| 제목 |
Posterior interosseous neuropathy resulted from ganglion cyst mimicking Schwannoma in elbow |
| 소속 |
Dongguk University Ilsan Hospital, Department of Rehabilitation Medicine1, Dongguk University Gyeongju Hospital, Department of Rehabilitation Medicine2 |
| 저자 |
Ho Jun Lee1†, Yong Jin Cho1*, Bumsun Kwon1, Jin-woo park1, Ki Yeun Nam1, Taeyeon Kim1, Jung Hwan Lee2 |
Background:
Posterior interosseous neuropathy (PIN) resulted from mass lesions (e.g., ganglion cysts, tumor) is rare. The clinical presentation of persons with PIN is somewhat variable depending upon the location of neural insult. We report an unusual PIN due to ganglion cyst mimicking Schwannoma.
Case Report:
Twenty seven years old man visited with complaints of right elbow pain, which began 3 months ago without history of trauma. He did not complain of weakness and sensory change in hand and forearm. Small palpable fixed mass was detected between brachioradialis muscle and biceps tendon. MRI showed cystic mass of low signal intensity (SI) on T1WI and high SI on T2WI with split fat sign along radial nerve between brachioradialis muscle and brachialis tendon, which findings suggest the possibility of Schwannoma. (Fig. 1.) After 50 days of first visit, he underwent surgery for mass excision. At admission mild weakness of finger extension (thumb extension MRC grade 4, 2nd finger extension grade 4, 3rd-5th finger extension grade 3) without sensory change, which was found just prior to surgery, was detected. After excision the mass was identified as ganglion cyst with stalk connected with radiocapitellar joint capsule, (Fig. 2) After 3 months of surgery, third and fourth finger weakness slightly improved from grade 3 to grade 4 and electrodiagnostic (EDX) study confirmed posterior interosseous neuropathy with mild partial axonotmesis state.
Conclusions:
The occurrence of ganglion cyst in the elbow joint causing PIN is unusual and can be misdiagnosed as Schwannoma. Fortunately neurologic deficit was followed after detection of mass. Accurate diagnosis is important to treatment and prognosis.
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Preoperative T2-weighted MRI shows lobulated cystic mass along radial nerve
Ganglion cyst connected radiocapitellar joint along radial nerve (Intraoperative finding)
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