The 68th
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Ultrasound guided treatment of common peroneal neuropathy caused by Baker’s cyst - a case report -
Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital. Seoul, South Korea.1
Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University. Seoul, South Korea.2
Second Armor Brigade. Paju, South Korea.3
Peroneal neuropathy is the third most common focal neuropathy, and its common symptom is weakness of ankle dorsiflexion. The causes of peripheral neuropathy are generalized diseases, direct injury, infection, and compression. Treatments are focused on symptomatic relief. We present a case of common peroneal neuropathy caused by Baker’s cyst at the level of fibular head.
A 57-year-old woman visited our pain clinic for limping gait and pain of left lower leg. Numbness and pain follows the deep and superficial peroneal nerve territory and the pain severity was 8/10 in VAS. The motor power of ankle dorsiflexion and big toe extension were grade I. 1 month ago, left common peroneal neuropathy with severe partial axonotmesis or severe conduction block had been diagnosed on electromyography. Findings compatible with Kellgren-Lawrence grade III osteoarthritis were shown on simple radiologic study of the left knee. On ultrasound examination of the left knee, a large Baker’s cyst was extending to fibular head and compressing the common peroneal nerve (Fig. 1A). Therefore, ultrasound guided aspiration and common peroneal nerve block were performed (Fig. 1B). Immediately after nerve block, the pain, dysesthesia, and limping gait were relieved. 4 weeks later, MRI images showed that perineural ganglion was encasing the peroneal nerve around fibular head level (Fig. 2A). Also, there was increased signal intensity in proximal anterior compartment of lower leg, which could indicate denervation injury (Fig. 2B). Yet, the pain severity was 0/10 in VAS. Therefore, viscosupplementation with sodium hyaluronate and second common peroneal nerve block with 20mg of triamcinolone acetate were performed at her second visit of our pain clinic (Fig. 1C). Six months after the procedure, the complete relief of pain and limping gait was still maintained, and there was no need for further management.
This case was initially diagnosed bases on her symptoms and electromyography results without knowing the exact cause. It was not easy to reveal the cause due to the uncommon location of Baker’s cyst, lateral side of popliteal area. By using ultrasound, we easily found the Baker’s cyst at the level of fibular head which was causing the neuropathy. Baker’s cyst is usually known to require surgical removal. We were able to effectively treat neuropathy with just ultrasound-guided aspiration.
A 57-year-old woman visited our pain clinic for limping gait and pain of left lower leg. Numbness and pain follows the deep and superficial peroneal nerve territory and the pain severity was 8/10 in VAS. The motor power of ankle dorsiflexion and big toe extension were grade I. 1 month ago, left common peroneal neuropathy with severe partial axonotmesis or severe conduction block had been diagnosed on electromyography. Findings compatible with Kellgren-Lawrence grade III osteoarthritis were shown on simple radiologic study of the left knee. On ultrasound examination of the left knee, a large Baker’s cyst was extending to fibular head and compressing the common peroneal nerve (Fig. 1A). Therefore, ultrasound guided aspiration and common peroneal nerve block were performed (Fig. 1B). Immediately after nerve block, the pain, dysesthesia, and limping gait were relieved. 4 weeks later, MRI images showed that perineural ganglion was encasing the peroneal nerve around fibular head level (Fig. 2A). Also, there was increased signal intensity in proximal anterior compartment of lower leg, which could indicate denervation injury (Fig. 2B). Yet, the pain severity was 0/10 in VAS. Therefore, viscosupplementation with sodium hyaluronate and second common peroneal nerve block with 20mg of triamcinolone acetate were performed at her second visit of our pain clinic (Fig. 1C). Six months after the procedure, the complete relief of pain and limping gait was still maintained, and there was no need for further management.
This case was initially diagnosed bases on her symptoms and electromyography results without knowing the exact cause. It was not easy to reveal the cause due to the uncommon location of Baker’s cyst, lateral side of popliteal area. By using ultrasound, we easily found the Baker’s cyst at the level of fibular head which was causing the neuropathy. Baker’s cyst is usually known to require surgical removal. We were able to effectively treat neuropathy with just ultrasound-guided aspiration.
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