Abstract
Intraneural ganglion cysts are rare mucinous cyst originating within the epineurium
of peripheral nerves. They occur most commonly in the peroneal nerve. However, they
have also been described in many nerves in the vicinity of synovial joints. Intraneural
ganglion cysts in the upper extremity are rare. Those at the elbow joint comprise
only 9% of intraneural ganglion ever reported.
A 66-year-old and right-handed male patient presented with a sudden onset of right-hand
weakness. He initially noticed paresthesia with decreased sensation in the lateral
two digits and radial palm in his right hand. Physical examination showed thenar muscle
atrophy and muscle weakness of the abductor pollicis brevis in the right hand. Preoperative
diagnosis of intraneural ganglion cyst was made on the basis of characteristic magnetic
resonance imaging (MRI) findings. On exploration, the ulnar nerve was identified proximal
to the elbow joint. Its articular branch was addressed and divided from the elbow
joint.
To the best of our knowledge, addressing the articular branch connecting the glenohumeral
joint for the treatment of intraneural ganglion at the elbow has only been reported
twice. We experienced a rare occurrence of intraneural ganglion cyst at the elbow
manifesting an ulnar neuropathy. Here, we report intraoperative findings for the articular
branch-connected to intraneural ganglion of the ulnar nerve at the elbow. Early diagnosis
of intraneural ganglion with precise identification of the pathology and addressing
the articular branch with atraumatic dissection of ganglion cyst are essential to
achieve successful treatment for this rare lesion.
Keywords
cyst - intraneural ganglion cyst - ganglion - ulnar nerve - ulnar neuropathy
