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

Abstract

BackgroundTo 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.MethodsPatients 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.ResultsMagnetic 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.ConclusionsSynovial 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.

Posterior Arthroscopic Treatment of a Massive Effusion in the Flexor Hallucis Longus Tendon Sheath Associated with Stenosing Tenosynovitis and Os Trigonum

“…However, we treated a massive effusion in the FHL tendon sheath with stenosing tenosynovitis involving an os trigonum via posterior ankle arthroscopy. This point might be different from reports by Qu et al [19] and Lee et al [20].…”

“…Qu et al reported cases of diffuse FHL tenosynovitis with effusion at a level proximal to the ankle joint posteriorly and/or between the talar tubercles and the master knot of Henry, although it was treated by open extensive tenosynovectomy [19]. Lee also reported cases of effusion with the FHL tendon sheath at a level of the interphalangeal joint and/or the metatarsophalangeal joint, although it was treated by an open procedure [20]. However, we treated a massive effusion in the FHL tendon sheath with stenosing tenosynovitis involving an os trigonum via posterior ankle arthroscopy.…”

Operative Treatment for Ganglion Cyst of Flexor Hallucis Longus Sheath

“…The development of a ganglion cyst connected to a tendon sheath is thought to be proceeded by mucoid degeneration of the tendon’s collagen fibers and cellular hyperplasia associated with active mucin secretion. 14 Lee et al 8 suggested that HGC may be secondary to joint injury or repetitive trauma. The hallux is under pressure during weightbearing, and fluid leakage through the stalk (containing the tracts) of the cyst may act as a 1-way valve.…”

“…The hallux is under pressure during weightbearing, and fluid leakage through the stalk (containing the tracts) of the cyst may act as a 1-way valve. Lee et al 8 assessed ganglion cysts around the hallux with magnetic resonance imaging and operative detection. It was found that the cysts were connected to synovial cysts in the FHL tendon sheath originating from the interphalangeal or metatarsophalangeal joint.…”

A Unique Technique for Precise Targeting in Treatment of Rare Bifocal Intraosseous Ganglion Cysts of the Talus: A Case Report and Review of the Literature

“…Intraosseous ganglia contain a gelatinous material with a histopathologic appearance similar to that of a soft-tissue ganglion, and they are rarely reported lesions. They have a tendency to occur in the metaphysis of long bones of the lower extremity, such as distal tibia; however, the wrist, femoral head, medial malleolus, and carpal bones are other well-recognized sites [ 4 , 5 ]. Patients with osseous ganglia experience intermittent pain that frequently increases with activity.…”