Relapsing Ganglion Cyst of the Hip: A Rare Cause of Disabling Sciatica

Abstract

Ganglion cysts of the hip are uncommon, and often asymptomatic. We report a case of a patient suffering from disabling sciatic nerve compression by a rare and relapsing ganglion cyst of the hip. The 49-year old man had a 3-year history of right lower limb neuropathic pain, and functional impairment, refractory to cycles of oral medication. On examination, he had gluteal tenderness, with no palpable mass, foot drop, absence of Achilles reflex, and steppage gait. Previous investigation suggested diagnosis of refractory sciatica due to lumbar herniary compression. After an unsuccessful bout of conservative treatment, hip magnetic resonance revealed a probable neurogenic cyst compressing the sciatic nerve. He underwent arthroscopic removal of the lesion, with pain relief, but symptoms reappeared 4 weeks later. Subsequent magnetic resonance confirmed relapsing of the cyst, and since then he is experiencing progressive disability. Sciatica is most commonly caused by herniated discs or lumbar spinal stenosis. When conservative treatment fails, other etiologies must be investigated even when there is previous presumptive diagnosis.