findings according to the structures compressed. METHOD Case reports and series obtained after a thorough MEDLINE search were indexed according to compressed structures. Patient demographics, main findings, method of diagnosis, cyst size, outcomes, and follow-up were recorded for each publication. RESULTS Signs and symptoms related to popliteal vein and tibial nerve compression were the most frequent presentation of symptomatic Baker cysts, due to the anatomic vulnerability of these structures within the popliteal fossa and their relative sensitivity to compression. Patients with tibial nerve entrapment demonstrated gastrocnemius muscle atrophy, paresthesias, and pain. Those with popliteal vein compression experienced swelling, pain, and rarely, venous thromboembolism. Isolated arterial compression, presenting with intermittent claudication, is a rare occurrence because it is a relatively stiff-walled vessel, has a higher pressure, and is located deep in the popliteal fossa. Combinations of these compression syndromes are most frequently encountered in the context of cyst rupture and resulting compartment syndrome. CONCLUSIONS Baker cyst is an important pathology for the differential diagnosis of popliteal neurovascular compression phenomena. It has a wide spectrum of presentation, therefore requiring accurate diagnosis for proper patient management. Because Baker cyst is by definition a chronic disorder, long-term follow-up is necessary to monitor patient recovery and prevent recurrence.
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Macfarlane AJR, Sites BD, Sites VR, Naraghi AM, Chan VWS, Singh M, Antonakakis JG, Brull R. Musculoskeletal sonopathology and ultrasound-guided regional anesthesia. HSS J 2011; 7:64-71. [PMID: 22294960 PMCID: PMC3026115 DOI: 10.1007/s11420-010-9174-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 06/11/2010] [Indexed: 02/07/2023]
Abstract
The use of real-time ultrasound guidance has revolutionized the practice of regional anesthesia. Ultrasound is rapidly becoming the technique of choice for nerve blockade due to increased success rates, faster onset, and potentially improved safety. In the course of ultrasound-guided regional anesthesia, unexpected pathology may be encountered. Such anomalous or pathological findings may alter the choice of nerve block and occasionally affect surgical management. This case series presents a variety of musculoskeletal conditions that may be encountered during ultrasound-guided regional anesthesia practice.
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Affiliation(s)
| | - Brian D. Sites
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | | | - Ali M. Naraghi
- Joint Department of Medical Imaging of University Health Network and Mount Sinai Hospital, Toronto Western Hospital, Toronto, ON Canada
| | - Vincent W. S. Chan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada
| | - Mandeep Singh
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada
| | - John G. Antonakakis
- Department of Anesthesiology, University of Virginia, Charlottesville, VA USA
| | - Richard Brull
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada
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11
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An unusual popliteal cyst causing compressive neuropathy of the common peroneal nerve. CURRENT ORTHOPAEDIC PRACTICE 2009. [DOI: 10.1097/bco.0b013e3181a1a4b5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Carr JA, Carr SEW. Giant Synovial Cyst of the Anterior Compartment: An Unusual Cause of Chronic Knee Pain After Trauma. Eur J Trauma Emerg Surg 2009; 35:71-3. [PMID: 26814536 DOI: 10.1007/s00068-008-8020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Accepted: 06/08/2008] [Indexed: 10/21/2022]
Abstract
There is almost no literature describing the management and rationale for intervention for posttraumatic, extra-articular synovial cysts of the knee. We describe the very rare case of a 45-year-old blind man who developed chronic knee pain after a traumatic injury. He was found to have a giant, posttraumatic, true synovial cyst of the knee in an extra-articular location and migrating down the anterior compartment. The surgical management, potential complications, and rationale for intervention are discussed.
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Affiliation(s)
- John A Carr
- Passavant Surgical Associates, 1600 West Walnut Street, Jacksonville, IL, 62650, USA. .,Passavant Surgical Associates, 1600 West Walnut Street, Jacksonville, IL, 62650, USA.
| | - Seann E W Carr
- Department of Orthopedic Surgery, Scripps Green Hospital, La Jolla, CA, USA
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Abstract
OBJECTIVE To review the epidemiology, clinical presentation, pathogenesis, imaging, differential diagnosis, complications, and treatment of popliteal cysts. METHODS References were taken from MEDLINE from 1985 to 1998 under the subject "Popliteal Cyst" with subheadings of Radiography, Ultrasonography, and Radionuclide Imaging. Other pertinent references were used. Childhood cysts were excluded. RESULTS Depending on the studied population and the imaging technique, 5% to 32% of knee problems may have these cysts, with 2 age-incidence peaks of 4 to 7 years and 35 to 70 years. In older patients there is usually coexistent joint pathology. Symptoms may arise in the popliteal fossa from the cyst itself or be dominated by knee pain from coexisting knee pathology. Many cysts are asymptomatic. Physical examination will miss one half of these cysts. Pathogenesis depends on the connection between the joint and bursa, with a valvelike effect allowing passage of fluid from the joint into the bursa with subsequent distention producing these cysts. Some bursae have no such joint-bursal communication, and the cysts arise primarily as bursitis of the gastrocnemio-semimembranosus bursa. Imaging is performed by plain x-ray, ultrasound, arthrography, computerized axial tomography, magnetic resonance imaging, or nuclear scan; sonography is the method of choice. Complicated cysts with extension or rupture into the calf mimic phlebitis, an important differential diagnosis. Asymptomatic cysts found incidentally need no treatment; most symptomatic cysts respond to intra-articular corticosteroid injections. Surgical excision is rarely necessary. CONCLUSIONS AND RELEVANCE Popliteal cysts are fairly common, may not be found on physical examination, require imaging (preferably sonography) to be identified, mimic phlebitis when extending into the calf, and often respond to intra-articular steroid or, rarely, surgical resection.
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Affiliation(s)
- J R Handy
- Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta, GA, USA
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Martí-Bonmatí L, Mollá E, Dosdá R, Casillas C, Ferrer P. MR imaging of Baker cysts --prevalence and relation to internal derangements of the knee. MAGMA (NEW YORK, N.Y.) 2000; 10:205-10. [PMID: 10873212 DOI: 10.1007/bf02590647] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the prevalence of popliteal cysts in patients studied with magnetic resonance (MR) imaging. Cyst presence and volume will be related to other internal derangement of the knee. MATERIALS AND METHODS Three hundred and eighty-two consecutive patients with a MR study of the knee were included. Images were obtained in the three spatial orthogonal planes and evaluated through consensus. Four categories were established for the Baker cyst and synovial fluid (absence, minimum, moderate and massive), and the presence of meniscal, cruciate ligaments and cartilage lesions were recorded. Statistical analysis was carried out with bivariate analysis (chi(2) of Pearson and Gamma tests). RESULTS From the 382 patients, 145 had Baker cysts (38.0%). Cyst content was minimum in 99, moderate in 34 and massive in 12. Joint effusion was observed in 269 patients (70.4%), being minimal in 140 patients, moderate in 119 and massive in ten. Meniscal lesions were observed in 195 patients (51%), while 58 patients (15%) had a cruciate ligament lesion. Baker cyst had a statistically significant direct relationship with the presence and quantity of synovial fluid (P=0.002) and with the presence and type of meniscal lesion (P=0.01) but not with cruciate ligaments or cartilage lesions. CONCLUSIONS The prevalence of Baker cysts in MR studies of the knee is high. Its presence and volume are related to the quantity of synovial fluid, and to the presence and severity of meniscal lesions.
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Affiliation(s)
- L Martí-Bonmatí
- Magnetic Resonance Service, ATQ-Clínica Quirón, 46010, Valencia, Spain.
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Lee JH, Jun JB, Lee HS, Yun HR, Choi CH, Park SB, Hong EK, Yoo DH, Kim SY. Posterior tibial neuropathy by a Baker's cyst: case report. Korean J Intern Med 2000; 15:96-8. [PMID: 10714101 PMCID: PMC4531743 DOI: 10.3904/kjim.2000.15.1.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Baker's cysts are rare cause of peripheral nerve entrapment and only a few cases of tibial nerve entrapment resulting from the popliteal cyst in the calf muscle have been reported in the literature. We present a case of rheumatoid arthritis complicated by a Baker's cyst with a tibial nerve entrapment. It is important to diagnose a Baker's cyst early and to differentiate it from thrombophlebitis, a popliteal aneurysm, tumor or muscle tear to effect optimal therapy and to obviate a potential neuropathy. Prompt recognition of these cases may save the patients unnecessary procedures and delay in treatment.
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Affiliation(s)
- J H Lee
- Hospital for Rheumatic Diseases, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Abstract
Entrapment neuropathies of the tibial nerve are relatively rare. They are often misdiagnosed largely because of the clinician's low index of suspicion. The clinical features, diagnostic studies, and treatment of these disorders are reviewed in detail in this article. Almost all of these disorders can now be confirmed through nerve conduction and other image studies.
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Affiliation(s)
- S J Oh
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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