Double synovial cyst of the proximal tibiofibular joint confirmed by MRI as a cause of the peroneal tunnel syndrome.

The aim of this case report is to present an unusual double synovial cyst that arose from the proximal tibiofibular joint compressing the peroneal nerve in the peroneal tunnel and was unrecognized at the beginning. According to the review of literature back to 1891, only 62 cases of cysts originating from the proximal tibiofibular joint (PTFJ) have been described. We report a case of a 32 year old male patient who was admitted to the Department of Orthopaedic Surgery because of a classic peroneal tunnel syndrome of the left leg. On the lateral side of the proximal third of his left leg a tumefaction of 12 x 2.5 cm was visible. The sonography showed a characteristic image of the para-articular synovial cyst of the left knee. A surgical extirpation of the synovial cyst and decompression of the peroneal nerve in the peroneal tunnel were performed. PHD confirmed a classic synovial cyst. Postoperatively, the symptoms of the peroneal nerve compression disappeared. Three years after the first surgical intervention the patient was readmitted to the Department because of quite similar problems, only the neurological symptoms were less intensive than during the first admittance. This time the performed MR imaging showed a double synovial cyst originating from the proximal tibiofibular joint. The surgical treatment consisted of a total extirpation of both cysts including the narrow stalks of communication with the PTFJ. The joint was opened and a synovectomy was done using an electrocauter and a sharp curette. Regular check-ups were done every 6 months and twice during the control period of 4 years, as was the MR imaging control. MRI findings 4 years after the second surgical intervention were normal. Clinical findings after 7 years were normal and we are sure that the recidivation of the synovial cyst excluded. The MRI diagnostics was crucial for an adequate surgical treatment and the relief of the peroneal tunnel syndrome symptoms.

One-stage operation for locked bilateral posterior dislocation of the shoulder.

A man of 52 years of age had a grand mal seizure. He presented to our unit three months later with irreducible bilateral posterior dislocation of the shoulder. CT scans revealed large compression defects on the anteromedial aspect of the heads of both humeri. The defect on the right side was of more than 50% of the articular surface, and on the left side of 40%. He was treated by a one-stage operation with a hemiarthroplasty on one side and reconstruction of the head by an osteochondral autograft on the other. Three years later the clinical and radiological results were excellent.

Frozen section analysis of breast biopsy specimens.

The authors compared the diagnoses from intraoperative frozen section consultation with the final diagnosis using permanent tissue sections from 179 breast biopsy specimens. Of these, there were 175 correct diagnoses (97.8%), two diagnoses were incorrect (1.1%) and two were inconclusive (1.1%). The distribution of the correct diagnoses within each particular group of breast diseases proves that in the invasive tumor group the diagnosis on FS was correct for 101 patients (98.1%) and incorrect for two patients (1.9%). In the fibrocystic breast disease group, diagnoses correlated for 42 patients (97.7%), whereas the problem in diagnosing the extent of epithelial proliferation appeared for only one patient (2.3%) and was categorized as an inconclusive diagnosis. Of 4 incorrect and inconclusive diagnoses, two occurred as a result of sampling nonrepresentative tissue specimens and two as a result of diagnostic misinterpretation. This study has shown that for the determination of the histological type of carcinoma, FS is not of significant morphological value since correct diagnoses were made for only 60% of the patients.

Intraoperatively proven anomalous Struthers' ligament diagnosed by MRI.

A case of median nerve entrapment at the elbow between the supracondylar process and an anomalous insertion of Struthers' ligament is presented. The diagnosis of anomalous insertion of the ligament was made by MRI and confirmed at operation. Struthers' ligament originated as usual from the supracondylar process but did not reach the medial epicondyle of the humerus, inserting instead in the brachial fascia above the epicondyle. The incomplete Struthers' ligament functioned, however, as a complete ligament. It produced symptoms identical to supracondylar process syndrome. Excision of the supracondylar process of the humerus and Struthers' ligament relieved symptoms in this athlete.