Hospital For Special Surgery: Ultrasound of the Month - Case 26

Clinical History •

47 year old male presents with medial ankle and foot pain and weakness with intermittent burning sensations

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No history of prior ankle surgery

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EMG consistent with tibial nerve

Ultrasound of the Month – Case 26

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Ultrasound of the Month – Case 26

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Ultrasound of the Month – Case 26

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Ultrasound of the Month – Case 26

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Diagnosis: •

Tarsal tunnel syndrome secondary to tibial nerve compression from a perineural ganglion cyst

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Treatment of choice is ultrasound-guided aspiration of the cyst with resulting nerve decompression

Ultrasound of the Month – Case 26

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Ultrasound of the Month – Case 26

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Tarsal Tunnel Syndrome • •

Pain and paresthesia due to compression of the tibial nerve or its branches Common causes: ganglion cyst tibial nerve neuroma scar/fibrosis (post-op or trauma) tibial artery aneurysm tibial venous varices

Ultrasound of the Month – Case 26

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Tarsal Tunnel Syndrome • •

The diagnosis is generally suspected on a clinical basis and can be confirmed by EMG testing Ultrasound or MRI may be used for confirmation of the diagnosis and determination of the cause of nerve compression

Ultrasound of the Month – Case 26

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Treatment of Tarsal Tunnel Ganglion Cysts

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Ultrasound allows percutaneous aspiration of the ganglion while avoiding the adjacent neurovascular structures and is generally the initial treatment of choice

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If the ganglion recurs or if symptoms do not improve, surgery may be necessary

Ultrasound of the Month – Case 26

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