Lessons in clinical reasoning - pitfalls, myths, and pearls: a case of tarsal tunnel syndrome caused by an intraneural ganglion cyst.
| Autor: | Phadke SV; Visiting Orthopaedic Surgeon, 29491 Indian Institute of Technology , Mumbai, India., Dalal C; Visiting Orthopaedic Surgeon, Madhu Polyclinic and Nursing Home, 29491 Indian Institute of Technology , Mumbai, India., Seetharaman R; Department of Pharmacology & Therapeutics, 29549 Seth GS Medical College & KEM Hospital , Mumbai, India., Parsons AS; Department of Medicine and Public Health, 12349 University of Virginia School of Medicine , Charlottesville, VA, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Diagnosis (Berlin, Germany) [Diagnosis (Berl)] 2024 Feb 26; Vol. 11 (3), pp. 337-342. Date of Electronic Publication: 2024 Feb 26 (Print Publication: 2024). |
| DOI: | 10.1515/dx-2023-0161 |
| Abstrakt: | Objectives: Intraneural ganglionic cysts are non-neoplastic cysts that can cause signs and symptoms of peripheral neuropathy. However, the scarcity of such cases can lead to cognitive biases. Early surgical exploration of space occupying lesions plays an important role in identification and improving the outcomes for intraneural ganglionic cysts. Case Presentation: This patient presented with loss of sensation on the right sole with tingling numbness for six months. A diagnosis of tarsal tunnel syndrome was made. Nerve conduction study revealed that the mixed nerve action potential (NAP) was absent in the right medial and lateral plantar nerves. The magnetic resonance imaging (MRI) found a cystic lesion measuring 1.4×1.8×3.8 cm as the presumed cause of the neuropathy. Surgical exploration revealed a ganglionic cyst traversing towards the flexor retinaculum with baby cysts. The latter finding came as a surprise to the treating surgeon and was confirmed to be an intraneural ganglionic cyst based on the histopathology report. Conclusions: Through integrated commentary by a case discussant and reflection by an orthopedician, this case highlights the significance of the availability heuristic, confirmation bias, and anchoring bias in a case of rare disease. Despite diagnostic delays, a medically knowledgeable patient's involvement in their own care lead to a more positive outcome. A fish-bone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic delay. Finally, this case provides clinical teaching points in addition to a pitfall, myth, and pearl related to availability heuristic and the sunk cost fallacy. (© 2024 Walter de Gruyter GmbH, Berlin/Boston.) |
| Databáze: | MEDLINE |
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