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Lee BJ, Sawyer GA, Dasilva MF. Methylene blue-enhanced arthroscopic resection of dorsal wrist ganglions. Tech Hand Up Extrem Surg 2011; 15:243-246. [PMID: 22105637 DOI: 10.1097/bth.0b013e3182206c49] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The ganglion is the most common soft tissue mass of the hand and wrist. Over the past 10 to 15 years, there has been a growing interest in arthroscopic treatment of dorsal wrist ganglions. Proposed advantages of arthroscopy include greater motion (particularly wrist flexion), improved cosmesis, and potential to identify/treat other intra-articular pathology. Despite the documented clinical success of arthroscopic ganglion excision, limitations include inconsistent identification of the ganglion stalk. Our described technique offers a means by which to improve visualization of the ganglion stalk intra-articularly to produce a more effective and efficient arthroscopic ganglion excision. During the procedure, a small volume of methylene blue solution is injected into the cyst. Its communication with the joint is apparent arthroscopically, thus identifying the location of the stalk. With the ability to precisely identify the ganglion stalk using an injection of methylene blue, the surgeon can direct the arthroscopic debridement toward the appropriate pathologic tissue. Unnecessary debridement of uninvolved tissue can be avoided with the technique. This also allows for optimal portal placement and, in particular, indicates whether a midcarpal portal should be employed. This should result in fewer recurrences, decreased operative time, and less iatrogenic injury.
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Okada M, Sakaguchi K, Oebisu N, Takamatsu K, Nakamura H. A ganglion within the ulnar nerve and communication with the distal radioulnar joint via an articular branch: case report. J Hand Surg Am 2011; 36:2024-6. [PMID: 21975094 DOI: 10.1016/j.jhsa.2011.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 08/10/2011] [Accepted: 08/11/2011] [Indexed: 02/02/2023]
Abstract
An intraneural ganglion is rare, and involvement of an articular nerve may suggest a possible pathogenesis. We report an intraneural ganglion of the ulnar nerve with a connection to the distal radioulnar joint via the articular branch. We excised the ganglion, the stalk, and the articular branch. To date, there has been no recurrence.
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78
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Abe Y, Watson HK, Renaud S. FLEXOR TENDON SHEATH GANGLION: ANALYSIS OF 128 CASES. ACTA ACUST UNITED AC 2011; 9:1-4. [PMID: 15368618 DOI: 10.1142/s0218810404001930] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2003] [Accepted: 11/26/2003] [Indexed: 11/18/2022]
Abstract
A 30-year analysis of 128 patients with flexor tendon sheath ganglion was investigated. The majority of patients were females with sex ratio of 2.6 : 1. Most of the patients are in their third to fifth decade of life. Hand dominance, previous trauma as well as other illnesses involving the hand did not show any correlation to the formation of ganglion. The middle finger was most commonly affected and 69% of the ganglion were located on A1 and A2 pulley. Recurrence was high (89%) after multiple percutaneous puncture and treatment was successful with no cases of recurrence after surgical excision.
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Yasuda M, Masada K, Takeuchi E. DORSAL WRIST SYNDROME REPAIR. ACTA ACUST UNITED AC 2011; 9:45-8. [PMID: 15368625 DOI: 10.1142/s0218810404002054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2003] [Accepted: 02/16/2004] [Indexed: 11/18/2022]
Abstract
Dorsal wrist pain with or without a palpable dorsal wrist ganglion is a common complaint. Watson developed the concept of the dorsal wrist syndrome (DWS) which is an entity encompassing pre-dynamic rotary subluxation of the scaphoid and the overloaded wrist. We reviewed 20 cases of DWS treated surgically. There were nine males (11 wrists) and nine females (nine wrists). Post-operative follow-up ranged from five to 67 months (mean, 37 months). At operation, we observed SLL tears in eight wrists and dorsal ganglia in 12 cases. Following surgery, 12 cases reported being pain free, five had mild pain, two moderate pain and one case reported severe pain. Post-operative extension/flexion was 73/70 average. Post-operative grip strength was 28 kg average. We believe that excision of the posterior interosseous nerve and the dorsal capsule including the ganglion, if present, provides pain relief in DWS.
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Robla-Costales J, Socolovsky M, Dubrovsky A, Astorino F, Fernández-Fernández J, Ibáñez-Plágaro J, García-Cosamalón J. [Intraneural cysts of the peroneal nerve in childhood: report of 2 cases and literature review]. Neurocirugia (Astur) 2011; 22:324-331. [PMID: 21858406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Intraneural cysts are benign lesions filled with mucinous content and located inside the epineurum of the peripheral nerves. Peroneal nerve is the most affected nerve. The entity is rare and its ethiopathology still remains to be definitely elucidated. In 2003 Spinner et al published their articular theory, implicated in the formation and frequent recurrence of these lesions after surgical treatment. The practical application of this theory, nowadays almost universally accepted, generated an important diminution in the recurrence rate after surgical evacuation of this lesions, previously very elevated. Most of the cases of this entity are described in adults. In the present paper we describe two pediatric cases and analyze the clinical aspects of these cysts in pediatric and adults patients. Peroneal intraneural cysts are one of the differential diagnoses in foot drop, and an adequate treatment concludes in a complete remission of the symptoms.
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82
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Nam D, Macaulay A, Cross M, Shindle MK, Warren RF. Posterior cruciate ligament resection for ganglion cyst and associated ligament degeneration. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2011; 40:E110-E114. [PMID: 21869944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
With increased use of magnetic resonance imaging (MRI) and arthroscopy, intra-articular ganglion cysts of the posterior cruciate ligament (PCL) have received more recognition as a possible cause of knee discomfort. Reported treatment options have ranged from ultrasound-guided cyst aspiration to arthroscopic cyst resection. In this report, we present the case of a patient who, on MRI, was diagnosed with a symptomatic intrasubstance PCL ganglion that later, during surgery, demonstrated mucinous degeneration of the entire ligament. Treatment was complete resection of the PCL. Five years after surgery, the patient demonstrated excellent, asymptomatic knee function. Although the best treatment for an intrasubstance PCL ganglion cyst that has caused degeneration of the entire ligament is unknown, PCL resection without reconstruction should be considered a viable option. It can result in a large increase in range of motion and function.
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Derman P, Kamath AF, Kelly Iv JD. Ganglion cysts of the posterior cruciate ligament. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2011; 40:257-258. [PMID: 21734935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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84
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Shimizu A, Ikeda M, Kobayashi Y, Saito I, Oka Y. Carpal tunnel syndrome caused by a ganglion in the carpal tunnel with an atypical type of palsy: a case report. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2011; 16:339-341. [PMID: 22072471 DOI: 10.1142/s0218810411005655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 03/12/2011] [Accepted: 03/18/2011] [Indexed: 05/31/2023]
Abstract
Carpal tunnel syndrome caused by a ganglion is a rare condition. We report a case which presented with a rapidly progressive onset of symptoms and subsequent thenar palsy.
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85
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Wang YJ, Cui GQ. Arthroscopic excision of spinoglenoid notch cyst through two different approaches. Chin Med J (Engl) 2010; 123:3154-3156. [PMID: 21162974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Muzii VF, Tanganelli P, Signori G, Zalaffi A. Ganglion cyst of the ligamentum flavum: a rare cause of cervical spinal cord compression. A case report. J Neurol Neurosurg Psychiatry 2010; 81:940-1. [PMID: 20562396 DOI: 10.1136/jnnp.2008.169169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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87
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Park HJ, Lee SM, Choi JA, Park NH, Kim HS, Park SI. Preoperative localization of cystic lesions in the knee using ultrasound-guided injection of indigo carmine. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:305-308. [PMID: 20544866 DOI: 10.1002/jcu.20682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To evaluate the feasibility and effectiveness of preoperative localization of cystic lesions in the knee using ultrasound-guided indigo carmine injection. METHOD Twenty-three cysts in the knee in 23 patients (M:F = 15:8, mean age, 42 years) were localized preoperatively by ultrasound-guided indigo carmine injection. These included 12 meniscal cysts, 7 popliteal cysts, and 4 ganglion cysts. To stain the lesions, 0.2-3 mL of indigo carmine was injected into the cyst using a 22-gauge spinal needle. After localization, the patient was immediately transferred to the operating room and surgery was performed. Intraoperative findings and arthroscopic images were reviewed. RESULT All 23 cysts were stained successfully. Twenty cases were confirmed during arthroscopy and 3 cases were confirmed during excisional surgery. There was no significant bleeding/hematoma or anaphylactic reaction. Four patients felt pain during aspiration before indigo carmine injection. The lesions were stained blue and could be clearly identified by the surgeon and were removed arthroscopically or by open surgery. CONCLUSION Preoperative localization of cystic lesions in the knee joint region using ultrasound-guided indigo carmine injection is a feasible technique and can be easily and safely be performed.
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Wang M, Zhang X, Hao Y, Zhou Y, Wang J, Zhang Z, Li C. [Arthroscopic treatment of intra-articular meniscal cysts]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2010; 24:535-537. [PMID: 20540253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To investigate the treatment and therapeutic efficacy of intra-articular meniscal cysts by arthroscopy. METHODS From January 2005 to December 2009, 9 cases of intra-articular meniscal cysts were treated by arthroscopy, including 5 males and 4 females, with an average age of 33.8 years (range, 24-46 years). Six patients suffered in left knees, 3 in right ones. Just 1 case had trauma history, the others had no obvious predisposing causes. The average course of the disease was 24.2 months (range, 4-36 months). The Lysholm score was (74.2 +/- 11.6) points. Arthroscopy showed that the locations of cysts were the anterior horn of lateral meniscus in 8 cases and the anterior horn of medial meniscus in 1 case; all being single cyst (of them, 3 being multilocular cyst). RESULTS All incisions healed primarily with no complications of infection and joint effusion. All 9 patients were followed up from 3 to 48 months with an average of 12.7 months. Preoperative symptoms disappeared or reduced and the range of motion of the knee returned to normal. The Lysholm score was (95.1 +/- 3.4) points after 3 months of operation, showing significant difference (P < 0.01) when compared with the score before operation. According to assessment standard described by Choy, the treatment outcome was excellent in 6 cases, good in 2 cases, and general in 1 case; the excellent and good rate was 88.9%. No recurrence was found during follow-up. CONCLUSION Arthroscopic surgery shows the advantages to maintain good function of knee for the treatment of meniscal cyst, it is the best choice for intra-articular meniscal cysts because of its mini-trauma, rapid recovery, thorough treatment and less recurrence. Simultaneously, partial or total meniscectomy or meniscus repairing under arthroscopy is performed.
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89
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Gong W, Ge F, Chen L. A giant ganglion cyst of hip joint causing lower limb edema. Saudi Med J 2010; 31:569-571. [PMID: 20464050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Lower limb edema caused by a giant ganglion cyst of hip joint, rather than deep venous insufficiency or lymphedema, is unusual particularly for guiding clinical practice. In this study, we present a rare case of a 76-year-old man with a 3-month history of progressive swelling of right lower extremity and 2-month history of a known inguinal mass, which was initially thought as hemangioma by using ultrasound. But, subsequent computed tomography examination and exploration surgery revealed a giant ganglion cyst compressing the right femoral vein. Resection of the cyst led to complete resolution of symptoms postoperatively. To the best of our knowledge this is a very rare case of giant ganglion cyst of hip joint origin causing lower limb edema in the literature.
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90
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Fukuda A, Kato K, Sudo A, Uchida A. Ganglion cyst arising from the posterolateral capsule of the knee. J Orthop Sci 2010; 15:261-4. [PMID: 20358342 DOI: 10.1007/s00776-009-1434-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 07/24/2009] [Indexed: 11/24/2022]
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91
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Waldschmidt U, Slongo T. An unusual cause of paralysis of the peroneal nerve-a case report. J Pediatr Surg 2010; 45:259-61. [PMID: 20105616 DOI: 10.1016/j.jpedsurg.2009.09.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 09/24/2009] [Accepted: 09/24/2009] [Indexed: 11/18/2022]
Abstract
A 12-year-old boy was referred to our clinic because of progressive paresis of left peroneal nerve. Ultrasound showed a cystic mass close to the proximity of the fibula neck. Puncture revealed jelly-like fluid, but that could not relieve symptoms. Six weeks after onset of symptoms, the boy had complete paresis. Peroneal intraneural ganglia are a rare entity of paralysis of the lower limb in children; more often these symptoms occur because of exostosis. Surgical exploration showed a cystic formation involving the common peroneal nerve. Total recovery of nerve function was seen two years later. Patients with exostosis showed varying outcomes. In children with symptoms suspicious of nerve compression, fast diagnosis and immediate treatment are mandatory to regain best possible recovery.
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92
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Natsis K, Papathanasiou E, Anastasopoulos N. Accessory extensor digiti minimi muscle simulating a soft tissue mass during surgery: a case report. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2010; 15:235-236. [PMID: 21089202 DOI: 10.1142/s0218810410004862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 06/01/2010] [Accepted: 06/07/2010] [Indexed: 05/30/2023]
Abstract
During a wrist ganglion excision originating at the tendon sheath of the extensor carpi ulnaris muscle, a soft tissue mass was observed just radial and distal to the surgical field. Dissection of the mass revealed an accessory extensor digiti minimi muscle belly which joined the radial extensor digiti minimi tendon. The surgical impact is discussed.
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93
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Kircanov VA, Chumakov NV. [Giant ganglion of the hand]. Khirurgiia (Mosk) 2010:75-76. [PMID: 20524241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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94
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Wang H, Hu Q, Zhang C, Liu J, Zhang Y. [An improved surgical strategy and treatment outcome of dorsal wrist ganglion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2010; 24:57-59. [PMID: 20135973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the clinical outcome of treating dorsal wrist ganglion with an improved surgical strategy by excising the ganglion completely along their stalk and repairing the dorsal carpal ligaments under brachial anesthesia. METHODS From March 2005 to January 2007, 34 patients with dorsal wrist ganglion were treated and studied retrospectively. There were 14 males and 20 females, aged 25-65 years (43 years on average). The left sides were involved in 22 cases and right sides in 12 cases. Thirteen cases of relapse received excision for 1 to 4 times under local anesthesia, with a mean period of 17 months (14 days to 7 years) from excision to recurrence. Twenty-one patients were first attack cases with a mean period of 11 months (15 days to 8 years) from diagnosis to excision. The size of the ganglion ranged from 1.5 cm x 1.2 cm to 4.5 cm x 4.0 cm. Now, each surgical process was performed under brachial anesthesia, and a pneumathode tourniquet was used. In 6 patients, the stalks of ganglion did not invade the carpal ligaments, and ganglion was removed completely without immobilization after operation. In 28 patients, the stalks of ganglion invaded the carpal ligaments, ganglion was excised completely along its stalk to the dorsal carpal structure; the ligaments were sutured directly in 16 cases and were repaired with adjacent tissue such as the wall of sheathing canal of extensor tendon in 12 cases. The wrists were immobilised for 3 weeks. RESULTS Primary wound healing was achieved in all incisions. All patients were followed up for 26-36 months with an average of 31.5 months. Only 2 cases (5.9%) recurred. The range of motion of the wrist remained normal and the symptom of the dorsal wrist was relieved slightly. Patients' satisfaction score ranged from 60 to 100, with an average of 83.8. CONCLUSION The ganglion should be excised completely together with defect repair of dorsal carpal ligament under brachial anesthesia and the wrist immobilised for 3 weeks, the recurrence rate will be reduced greatly.
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Yoo JH, Kim EH, Min KD, Lee BI. Arthroscopic excision of the ganglion in the posterior septum by posterior trans-septal portal: report of two cases. Arch Orthop Trauma Surg 2009; 129:1047-51. [PMID: 18654790 DOI: 10.1007/s00402-008-0703-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Indexed: 12/23/2022]
Abstract
We report two cases of ganglion cysts in the posterior septum of the knee joint, one as parameniscal cyst from the posterior horn of the lateral meniscus extending to posterior septum, and the other as a cyst located in the posterior septum adjacent to the posterior cruciate ligament, which were both arthroscopically excised expediently by posterior trans-septal portal. The posterior compartment of the knee is not readily accessible by ordinary arthroscopic portals, and therefore has been considered as 'blind spot' conventionally. The posterior trans-septal portal is useful for assorted diagnostic or manipulative procedures in the posterior compartment of the knee.
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96
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Vilchez F, Erquicia J, Pelfort X, Monllau JC. [Symptomatic ganglions in the knee joint. Report of three cases and literature review]. ACTA ORTOPEDICA MEXICANA 2009; 23:223-227. [PMID: 19960661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The cystic lesions seen around the knee are usually meniscal or popliteal cysts. Cysts inside the articular cavity of the knee are rare and they are usually detected as incidental MRI findings. The ganglions originating in the cruciate ligaments or the infrapatellar fat have rarely been reported. We are reporting the cases of three intraarticular ganglions. The clinical diagnosis was made with magnetic resonance imaging. All patients were treated With arthroscopic surgery using the synovial shaver to remove the tissue. The three patients were reported as asymptomatic during the follow-up, with full range of motion. CONCLUSIONS The literature review shows that the origin of ganglions is controversial. The three reported cases show that this is a pathology that should be suspected, as it is difficult to diagnose. MRI is essential to make the diagnosis and the arthroscopic treatment of intraarticular ganglions is effective.
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Lima SM, de Souza Maliska MC, Dimitroulis G, Modolo F, Nazareno Gil J. Painful deviation of the mandible. ACTA ACUST UNITED AC 2009; 107:749-53. [PMID: 19230727 DOI: 10.1016/j.tripleo.2009.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 12/25/2008] [Accepted: 01/03/2009] [Indexed: 11/17/2022]
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Spinner RJ, Wang H, Hébert-Blouin MN, Skinner JA, Amrami KK. Sciatic cross-over in patients with peroneal and tibial intraneural ganglia confirmed by knee MR arthrography. Acta Neurochir (Wien) 2009; 151:89-98. [PMID: 19148568 DOI: 10.1007/s00701-008-0182-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 11/20/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND A predictable mechanism and stereotypic patterns of peroneal intraneural ganglia are being defined based on careful analysis of MRIs. Peroneal and tibial intraneural ganglia extending from the superior tibiofibular joint which extend to the level of the sciatic nerve have been observed leading to the hypothesis that sciatic cross-over could exist. Such a cross-over phenomenon would allow intraneural cyst from the peroneal nerve by means of its shared epineurial sheath within the sciatic nerve to cross over to involve the tibial nerve, or vice versa from a tibial intraneural cyst to the peroneal nerve. METHOD AND FINDINGS One patient with a peroneal intraneural ganglion and another with a tibial intraneural ganglion each underwent a knee MR arthrogram. These studies were not only definitive in demonstrating the communication of the cyst to the superior tibiofibular joint connection but also in confirming sciatic cross-over. Contrast injected into the knee could be demonstrated tracking to the superior tibiofibular joint and then proximally into the common peroneal or tibial nerve respectively, crossing over at the sciatic nerve, and then descending down the tibial and peroneal nerves. The arthrographic findings mirrored MR images upon their retrospective review. CONCLUSIONS This study provides direct in vivo proof of the nature of sciatic cross-over theorized by critical review of MRIs and/or experimental dye injections done in cadavers. This study is important in clarifying the potential paths of propagation of intraneural cysts at points of major bifurcation.
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Inaparthy PK, Anwar F, Botchu R, Jähnich H, Katchburian MV. Compression of the deep branch of the ulnar nerve in Guyon's canal by a ganglion: two cases. Arch Orthop Trauma Surg 2008; 128:641-3. [PMID: 18509691 DOI: 10.1007/s00402-008-0636-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Ulnar nerve compression at the wrist can be caused by a variety of intrinsic and extrinsic factors. Isolated compression of only the deep branch of ulnar nerve by a ganglion is very uncommon. Ultrasound examination can clearly show the cystic lesion compressing the nerves. MATERIALS AND METHODS We present two cases of compression of deep branch of ulnar nerve by a ganglion in the Guyon's canal. Two male patients presented with history of progressive weakness and paraesthesia in the medial 1(1/2) digits of the non-dominant hand. Interestingly, both the patients noticed sudden onset and rapid progress of the symptoms and signs. Clinical examination revealed typical symptoms of ulnar nerve (deep branch) palsy. Nerve conduction studies showed severe denervation of the deep branch of the ulnar nerves in both the patients and ultrasound confirmed the diagnosis. Surgical decompression led to complete recovery. RESULTS AND DISCUSSION Whilst compression by a ganglion in the Guyon's canal is rare but well recognized, a feature of both of our cases was the rapid progression and severe nature of the compressive symptoms and signs. This is in contrast to the more typical features of compressive neuropathy and should alert the clinician to the possible underlying cause of compression. Early decompression has the potential to promote a complete recovery.
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Cebesoy O. Intraosseous ganglion of the talus treated with the talonavicular joint approach without exposing the ankle joint. J Am Podiatr Med Assoc 2008; 97:424-7. [PMID: 17901351 DOI: 10.7547/0970424] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intraosseous ganglion, which is generally seen in metaphyseal-epiphyseal regions of long bones, is not a rare disorder. It is extremely rare in the talus, however. Differential diagnosis of a cystic talar lesion should include enchondroma, chondroblastoma, giant cell tumor, and unicameral bone cyst. This article presents a case of intraosseous ganglion of the talus in a 38-year-old woman treated with a new surgical approach and technique. The patient had mild ankle pain at the arc of motion in her right ankle that increased with activity. Radiographs and magnetic resonance images showed a cystic lesion in the medial side of the talar dome. It was treated by curettage and autocorticocancellous bone grafting through an opening in the talonavicular joint without disturbing the intact talar dome cartilage. One month after the operation, the patient had an excellent clinical outcome. This approach and technique can be used to treat other lesions of the talus that do not involve the joint space.
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