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. 2018 Mar;10(1):94-98.
doi: 10.4055/cios.2018.10.1.94. Epub 2018 Feb 27.

Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux

Jung Woo Lee  1 , Min Wook Joo  2 , Jin-Kyeong Sung  3 , Jae-Hoon Ahn  4 , Yong-Koo Kang  2
Affiliations

Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux

Jung Woo Lee et al. Clin Orthop Surg. 2018 Mar.

Abstract

Background: To describe the clinical and magnetic resonance imaging findings of ganglion cysts with effusion in the flexor hallucis longus tendon sheath around the hallux to evaluate their origin.

Methods: Patients with recurrent or painful ganglion cysts around the hallux with effusion in the flexor hallucis longus tendon sheath who underwent surgical treatment at St. Vincent's Hospital from February 2007 to August 2016 were investigated. Surgical indication was a painful or recurrent mass caused by the cystic lesions. Those without effusion of the flexor hallucis longus tendon sheath were excluded. We assessed the clinical and magnetic resonance imaging findings.

Results: Magnetic resonance imaging findings in all patients showed several ganglion cysts around the hallux and large fluid accumulations within the flexor hallucis longus tendon sheath. Regarding the location, six ganglion cysts were on the dorsomedial aspect, one on the plantar medial aspect, seven on the plantar lateral aspect, and one in the toe pulp. Ten patients showed joint effusions in both the metatarsophalangeal and interphalangeal joints, two in the metatarsophalangeal joints, and three in the interphalangeal joints. There were communication stalks with a tail shape or abutment between ganglion cysts with surrounding joint effusions. Intraoperatively, connections between ganglion cysts, the synovial cyst of the flexor hallucis longus tendon sheath, and surrounding joints were seen.

Conclusions: Synovial fluid accumulation in the metatarsophalangeal or interphalangeal joint supplies the synovial cyst of the flexor hallucis longus tendon sheath and subsequently ganglion cysts in the hallux. In clinical practice, the surgeon should carefully check surrounding joints with tendon sheaths to prevent recurrence of the ganglion cysts around the hallux.

Keywords: Ganglion cysts; Hallux; Recurrence.

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Conflict of interest statement

CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. A 62-year-old male with ganglion cyst around the hallux. On axial view magnetic resonance imaging, ganglion cysts around the hallux had communicating stalks with the interphalangeal joint, and there was a large fluid accumulation within the synovial sheath of the flexor hallucis longus. This patient also had a joint effusion in both the metatarsophalangeal and interphalangeal joints.
Fig. 2
Fig. 2. A 50-year-old female with ganglion cyst around the hallux. (A) On coronal view magnetic resonance imaging, multiple ganglion cysts were seen around the hallux, and the flexor hallucis longus (FHL) tendon sheath was connected to the surrounding metatarsophalangeal joint. (B) A large fluid accumulation was seen within the synovial sheath of the FHL. (C) There were communication stalks between the cyst of the FHL tendon sheath and the surrounding interphalangeal joint. (D) A large fluid accumulation was seen around the hallux.
Fig. 3
Fig. 3. A 54-year-old female with ganglion cyst around the hallux. Intraoperatively, there were communication stalks between the cyst of the flexor hallucis longus tendon sheath and the surrounding joints.
See this image and copyright information in PMC

References

    1. Angelides AC, Wallace PF. The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg Am. 1976;1(3):228–235. - PubMed
    1. Kirby EJ, Shereff MJ, Lewis MM. Soft-tissue tumors and tumor-like lesions of the foot: an analysis of eighty-three cases. J Bone Joint Surg Am. 1989;71(4):621–626. - PubMed
    1. Macdonald DJ, Holt G, Vass K, Marsh A, Kumar CS. The differential diagnosis of foot lumps: 101 cases treated surgically in North Glasgow over 4 years. Ann R Coll Surg Engl. 2007;89(3):272–275. - PMC - PubMed
    1. Weishaupt D, Schweitzer ME, Morrison WB, Haims AH, Wapner K, Kahn M. MRI of the foot and ankle: prevalence and distribution of occult and palpable ganglia. J Magn Reson Imaging. 2001;14(4):464–471. - PubMed
    1. Tanaka Y, Takakura Y, Kumai T, Sugimoto K, Taniguchi A, Hattori K. Sclerotherapy for intractable ganglion cyst of the hallux. Foot Ankle Int. 2009;30(2):128–132. - PubMed

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