The First Described Joint-Associated Intraneural Ganglion Cyst

Abstract

This article describes the identification of the first known specimen in which an articular origin for an intraneural cyst was recognized. Prompted by early citations in the 20th century of a valuable 1904 tibial intraneural ganglion housed at St. Bartholomew's Hospital in London, we traveled there to research it. We fortuitously discovered a citation to an earlier joint-related specimen, one that had not previously been referenced correctly in subsequent publications on intraneural cysts for more than a century. The original anatomic description dating to 1884, summarized in 3 lines in a museum catalog, was attributed to T. Swinford Edwards. This cadaveric specimen affected the deep branch of the ulnar nerve and arose from a carpal joint. Additional information was provided in a Transactions in 1884. An original drawing of the specimen was published in a textbook written in 1889 by Anthony Bowlby, a former curator, both of which credited F. (Frederick) Swinford Edwards, a demonstrator in anatomy and surgery at St. Bartholomew's. Unfortunately, the specimen could not be located and is presumed lost. To establish this specimen as the first known example of a joint-related intraneural cyst, we completed a review of >400 other cases and confirmed this statement. The first observation of an articular origin for an intraneural cyst, made by 2 eminent surgeons, has not been properly acknowledged. Considered with a modern perspective, this historical case solidifies the articular (synovial) origin for these unusual intraneural cysts, a finding that has important treatment implications.