Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2021; 9(17): 4433-4440
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4433
Intraneural ganglion cyst of the lumbosacral plexus mimicking L5 radiculopathy: A case report
Jun Gyu Lee, Hyungsun Peo, Jang Hyuk Cho, Du Hwan Kim
Jun Gyu Lee, Hyungsun Peo, Du Hwan Kim, Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, South Korea
Jang Hyuk Cho, Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea
Author contributions: Lee JG, Peo H, Cho JH, and Kim DH drafted manuscript; Lee JG and Peo H reviewed the literature; Cho JH and Kim DH collected medical history and diagnostic findings; Kim DH designed this report and supervised study; all authors have read and approve the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Du Hwan Kim, MD, PhD, Associate Professor, Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, South Korea. ri-pheonix@hanmail.net
Received: February 10, 2021
Peer-review started: February 10, 2021
First decision: March 11, 2021
Revised: March 16, 2021
Accepted: March 24, 2021
Article in press: March 24, 2021
Published online: June 16, 2021
Processing time: 104 Days and 20.4 Hours
Abstract
BACKGROUND

Intraneural ganglion cysts are benign gelatinous masses that form within the epineurium of a peripheral nerve. Only few cases of intraneural ganglion cyst arising from the hip joint have been reported.

CASE SUMMARY

A previously healthy 65-year-old woman who had been experiencing left buttock pain radiating to the dorsum of the foot for 2 years visited our clinic. Prior to visiting the clinic, she underwent lumbar spine magnetic resonance imaging and received physiotherapy, pain killers, and epidural injections based on a presumptive diagnosis of spinal stenosis for 2 years in other hospitals. Repeat magnetic resonance imaging revealed joint connection of the articular branch of the hip joint and rostral extension of the cyst along the L5 spinal nerve near the L5-S1 neural foramen. The patient was diagnosed with intraneural ganglion cyst arising from the articular branch of the hip joint based on high-resolution magnetic resonance neurography. Using the arthroscopic approach, a cystic opening within the intra-articular space was detected, and cyst decompression was then performed. The pain in the left leg was significantly relieved during the 6-mo follow-up.

CONCLUSION

Although intraneural ganglion cysts arising from the hip joint are rare, they can cause typical radicular pain and mimic common L5 radiculopathy. Typical cyst ascent phenomenon starting from the termination of the articular branch on magnetic resonance imaging is a crucial finding indicative of intraneural ganglion cysts arising from the hip joint.

Keywords: Intraneural ganglion cyst; Radiculopathy; Labrum; Hip joint; Sciatic nerve; Lumbosacral plexus; Case report

Core Tip: This report presents a rare case of an intraneural ganglion cyst arising from the hip joint. At present, the patient demonstrated typical radicular pain of lower extremity. If there is no lesion in the lumbar spine that can be associated with radicular pain, the hip joint pathology must be comprehensively evaluated, with consideration of the possibility of intraneural ganglion cysts. High-resolution magnetic resonance neurography can be helpful in identifying a possible joint connection in juxta-articular ganglia cysts, and arthroscopic debridement and cyst decompression can be alternative treatments to cyst resection.