Pseudotumoral ganglion cyst of a finger with unexpected remote origin: multimodality imaging

Endoscopic Resection of Ulnar Bursa of the Palm: 2 Ulnar Portals Technique

Ulnar bursa of the hand invaginates the flexor digitorum superficialis and flexor digitorum profundus tendons of the little, ring, long, and index fingers. Distension of this bursa can have an inflammatory or infective cause. It can also originate from pathology of another site (e.g., degenerative wrist joint). Because of the tough overlying palmar aponeurosis, distended ulnar bursa can have swelling at a remote site. The distended ulnar bursa can also have compressive neuropathy to the ulnar nerve and median nerve. The purpose of this Technical Note is to describe the technical details of the 2 ulnar portals technique involving endoscopic resection of the ulnar bursa. This is indicated for symptomatic distension of the ulnar bursa, especially with hypothenar extension.

Refractory satellite ganglion cyst in the hallux and finger

Painful ganglion cysts that develop in the hallux and finger usually enlarge progressively to the peripheral direction. Simple resection of satellite ganglion cyst alone has been reported to cause a high rate of recurrence and treatment is often very difficult. The purpose of this study is to evaluate the appropriate surgical treatment for painful satellite ganglion cysts in the hallux and finger and discuss the origin of the ganglion cysts in cases treated surgically at our hospital. We reviewed five cases (three males and two females, ages 55-87 years), three of which occurred in the hallux and two in the finger. In all cases, the preoperative magnetic resonance image showed a large fluid of the flexor tendon sheath. And also, joint effusion was found in the metatarsophalangeal joint and the proximal interphalangeal joint. The first case of the hallux ganglion underwent simple excision of the cyst and had recurrences three times. In the other four cases, the additional synovectomy of the metatarsophalangeal joint and the proximal interphalangeal joint was performed along with ganglion cyst excision. These cases had no recurrence up to 1 year after operation. Recently, there have been reports that tendon sheath ganglions are connected to the ankle, wrist, hallux, and phalangeal joints. Although there are a few cases in our department, satellite ganglion cyst of the hallux and finger possibly originates from adjacent joints. Additional synovectomy of the affected joint should be performed for the excision of satellite ganglion cyst to prevent recurrence.

Synovial Cyst of the Little Finger Originating From a Degenerative Wrist Joint

A 67-year-old woman had a painless tumor in the pulp of her left little finger, which was diagnosed as a synovial cyst. She underwent 2 surgeries to remove the cyst; however, she had a third recurrence. Magnetic resonance imaging revealed that the cyst originated from the flexor tenosynovitis associated with degenerative arthritis of the distal radioulnar joint and pisotriquetral joint. We performed flexor tenosynovectomy and a salvage procedure for the degenerative wrist joint with a Sauve-Kapandji procedure for distal radioulnar joint osteoarthritis and pisiformectomy for pisotriquetral joint arthritis. One year after surgery, the synovial cyst had not recurred, and the functional outcomes of the wrist joint were good. Flexor tenosynovectomy and concurrent joint salvage procedure may be good treatment choices for synovial cysts originating from the flexor tenosynovitis associated with a degenerative wrist joint.

Giant intraosseous ganglion of the fibula: multimodality imaging

Intraosseous ganglia around the knee are most commonly located in the proximal tibia and limited to the epiphyseal-metaphyseal region. We report the case of a giant intraosseous ganglion of the fibula. MRI demonstrated the fluid avascular content of the lesion. CT arthrography of the knee demonstrated partial opacification of the lesion through a cortical bone defect. The lesion was treated with curettage and bone grafting. Anatomopathological examination confirmed the medical imaging diagnosis of intraosseous ganglion. This case highlights the value of joint opacification with CT arthrography to demonstrate the communication between the articular cavity and the ganglion.

Endoscopic Synovectomy of the Ulnar Bursa of the Palm of the Hand

Synovitis of the ulnar bursa is associated with tenosynovitis of the flexor tendons. Reported causes include suppurative or tuberculous infection, rheumatoid arthritis, and pigmented villonodular synovitis. Open synovectomy requires extensive soft-tissue dissection and may result in extensive scarring. The purpose of this Technical Note is to describe the technical details of endoscopic synovectomy of the ulnar bursa of the palm of the hand. This minimally invasive approach with small incisions allows aggressive postoperative hand therapy and avoids the complications of tendon adhesions, joint contractures, and hand stiffness.

Little Finger Flexor Tendoscopy, Endoscopy of the Ulnar Bursa and Midpalmar Space

Inflammatory, infectious, and even neoplastic processes can involve the deep subfascial space of the hand. Suppurative deep-space infection is treated primarily with surgical drainage. Open approaches to these deep spaces carry the risk of exposed flexor tendons and nerves without adequate soft tissue coverage. The purpose of this Technical Note is to describe the technical details of little finger flexor tendoscopy, endoscopy of the ulnar bursa and midpalmar space, which will reduce the risk of exposed tendons or nerves associated with open approaches and allow aggressive hand therapy in the early postoperative period because of the minimal surgical trauma and small surgical wounds.

Uncommon observation of bifocal giant subchondral cysts in the hip: diagnostic role of CT arthrography and MRI, with pathological correlation

Subchondral cysts (or geodes) are common in osteoarthritis (OA), usually in association with other typical signs, i.e., joint space narrowing, subchondral bone sclerosis, and osteophytosis. However, large lesions without the typical signs of OA or lesions located outside the weight-bearing areas are unusual and may be confused for other conditions, in particular, those of tumoral origin. We report the findings in a 48-year-old man who had been complaining of left buttock pain for 3 years, getting worse over the last year, and an evolutive limited range of motion of the hip. The pain was increased by weight-bearing and was not relieved by nonsteroidal anti-inflammatory drugs. Radiographs and CT showed a large multilocular lytic lesion within the femoral head and a large lytic lesion in the left ilio-ischiatic ramus, raising the question of bifocal tumoral involvement. On MRI, the lesions had low signal intensity on T1- and high signal intensity on T2-weighted MR images, with subtle peripheral enhancement on post-contrast T1-weighted images. CT arthrography, by demonstrating a communication between the femoral head and ischiatic cysts and the joint space allowed us to definitively rule out malignant conditions and to make the diagnosis of subchondral bone cysts. Total hip arthroplasty was performed. Pathological analysis of the resected femoral head and of material obtained at curettage of the ischiatic lesion confirmed the diagnosis of degenerative geodes. This case illustrates an atypical bifocal location of giant subchondral cysts in the hip joint mimicking lytic tumors, in the absence of osteoarthritis or rheumatoid arthritis, and highlights the role of CT arthrography in identifying this condition.