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Ferreira Branco D, Botti P, Bouvet C, Abs B, Buzzi M, Beaulieu JY, Poletti PA, Bouredoucen H, Boudabbous S. Dorsal wrist ganglion: clinical and imaging correlation in symptomatic population based on high-field MRI. Eur Radiol 2024:10.1007/s00330-024-10831-3. [PMID: 38856779 DOI: 10.1007/s00330-024-10831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/26/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES To determine prevalence in the symptomatic population of dorsal mucoid cysts centered on dorsal capsuloscapholunate septum (DCSS) using high-field magnetic resonance imaging (MRI) for anatomoclinical and epidemiological correlations. MATERIALS AND METHODS This single-center retrospective study analyzed all 3-Tesla MRIs consecutively performed for painful wrists in 295 patients. Two blinded readers performed measurements. The protocol included T1 spin echo and 3D proton density sequences with fat saturation. Inter-observer reliability was assessed using kappa and intra-class correlation coefficients for cyst detection and volumetry, respectively. Disagreements concerning cyst detection were resolved by a consensus reading. Cyst size, relationship to extrinsic and scapholunate ligaments (SL), continuity of SL, minimum distance to the posterior interosseous nerve (PIN), cyst communication with joint, and anatomical classifications of cysts were analyzed. Correlation tests were performed to assess associations. RESULTS Two-hundred ninety-five patients (mean age 39.6 +/- 15.6 (standard deviation), 161 males) were evaluated for detection of dorsal wrist cysts identified in 150/295. In this subgroup, the mean age was 38.7 years (15-75), the sex ratio of 0.6 (59% women), and the median volume cyst of 8.7 mm3 (0.52-2555). Cyst detection, volume, and major axis measurements showed very high agreement between observers, respectively, 0.89, 0.96, and 0.91. 42 patients had dorsal SL pain. A weak negative correlation was found between distance to PIN and dorsal SL pain (r = -0.2415; p < 0.05) and a weak positive correlation between Guérini's classification and dorsal SL pain (r = 0.2466; p < 0.05). CONCLUSION High-field MRI is the modality of choice for the detection, anatomical, and volumetric assessment of dorsal cysts. Preoperative assessment will be aided by the proposed revised anatomical classification. CLINICAL RELEVANCE STATEMENT High-field MRI is the modality of choice for the anatomical study of dorsal ganglion cysts. It allows the radiologist to accurately describe the anatomical relationships, size, and visibility of the pedicle, essential information for the surgeon's preoperative assessment. KEY POINTS Dorsal mucoid wrist ganglion is a condition for which prevalence remains to be determined. High-field MRI is a reproducible imaging modality for the detection and assessment of dorsal wrist cysts. High-field MRI has a key role in the preoperative management of dorsal mucoid cysts.
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Affiliation(s)
- David Ferreira Branco
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.
| | - Paul Botti
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Cindy Bouvet
- Orthopedic and Traumatology Surgery Department, Hand Surgery Unit, Sion Hospital, Av. du Grand-Champsec 80, 1951, Sion, Switzerland
| | - Bilal Abs
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Marcello Buzzi
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Jean Yves Beaulieu
- Orthopedic and Traumatology Surgery Department, Hand Surgery Unit, Sion Hospital, Av. du Grand-Champsec 80, 1951, Sion, Switzerland
| | - Pierre-Alexandre Poletti
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Hicham Bouredoucen
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Sana Boudabbous
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
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Mitchell T, Hamilton N, Dean B, Rodgers S, Fowler-Davis S, McLean S. A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders. HAND THERAPY 2024; 29:3-20. [PMID: 38425437 PMCID: PMC10901165 DOI: 10.1177/17589983231219595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024]
Abstract
Introduction Non-traumatic wrist disorders (NTWD) are commonly encountered yet sparse resources exist to aid management. This study aimed to produce a literature map regarding diagnosis, management, pathways of care and outcome measures for NTWDs in the United Kingdom. Methods An interdisciplinary team of clinicians and academic researchers used Joanna Briggs Institute guidelines and the PRISMA ScR checklist in this scoping review. A mixed stakeholder group of patients and healthcare professionals identified 16 questions of importance to which the literature was mapped. An a-priori search strategy of both published and non-published material from five electronic databases and grey literature resources identified records. Two reviewers independently screened records for inclusion using explicit eligibility criteria with oversight from a third. Data extraction through narrative synthesis, charting and summary was performed independently by two reviewers. Results Of 185 studies meeting eligibility criteria, diagnoses of wrist pain, De Quervain's syndrome and ulna-sided pain were encountered most frequently, with uncontrolled non-randomised trial or cohort study being the most frequently used methodology. Diagnostic methods used included subjective questioning, self-reported pain, palpation and special tests. Best practice guidelines were found from three sources for two NTWD conditions. Seventeen types of conservative management, and 20 different patient-reported outcome measures were suggested for NTWD. Conclusion Substantial gaps in evidence exist in all parts of the patient journey for NTWD when mapped against an analytic framework (AF). Opportunities exist for future rigorous primary studies to address these gaps and the preliminary concerns about the quality of the literature regarding NTWD.
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Affiliation(s)
- Thomas Mitchell
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Nick Hamilton
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Ben Dean
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Sarah Rodgers
- The Hand Unit, Northern General Hospital, Sheffield, UK
| | | | - Sionnadh McLean
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
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Saad A, Iyengar KP, Botchu R. A rare case of an intratendinous ganglion cyst extending into the muscle belly of flexor carpi radialis: a case report and review of the literature. J Ultrasound 2023; 26:919-922. [PMID: 37029890 PMCID: PMC10632331 DOI: 10.1007/s40477-023-00784-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/06/2023] [Indexed: 04/09/2023] Open
Abstract
ITGCs (intratendinous ganglion cysts) involving the flexor compartment of the wrist are uncommon, and reports are scarce in the literature. The differential diagnosis is wide and can mimic sinister lesions. We report a case of a 62-year-old male, that presented to our tertiary orthopaedic oncology service with an intratendinous ganglion cyst, extending into the muscle belly of flexor carpi radialis. We describe this rare presentation and review the literature.
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Affiliation(s)
- Ahmed Saad
- Department of Orthopedics, Royal Orthopedic Hospital, Birmingham, UK
| | | | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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4
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Lu S, Kerluku J, Nwawka OK, Miller TT, Fufa DT. No Difference in Reintervention at 1-Year Between Ultrasound-Guided versus Blind Dorsal Carpal Ganglion Aspiration. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:728-732. [PMID: 38106948 PMCID: PMC10721498 DOI: 10.1016/j.jhsg.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/10/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose The purpose of this retrospective comparative study was to compare the efficacy of dorsal carpal ganglion aspiration in patients who underwent either "blind" (using surface anatomy alone) or ultrasound-guided (US-guided) aspiration. Methods Outcome measures were conducted during the coronavirus disease 2019 pandemic via telephone for a minimum of 12 months after aspiration, with efficacy defined by reintervention with either repeat aspiration or surgical excision. Results Data are reported for 141 patients (46 blind; 95 US-guided) at an average of 28 months (range, 12-55 months) from aspiration. Reintervention was not significantly different based on the mode of aspiration-26% and 24% for blind aspiration and US-guided, respectively. Patient-perceived recurrence was higher at 65% for the entire cohort. Patients who received steroid injection at the time of aspiration perceived lower rates of recurrence-44% versus 77% for patients who received a steroid injection and patients who did not, respectively. Conclusions This study found no significant difference between blind or US-guided aspiration in reintervention at a minimum of 1-year follow-up. Patients who received steroids at the time of aspiration perceived lower rates of recurrence. Type of study/level of evidence Therapeutic III.
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Affiliation(s)
- Shuting Lu
- Weill Cornell Medical College, New York, NY
| | - Jona Kerluku
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY
| | - Ogonna K. Nwawka
- Weill Cornell Medical College, New York, NY
- Department of Radiology, Hospital for Special Surgery, New York, NY
| | - Theodore T. Miller
- Weill Cornell Medical College, New York, NY
- Department of Radiology, Hospital for Special Surgery, New York, NY
| | - Duretti T. Fufa
- Weill Cornell Medical College, New York, NY
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY
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Cohen-Tanugi S, Dart S, Chadderdon C. Active Treatment of Pediatric Ganglia of the Wrist: What is the Risk of Recurrence? J Pediatr Orthop 2023; 43:e809-e812. [PMID: 37746886 DOI: 10.1097/bpo.0000000000002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Ganglion cysts are the most common soft tissue mass in the hand and wrist in both adults and children. More is known about wrist ganglia and their treatment outcomes in adults than in children. Current literature to guide the management of pediatric wrist ganglia is limited. The purpose of this study is to report on the rates of recurrence of pediatric wrist ganglia after active intervention-aspiration or surgical excision-at a single center, as well as to explore factors associated with recurrence in one of the largest samples to date of pediatric wrist ganglia. METHODS In all, 205 pediatric patients with wrist ganglia from our institution with at least 2-year follow up were included. The primary outcome was the recurrence rate after treatment type (aspiration vs. surgery). Secondary outcomes were demographic factors (age, sex, etc.), cyst location (volar vs. dorsal), duration of cyst before intervention, and surgeon specialty training (hand vs. non-hand). RESULTS Recurrence was seen in 58.4% (n=94) of patients undergoing their first aspiration.Recurrence was seen in 34% (n=97) of patients after the first surgery, but there was a significant difference in recurrence rate based on the surgeon's fellowship training. CONCLUSION In conclusion, surgery does appear to offer a higher chance of definitive resolution of pediatric wrist ganglia. Differences in technique among surgeons should be explored as a possible factor to explain the range of recurrence rates described in the limited literature on this topic. LEVEL OF EVIDENCE Level III-Retrospective Review.
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Affiliation(s)
- Samuel Cohen-Tanugi
- Atrium Health Musculoskeletal Institute
- OrthoCarolina Research Institute
- OrthoCarolina Hand Center, Charlotte
| | - Scott Dart
- Novant Health-EmergeOrtho, Wilmington, NC
| | - Christopher Chadderdon
- Atrium Health Musculoskeletal Institute
- OrthoCarolina Research Institute
- OrthoCarolina Hand Center, Charlotte
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McGill KC, Patel R, Chen D, Okwelogu N. Ultrasound-guided bursal injections. Skeletal Radiol 2023; 52:967-978. [PMID: 36008730 PMCID: PMC10027639 DOI: 10.1007/s00256-022-04153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 02/02/2023]
Abstract
The native bursa is a structure lined by synovium located adjacent to a joint which may serve to decrease friction between the tendons and overlying bone or skin. This extra-articular structure can become inflamed resulting in bursitis. Steroid injections have proven to be an effective method of treating bursal pathology in various anatomic locations. Performing these procedures requires a thorough understanding of relevant anatomy, proper technique, and expected outcomes. Ultrasound is a useful tool for pre procedure diagnostic evaluation and optimizing needle position during these procedures while avoiding adjacent structures. The purpose of this article is to review core principles of ultrasound-guided musculoskeletal procedures involving bursae throughout the upper and lower extremities.
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Affiliation(s)
- Kevin C McGill
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - Rina Patel
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - David Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
- Department of Radiology, University of California, Davis, CA, USA
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7
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Elahi MA, Moore ML, Pollock JR, Haglin JM, Lai C, Hinckley NB, Renfree K. Open Excision of Dorsal Wrist Ganglion. JBJS Essent Surg Tech 2023; 13:e21.00043. [PMID: 38274143 PMCID: PMC10807893 DOI: 10.2106/jbjs.st.21.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Background Ganglion cysts are benign soft-tissue tumors that are most commonly found in the wrist. Within the wrist, 60% to 70% of ganglion cysts occur on the dorsal side and 20% to 30% occur on the volar side1. Although ganglia arise from multiple sites over the dorsal wrist, dorsal ganglia most commonly originate at the scapholunate joint2,3. Open excision is the standard surgical treatment for dorsal wrist ganglia. This procedure is considered when symptoms such as pain and range-of-motion deficits begin to impact activities of daily living. Description Open excision of a dorsal wrist ganglion is commonly performed with the patient under general anesthesia or a regional block. The patient is placed in the supine position, and a tourniquet is applied on the affected upper limb. After outlining the periphery of the palpable ganglion, the surgeon makes a transverse or longitudinal incision over the ganglion. The surgeon then begins a deep dissection, dissecting through the subcutaneous tissue and isolating the ganglion while avoiding any rupture, if possible. Once the cyst has been identified, extensor tendons surrounding the cyst are retracted and the cyst and stalk are mobilized. The cyst and stalk are subsequently excised, and the wound is closed4. Alternatives Alternative treatments for dorsal wrist ganglia include nonoperative interventions such as observation, aspiration, controlled rupture, and injection. Operative treatments include arthroscopic and open dorsal wrist ganglion resections. Rationale Although nonoperative treatment can produce successful outcomes, the various modalities have been associated with recurrence rates ranging from 15% to 90%4. As a result, surgical excision remains the gold standard of treatment and is typically indicated when weakness, pain, and limited range of motion interfere with activities of daily living. Among surgical interventions, arthroscopic excision is a minimally invasive procedure that has become more common because of the reduced scarring and faster recovery5. However, open excision, which does not involve complex equipment, is regarded as the standard among surgical treatments. Although the rates of recurrence for arthroscopic versus open dorsal ganglion excision are similar, arthroscopic excision is less effective with regard to pain relief5,6. This difference in pain relief could potentially be the result of the neurectomy of the posterior interosseous nerve in an open excision. In contrast, an arthroscopic procedure may provide less relief of pain from the posterior interosseous nerve stump attaching to the scarred capsule5. Expected Outcomes Open excision of a dorsal wrist ganglion is a safe, reliable procedure. The recurrence rate after open excision is similar to that after arthroscopic excision and significantly lower recurrence than that after ganglion cyst aspiration6,7. Additionally, not all ganglion cysts can be aspirated. In a retrospective study assessing the risk of recurrence after open excision of ganglion cysts in 628 patients, researchers reported a recurrence rate of 4.1% among the 341 who underwent open dorsal ganglion excision. Furthermore, the authors reported male sex and less surgeon experience as significant risk factors for cyst recurrence8. In a study assessing outcomes of open dorsal ganglion excision in 125 active-duty military personnel, researchers reported a recurrence rate of 9%. More notably, the researchers found persistent pain at 4 weeks postoperatively in 14% of the participants. The authors recommended that patients whose daily activities require forceful wrist extension, such as athletes and military personnel, should be counseled on the potential functional limitations and residual pain from open dorsal wrist ganglion excision9. Important Tips When conducting an open excision, it is beneficial to identify the stalk of the cyst, allowing the surgeon to excise the complete ganglion complex and prevent recurrence.For large cysts that adhere to the surrounding soft tissue, it is helpful to rupture the ganglion in order to facilitate an easier deep dissection.Excising the scapholunate interosseous ligament could possibly lead to scapholunate dissociation and instability.The posterior interosseous nerve courses past the 4th dorsal compartment and may be resected during the deep dissection.
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Affiliation(s)
| | - M. Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | | | - Jack M. Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Cara Lai
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona
| | | | - Kevin Renfree
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona
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Horvath A, Zsidai B, Konaporshi S, Svantesson E, Hamrin Senorski E, Samuelsson K, Zeba N. Treatment of Primary Dorsal Wrist Ganglion-A Systematic Review. J Wrist Surg 2023; 12:177-190. [PMID: 36926205 PMCID: PMC10010899 DOI: 10.1055/s-0042-1753542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
Abstract
Purpose The aim of this study was to compare the rates of recurrence and wound infection in patients with primary dorsal wrist ganglion treated with aspiration (with or without an injection of an additive), open excision, or arthroscopic resection. Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered on PROSPERO. Systematic electronic searches in PubMed (MEDLINE), EMBASE, Web of Science, and the Cochrane Library of Controlled Trials were performed on May 5, 2020, and June 1, 2021, respectively. All clinical studies written in English determining the recurrence and wound infection rates after treatment of primary dorsal wrist ganglion with aspiration, open excision, or arthroscopic resection in patients over the age of 16 years were eligible for inclusion. Quality assessment was guided by the Cochrane Collaboration's tool for randomized controlled trials (RCTs) and the methodological index for nonrandomized studies (MINORS) tool for observational studies. Results The literature searches resulted in 1,691 studies. After screening, five RCTs, enrolling 233 patients, and six observational studies, enrolling 316 patients with primary dorsal wrist ganglions were included. Quality assessment of the included RCTs and observational studies determined the existing level of evidence pertaining to primary dorsal wrist ganglion treatment to be low. About 11 studies reported on recurrence rate, which ranged between 7 and 72% for patients initially treated with aspiration (with or without an injection of an additive). In comparison, the recurrence rate for the open excision and arthroscopic resection groups ranged between 6 to 41% and 0 to 16%, respectively. Four studies investigated wound-related complications, for which zero infections were reported, irrespective of treatment. Conclusion The evidence summarized in this systematic review demonstrates a considerable variability in recurrence rate following aspiration and open or arthroscopic resection of a primary dorsal wrist ganglion. The greatest variability in recurrence was displayed among studies on aspiration. The overall infection rate after treatment of dorsal wrist ganglions seems to be low regardless of the treatment type. However, the divergent results of individual studies highlight a pressing need for prospective controlled trials assessing outcomes following dorsal wrist ganglion treatment. Level of Evidence Systematic review on level 1 to 4 clinical therapeutic studies.
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Affiliation(s)
- Alexandra Horvath
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Bálint Zsidai
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Shanga Konaporshi
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eleonor Svantesson
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Nenad Zeba
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Hassan AM, Tesfaye EA, Rashiwala A, Roubaud MJ, Mericli AF. Functional Muscle Transfer after Oncologic Extremity Resection. J Reconstr Microsurg 2023; 39:195-208. [PMID: 35768008 DOI: 10.1055/a-1887-7530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Functional muscle transfer (FMT) can provide wound closure and restore adequate muscle function for patients with oncologic extremity defects. Herein we describe our institutional experience with FMT after oncological resection and provide a systematic review and meta-analysis of the available literature on this uncommon procedure. METHODS A single-institution retrospective review was performed, including all patients who received FMT after oncological resection from 2005 to 2021. For the systematic review and meta-analysis, PubMed, Cochrane, Medline, and Embase libraries were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; results were pooled, weighted by study size, and analyzed. RESULTS The meta-analysis consisted of seven studies with 70 patients overall, demonstrating a mean Medical Research Council (MRC) score of 3.78 (95% confidence interval: 2.97-4.56; p < 0.01). The systematic review included 28 studies with 103 patients. Receipt of adjuvant chemotherapy was associated with significantly lower mean MRC score (3.00 ± 1.35 vs. 3.90 ± 1.36; p = 0.019). Seventy-four percent of the patients underwent free FMT, with the most common donor muscle being the latissimus dorsi (55%). The flap loss rate was 0.8%. Neoadjuvant chemotherapy (p = 0.03), radiotherapy (p = 0.05), pedicled FMTs (p = 0.01), and a recipient femoral nerve (p = 0.02) were associated with significantly higher complication rates. The institutional retrospective review identified 13 patients who underwent FMT after oncological resection with a median follow-up time of 21 months (range: 6-74 months). The most common tumor necessitating FMT was undifferentiated pleomorphic sarcoma (77%), and the most common donor muscle was the latissimus dorsi (62%). A high body mass index was associated with prolonged neuromuscular recovery (R = 0.87, p = 0.002). CONCLUSION FMT after oncological resection may contribute to improved extremity function. Careful consideration of risk factors and preoperative planning is imperative for successful FMT outcomes.
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Affiliation(s)
- Abbas M Hassan
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eliora A Tesfaye
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Abhi Rashiwala
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Margaret J Roubaud
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander F Mericli
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Rana S, Pradhan A, Casaos J, Mozaffari K, Ghodrati F, Sugimoto B, Yang I, Nagasawa DT. Lumbar spinal ganglion cyst: A systematic review with case illustration. J Neurol Sci 2023; 445:120539. [PMID: 36638603 DOI: 10.1016/j.jns.2022.120539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/08/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Ganglion cysts are benign soft tissue lesions found in joints, most commonly wrists. The incidence for juxtafacet cysts, the condition under which spinal ganglion cysts are categorized, is between 0.06% and 5.8%. Spinal ganglion cysts often arise in the most mobile segment of the lumbar spine, L4-L5. Patients commonly present with pain, radiculopathy, and weakness. Conservative management is used, but surgical resection is the most common treatment modality. We aim to review the literature and present a rare case of an L2-L3 situated spinal ganglion cyst, treated with maximal safe resection. METHODS A systematic review of literature was conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and Cochrane databases were queried using Boolean operators and search terms, "spinal ganglion cyst, lumbar ganglion cyst, and lumbar juxtafacet cyst". Presentation, surgical management, and postoperative course of a 29-year-old male with an L2-L3 spinal ganglion cyst are also described. RESULTS The search yielded 824 articles; 23 met inclusion criteria. These papers consisted of 27 spinal ganglion cyst cases with disaggregated patient data. 63.0% of patients were male, and 53.4 years (range: 23-86) was the average age at presentation. Mean symptom duration was 1.9 years (range: 3 days-12 years). 70.4% of patients reported complete symptom resolution. 14.8% of cases noted neural foramen involvement. CONCLUSIONS Spinal ganglion cysts are benign lesions typically presenting with radiculopathy. Maximal safe resection is an effective treatment modality with low complication rates. Future studies are needed to understand if neural foramen involvement leads to increased symptom severity.
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Affiliation(s)
- Shivam Rana
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Anjali Pradhan
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Joshua Casaos
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Khashayar Mozaffari
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Farinaz Ghodrati
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Brianna Sugimoto
- Achieve Brain & Spine, Santa Monica, CA, United States of America
| | - Isaac Yang
- Department of Neurosurgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Department of Radiation Oncology, Los Angeles (UCLA), Los Angeles, CA, United States of America; Department of Head and Neck Surgery, Los Angeles (UCLA), Los Angeles, CA, United States of America; Jonsson Comprehensive Cancer Center, Los Angeles (UCLA), Los Angeles, CA, United States of America; Los Angeles Biomedical Research Institute, Los Angeles (UCLA), Los Angeles, CA, United States of America; Harbor-UCLA Medical Center, Los Angeles (UCLA), Los Angeles, CA, United States of America; David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, United States of America.
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Clark DM, Nelson SY, O'Hara M, Putko RM, Bedrin MD, Daniels CM. Surgical and Patient-Centered Outcomes of Open versus Arthroscopic Ganglion Cyst Excision: A Systematic Review. J Wrist Surg 2023; 12:32-39. [PMID: 36644727 PMCID: PMC9836780 DOI: 10.1055/s-0042-1749678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/20/2022] [Indexed: 01/18/2023]
Abstract
Introduction As the popularity of wrist arthroscopy grows, it continues to prove useful in the treatment of ganglion cysts. Previous studies comparing an arthroscopic technique to traditional open excision have demonstrated generally equivalent results regarding complications and cyst recurrence. However, this systematic review compares the two treatment methods not only regarding cyst recurrence but also regarding patient-centered outcomes. Additionally, new studies in the available literature may allow for further analysis. Methods This systematic review identified 23 articles published between 2000 and 2021 that met inclusion criteria. Articles were assessed for quality, and reported cyst recurrence rates, patient satisfaction, patients' preoperative and postoperative pain, and complications associated with either open or arthroscopic excisions were pooled into open excision and arthroscopic excision groups for analysis. Results In total, 23 studies accounted for 1,670 cases. Pooled data for patient-centered outcomes indicated a significantly higher patient satisfaction rate (89.2 vs 85.6%, p < 0.001) and higher reported pain relief (69.5 vs. 66.7%, p = 0.011) associated with arthroscopic excision versus open excision. Recurrence rates were also significantly lower for the arthroscopic excision group (9.4 vs. 11.2%, p < 0.001). Overall, the complication rate was significantly lower for arthroscopic excision (7.5 vs. 10.7%, p < 0.001), but the complication profile distinctly differed between the two methods. Conclusions Both arthroscopic and open excision of dorsal wrist ganglions are viable treatment options. However, the results of this meta-analysis suggest benefits associated with the arthroscopic technique in both patient-centered outcomes and in traditional, surgical outcomes. This may prove advantageous as wrist arthroscopy becomes more common.
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Affiliation(s)
- DesRaj M. Clark
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Sarah Y. Nelson
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Matthew O'Hara
- University of California Riverside, School of Medicine, Riverside, California
| | - Robert M. Putko
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Michael D. Bedrin
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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12
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Gobetti M, Santos JBGD, Pires FA, Nakachima LR, Belloti JC, Faloppa F. Treatment of Wrist Dorsal Synovial Cyst with Percutaneous Sclerotherapy Using Hypertonic Saline Solution. Rev Bras Ortop 2023; 58:108-113. [PMID: 36969777 PMCID: PMC10038704 DOI: 10.1055/s-0041-1740294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/20/2021] [Indexed: 03/26/2023] Open
Abstract
Objective To evaluate the efficacy of hypertonic saline infiltration as a sclerosing agent in the dorsal synovial cyst of the wrist. Method Patients of both genders, aged 18 years or older, with clinical and ultrasound diagnosis of synovial cyst, and without any previous treatment were selected. Case series in which 50 patients underwent aspiration of the contents of the cyst and infiltration of the hypertonic saline solution (2 ml sodium chloride solution 20% and 1 ml of lidocaine 2%). The patients were followed up for 24 weeks, when the parameters pain, strength, range of motion, function (quickDASH and Brief Michigan question), recurrence, and complications were evaluated. Results A total of 46 patients were evaluated for 24 weeks, 18 (39.1%) cysts evolved to resolution, and 28 (60.9%) presented recurrence. There was no statistically significant difference in the effect force or in the range of motion. There was no clinically significant difference in the scores of the questionnaires. The most frequent complications were pain and edema. Conclusion Infiltration with hypertonic saline solution for the treatment of dorsal synovial cyst of the wrist showed a recurrence rate of 60.9%.
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Affiliation(s)
- Murilo Gobetti
- Disciplina de Cirurgia da Mão e Membro Superior do Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Baptista Gomes dos Santos
- Disciplina de Cirurgia da Mão e Membro Superior do Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Fernando Araujo Pires
- Disciplina de Cirurgia da Mão e Membro Superior do Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Luis Renato Nakachima
- Disciplina de Cirurgia da Mão e Membro Superior do Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - João Carlos Belloti
- Disciplina de Cirurgia da Mão e Membro Superior do Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Flavio Faloppa
- Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil
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13
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Saremi H, bolbanabad MM, Abdollahian AR, Mohammadi Y. Clinical Results of Arthroscopic Resection of Dorsal Wrist Ganglion with a Minimum of 3 Years Follow-up. J Wrist Surg 2023; 12:52-55. [PMID: 36644718 PMCID: PMC9836768 DOI: 10.1055/s-0042-1756673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
Introduction Ganglion cysts are the most common benign tumors of the wrist. Their arthroscopic resection is becoming common. However, there are a limited number of studies comparing arthroscopic and open surgeries. This study evaluated the subjective and objective results of arthroscopy with a minimum of 3 years follow-up. Patients and Methods Patients with dorsal wrist ganglion who underwent arthroscopic ganglionectomy were evaluated regarding pain (using visual analog scale) and satisfaction as subjective results. We also evaluated their scar (with the Vancouver scar scale), range of motion, and recurrence as objective results. Results There were 20 patients in the study. Mean of follow-up time was 52.5 months. Recurrence rate was 5%, and visual analog scale of pain decreased from 3.7 to 0.5 at the final follow-up. Sixteen patients were completely satisfied, three patients were partially satisfied, and one patient was unsatisfied. The mean of Vancouver scar scale was 1.4 (range of 0-3). Improvement in range of flexion and extension of the wrist was significant without a significant complication. Conclusion Arthroscopic excision of dorsal wrist ganglion in the way described in this study is a safe and effective method that improves pain and range of motion of the wrist without major complications. The rate of recurrence was less than those reported for open surgery in long-term follow-up. The surgery scar has a promising score in Vancouver scar scale.
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Affiliation(s)
- Hossein Saremi
- Department of Orthopedics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | | | - Younes Mohammadi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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14
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Ganglions in the Hand and Wrist: Advances in 2 Decades. J Am Acad Orthop Surg 2023; 31:e58-e67. [PMID: 36580047 DOI: 10.5435/jaaos-d-22-00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/12/2022] [Indexed: 12/30/2022] Open
Abstract
Ganglion cysts represent the most common soft-tissue mass in the hand and wrist. Ganglion cysts are most commonly encountered at the dorsal or volar aspects of the wrist, although cysts may arise from the flexor tendon sheath, interphalangeal joint, and extensor tendons. Intraosseous and intraneural ganglion cysts have also been described. Diagnosis of ganglion cysts relies primarily on history and physical examination. Transillumination and aspiration of masses may be useful adjuncts to diagnosis. Imaging such as radiography and ultrasonography may be indicated to evaluate for associated conditions, such as degenerative joint disease, or to rule out a solid or heterogeneous mass. Advanced imaging such as MRI is generally reserved for patients in whom occult ganglions, intraosseous ganglions, or solid tumors, including sarcoma, remain a concern. Treatment of ganglion cysts includes observation, aspiration or puncture with possible corticosteroid injection, and surgical excision. Nonsurgical management may result in cyst resolution in over 50% of patients. Surgical excision is associated with recurrence rates of 7% to 39%. Advances in surgical techniques have allowed surgeons to conduct arthroscopic ganglion excision, with recurrence rates similar to those of open management. This study highlights the advances in diagnosis, treatment, and outcomes that have taken place over the past 2 decades for this common condition affecting the hand and wrist in the adult population.
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15
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Federer AE, Yoo M, Stephens AS, Nelson RE, Steadman JN, Tyser AR, Kazmers NH. Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis. J Hand Surg Am 2023; 48:9-18. [PMID: 36402604 PMCID: PMC9812920 DOI: 10.1016/j.jhsa.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/19/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Dorsal wrist ganglions are treated commonly with aspiration, or open or arthroscopic excision in operating room (OR) or procedure room (PR) settings. As it remains unclear which treatment strategy is most cost-effective in yielding cyst resolution, our purpose was to perform a formal cost-minimization analysis from the societal perspective in this context. METHODS A microsimulation decision analytic model evaluating 5 treatment strategies for dorsal wrist ganglions was developed, ending in either resolution or a single failed open revision surgical excision. Strategies included immediate open excision in the OR, immediate open excision in the PR, immediate arthroscopic excision in the OR, or 1 or 2 aspirations before each of the surgical options. Recurrence and complications rates were pooled from the literature for each treatment type. One-way sensitivity and threshold analyses were performed. RESULTS The most cost-minimal strategy was 2 aspiration attempts before open surgical excision in the PR setting ($1,603 ± 1,595 per resolved case), followed by 2 aspirations before open excision in the OR ($1,969 ± 2,165 per resolved case). Immediate arthroscopic excision was the costliest strategy ($6,539 ± 264 per resolved case). Single aspiration preoperatively was more cost-minimal than any form of immediate surgery ($2,918 ± 306 and $4,188 ± 306 per resolved case performed in the PR and OR, respectively). CONCLUSIONS From the societal perspective, performing 2 aspirations before surgical excision in the PR setting was the most cost-minimal treatment strategy, although in reference to surgeons who do not perform this procedure in the PR setting, open excision in the OR was nearly as cost-effective. As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Economic Decision Analysis II.
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Affiliation(s)
- Andrew E Federer
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Minkyoung Yoo
- Department of Economics, University of Utah, Salt Lake City, UT
| | | | - Richard E Nelson
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Jesse N Steadman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
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Konigsberg MW, Tedesco LJ, Mueller JD, Ball JR, Wu CH, Kadiyala RK, Strauch RJ, Rosenwasser MP. Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison. Hand (N Y) 2023; 18:133-138. [PMID: 33789496 PMCID: PMC9806526 DOI: 10.1177/15589447211003184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study directly compares the recurrence rates of dorsal wrist ganglion cysts in patients treated via open surgical excision versus arthroscopic surgical excision. We hypothesized that there would be no difference between recurrence rates with these 2 surgical options. METHODS We retrospectively reviewed the charts of all patients with a dorsal ganglion cyst undergoing either open or arthroscopic surgical excision at a single academic center with 3 fellowship-trained attending hand surgeons from 2012 to 2017. Charts were identified using Current Procedural Terminology codes and were reviewed using postoperative office notes for preoperative and postoperative symptoms, episodes of recurrence, time at which recurrence occurred, subsequent operations, and outcome at final follow-up. RESULTS The charts of 172 patients undergoing either arthroscopic or open dorsal ganglion excision were reviewed. Nine of 54 (16.7%) arthroscopic excisions resulted in cyst recurrence, while 8 of 118 (6.8%) open excisions resulted in cyst recurrence (P = .044). Two of 9 (22%) recurrences after arthroscopic ganglion excision versus 2 of 8 (25%) recurrences after open ganglion excision underwent repeat surgical intervention. Time to recurrence, as well as final follow-up, was not statistically different between groups. CONCLUSIONS Dorsal wrist ganglion cysts are the most common benign soft tissue mass of the upper extremity, but it remains unknown whether arthroscopic or open surgical excision leads to lower recurrence rate. Scant literature exists directly comparing these 2 methods of surgical excision. This study suggests that open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision.
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Affiliation(s)
| | - Liana J. Tedesco
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - John D. Mueller
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - Jacob R. Ball
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - Chia H. Wu
- Baylor College of Medicine, Houston,
TX, USA
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17
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Fujihara Y, Yamamoto M, Hidaka S, Sakai A, Hirata H. Vascularised versus non-vascularised bone graft for scaphoid nonunion: Meta-analysis of randomised controlled trials and comparative studies. JPRAS Open 2022; 35:76-88. [PMID: 36793769 PMCID: PMC9922807 DOI: 10.1016/j.jpra.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background Numerous studies have investigated surgical techniques for vascularised bone graft (VBG) for scaphoid nonunion; however, their efficacies remain unclear. Thus, to estimate the union rate of VBG for scaphoid nonunion, we performed a meta-analysis of randomised controlled trials (RCTs) and comparative studies. Methods A systematic search was conducted using PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials. The search formula was as follows: ((scaphoid nonunion) OR (scaphoid pseudarthrosis)) AND (bone graft). Only RCTs were used in the primary analysis, and comparative studies, including RCTs, in the secondary analysis. The primary outcome was nonunion rate. We compared the outcome between VBG and non-vascularised bone graft (NVBG), pedicled VBG and NVBG, and free VBG and NVBG. Results This study included a total of 4 RCTs (263 patients) and 12 observational studies (1411 patients). In the meta-analyses of both RCTs only and RCTs and other comparative studies, no significant difference in nonunion rate was found between VBG and NVBG (summary odds ratio [OR], 0.54; 95% confidence interval [CI], 0.19-1.52 and summary OR, 0.71; 95% CI, 0.45-1.12), respectively. The nonunion rates of pedicled VBG, free VBG, and NVBG were 15.0%, 10.2%, and 17.8%, respectively, and no significant difference was found. Conclusions Our results indicated that the postoperative union rate in NVBG is similar to that in VBG; thus, NVBG could be the first choice of treatment for scaphoid nonunion.
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Affiliation(s)
- Yuki Fujihara
- Department of Orthopaedic and Hand Surgery, Nagoya Ekisaikai Hospital,Address correspondence and requests for reprints to: Yuki Fujihara, M.D., Ph.D. Department of Orthopaedic and Hand Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonen-Cho, Nakagawa-Ku, Nagoya, 454-8502, Japan. Tel: (+81) 90-9944-4925; Fax: (+81) 052-652-7783
| | - Michiro Yamamoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoki Hidaka
- Department of Orthopaedic and Hand Surgery, Nagoya Ekisaikai Hospital
| | - Ai Sakai
- Department of Orthopaedic and Hand Surgery, Nagoya Ekisaikai Hospital
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Ortu S, Fiori E, Bagnoli I, Valente A, Pisanu F, Caggiari G, Doria C, Milano L. Complications of alcohol injections for Morton’s neuroma. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221116392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Morton’s neuroma (MN) is a neuropathic metatarsalgia that causes pain in the plantar aspect of the forefoot generally between the third and fourth metatarsal heads. Treatment can be nonoperative or surgical. Among nonoperative procedures, alcohol injections are still commonly used as considered simple, relatively safe and well-tolerated treatment. However, they present transient and minor complications. Methods Two hundred patients with a diagnosis of MN underwent ultrasound-guided injections with a 47.5% alcohol solution between 2013 and 2020. We reviewed the current literature to highlight the known complications of this treatment, comparing them to the complications developed by our patients. Results Three patients out of 200 patients, developed necrosis of skin and subcutaneous tissue not described in previous studies about MN. Conclusions Our study focuses attention on the complications subsequent to the alcohol injection therapy for MN. Patients and surgeons should be aware that in a small number of cases this therapy can be burdened by necrotic complications of the skin.
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Affiliation(s)
| | - Enrico Fiori
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Ignazio Bagnoli
- Orthopaedic Department – Foot Surgery, Humanitas Cellini, Torino, Italy
| | - Angiola Valente
- Orthopaedic Department – Foot Surgery, Humanitas Cellini, Torino, Italy
| | - Francesco Pisanu
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Gianfilippo Caggiari
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Carlo Doria
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Luigi Milano
- Orthopaedic Department – Foot Surgery, Humanitas Cellini, Torino, Italy
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Grégoire C, Guigal V. Efficacy of corticosteroid injections in the treatment of 85 ganglion cysts of the dorsal aspect of the wrist. Orthop Traumatol Surg Res 2022; 108:103198. [PMID: 35031514 DOI: 10.1016/j.otsr.2022.103198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Ganglion cysts of the dorsal aspect of the wrist are a benign pathology frequently encountered in consultations for hand surgery. Their treatment, irrespective of the type, presents a risk of recurrence and there is no consensus on the management to adopt. Medical treatments such as corticosteroid injections have recurrence rates between 8 and 74%. Surgical treatments seem to have better results, with less disparate failure rates, at around 15%. HYPOTHESIS The objective of this retrospective study was to determine the effectiveness of the aspiration and injection of corticosteroids under ultrasound guidance in the treatment of 85 ganglion cysts of the dorsal aspect of the wrist. PATIENTS AND METHODS We retrospectively included 99 patients suffering from a non-occult ganglion cyst of the dorsal aspect of the wrist, who had received a referral for aspiration, and subsequent injection of corticosteroids between January 2015 and December 2020. Data collection was carried out by the analysis of files on the institution's software, and by a phone call. Data such as age, sex, pre- and post-treatment QuickDASH score, as well as recurrence and second-line treatments were collected. RESULTS The average age of our cohort was 31, with a 65% female predominance. The recurrence rate after a first injection was 73.2% with a mean follow-up of 34 months. The QuickDASH score improved significantly by 26.2 points out of 100 in non-injected patients, and by 18.6 points out of 100 after injection, whether the cyst recurred or not. CONCLUSION With 73.2% recurrence, corticosteroid injections do not appear to be effective in treating dorsal ganglion cysts of the wrist. They lead to an improvement in the functional score of the wrist, but not significantly compared to treatment abstinence. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Coline Grégoire
- Clinique du Parc, 155, bis boulevard Stalingrad, 69006 Lyon, France.
| | - Vincent Guigal
- Clinique du Parc, 155, bis boulevard Stalingrad, 69006 Lyon, France
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20
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Abstract
Myxoid tumors of the soft tissue encompass a group of heterogenous tumors that are characterized by the presence of abundant extracellular myxoid or chondromyxoid matrix material. Fine needle aspiration (FNA) is variably used for diagnosing primary, recurrent, and metastatic myxoid soft tissue tumors. The spectrum of myxoid soft tissue tumors encountered in practice ranges from benign lesions such as simple ganglion cysts to high-grade malignant sarcomas such as myxofibrosarcoma. These myxoid tumors have clinical, cytologic, and histologic overlap. Therefore, making an accurate diagnosis by FNA alone is challenging. Despite this challenge, using a systematic cytomorphologic approach and ancillary studies, an accurate diagnosis is feasible in the majority of cases. This article provides a systematic approach to diagnosing myxoid soft tissue tumors by FNA along with a review of the literature.
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Affiliation(s)
- Swati Satturwar
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
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Bram JT, Falk DP, Chang B, Ty JM, Lin IC, Fazal FZ, Shah AS. Factors Influencing Why Children and Their Families Choose Surgery for Ganglion Cysts. J Hand Surg Am 2022; 47:1119.e1-1119.e8. [PMID: 34649743 DOI: 10.1016/j.jhsa.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 07/01/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Ganglion cysts of the hand/wrist are frequently managed without surgery but can be treated with surgical excision if there is pain or dysfunction. No studies have examined the specific factors predictive of surgical treatment for pediatric patients. METHODS This was a study of pediatric patients (≤18 years) with ganglion cysts of the hand/wrist seen between 2017 and 2019 at 2 institutions. Baseline demographic data were collected in addition to cyst characteristics, Wong-Baker pain scores, and Patient-Reported Outcomes Measurement Information System scores (pain, depression, upper extremity function, anxiety). Multivariable regression was used to determine the factors predictive of surgical intervention at ≥6 months of eligible follow-up. RESULTS A total of 167 patients with a mean age of 10.1 ± 5.3 years were included for analysis. Forty-three (25.7%) underwent surgical excision of their ganglion cyst at means of 2.3 months after the initial visit and 12.6 months after cyst appearance. Sex and cyst location were similar between cohorts. Surgical patients were older (12.1 vs 9.4 years, respectively) and presented to the clinic later after an appearance (10.9 vs 6.5 months, respectively) compared to nonsurgical patients. Surgical patients also had higher pain scores at presentation (median, 3 vs 0, respectively). Cysts receiving surgery were larger than those without surgery (81.4% vs 55.3% >1 cm, respectively). Pain interference Patient-Reported Outcomes Measurement Information System scores were higher in the surgical than the nonsurgical group (45.2 vs 39.6, respectively). In a multivariable analysis, pain scores ≥4 (odds ratio, 3.4) were predictive of surgery for patients ≥3 years, whereas older age (odds ratio, 1.1) and a cyst size >1 cm (odds ratio, 3.3) predicted surgery across all patients. CONCLUSIONS Pediatric patients with ganglion cysts who initially present at older ages with moderate/severe pain scores and larger cysts are more likely to ultimately choose surgical excision. Surgeons may observe a preference for earlier surgery in this subset of patients. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Joshua T Bram
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David P Falk
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Benjamin Chang
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jennifer M Ty
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Ines C Lin
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Faris Z Fazal
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Apurva S Shah
- Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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22
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Lenartowicz KA, Murthy NK, Desy NM, De La Pena NM, Wolf AS, Wilson TJ, Amrami KK, Spinner RJ. Does complete regression of intraneural ganglion cysts occur without surgery? Acta Neurochir (Wien) 2022; 164:2689-2698. [PMID: 35877047 DOI: 10.1007/s00701-022-05311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/01/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE The dynamic nature of intraneural ganglion cysts, including spontaneous expansion and regression, has been described. However, whether these cysts can regress completely in the absence of surgical management has important therapeutic implications. Therefore, we aim to review the literature for cyst regression without surgical intervention. METHODS We reviewed our database of 970 intraneural ganglion cysts in the literature to search for evidence of complete regression based on strict radiologic confirmation, either spontaneously, or after percutaneous cyst aspiration or steroid injection. RESULTS We did not find any examples of complete regression without surgical treatment that met inclusion criteria. Spontaneous regression was reported in four cases; however, only two cases had follow-up imaging, both of which demonstrated residual cysts. Nineteen cases of percutaneous intervention were found in the literature, 13 of which reported clinical improvement following aspiration/steroid injection; however, only seven cases had available imaging. Only two cases reported complete resolution of cyst on MR imaging at follow-up, but reinterpretation found residual intraneural cyst in both cases. CONCLUSION We believe that pathology (structural abnormalities and/or increased joint fluid) always exists at the joint origin of intraneural ganglion cysts which persist even with regression of the cyst. The persistence of a capsular abnormality or defect can lead to recurrence of the cyst in the future, and while imaging may show dramatic decreases in cyst size, truly focused assessment of images will show a tiny focus of persistent intraneural cyst at the joint origin. Thus, expectant management or percutaneous intervention may lead to regression, but not complete resolution, of intraneural ganglion cysts.
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Affiliation(s)
| | - Nikhil K Murthy
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Nicholas M Desy
- Department of Orthopedics, University of Calgary, Alberta, Calgary, Canada
| | | | - Alexandre S Wolf
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | | | | | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Natroshvili T, Peperkamp K, Malyar MA, Wijnberg D, Heine EP, Walbeehm ET. Rare Tumors Causing Median Nerve Compression in Adults-A Narrative Review. Arch Plast Surg 2022; 49:656-662. [PMID: 36159378 PMCID: PMC9507571 DOI: 10.1055/s-0042-1756345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/11/2022] [Indexed: 11/01/2022] Open
Abstract
The median nerve can be compressed due to a tumor along the course of the median nerve, causing typical compression symptoms or even persistence or recurrence after an operation. The aim of this review is to provide a comprehensive overview of rare tumors described in recent publications that cause median nerve compression and to evaluate treatment options. The PubMed, Embase, and Web of Science databases were searched for studies describing median nerve compression due to a tumor in adults, published from the year 2000 and written in English. From 94 studies, information of approximately 100 patients have been obtained. Results The rare tumors causing compression were in 32 patients located at the carpal tunnel, in 21 cases in the palm of the hand, and 28 proximal from the carpal tunnel. In the other cases the compression site extended over a longer trajectory. There were 37 different histological types of lesions. Complete resection of the tumor was possible in 58 cases. A total of 8 patients presented for the second time after receiving initial therapy. During follow-up, three cases of recurrence were reported with a mean follow-up period of 11 months. The most common published cause of median nerve compression is the lipofibromatous hamartoma. Besides the typical sensory and motor symptoms of median nerve compression, a thorough physical examination of the complete upper extremity is necessary to find any swelling or triggering that might raise suspicion of the presence of a tumor.
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Affiliation(s)
- Tinatin Natroshvili
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Kirsten Peperkamp
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Masoud A Malyar
- Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - David Wijnberg
- Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Erwin P Heine
- Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Erik T Walbeehm
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Krishnan P, Wolf JM. Pediatric Ganglions of the Hand and Wrist: A Review of Current Literature. J Hand Surg Am 2022; 47:554-560. [PMID: 35216864 DOI: 10.1016/j.jhsa.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/26/2021] [Indexed: 02/02/2023]
Abstract
The etiology, epidemiology, and treatment outcomes of ganglions in children have not been studied in depth. Most research has mainly focused on adults with this condition, with some research suggesting differing epidemiology and outcomes in the pediatric population. This review focuses on the existing literature on pediatric ganglions of the hand and wrist, highlighting 17 studies focused on prevalence and treatment outcomes. Within the pediatric population, epidemiology and outcomes differ depending on patient age. In children aged <10 years, cysts present on the volar aspect of the wrist and are generally amenable to observation, with spontaneous regression. For patients aged >10 years, ganglions resemble those in the adult population and present on the dorsal aspect of the wrist. Open surgical excision demonstrates a relatively low recurrence rate with minimal complications and is currently recommended for treatment.
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Affiliation(s)
- Pranav Krishnan
- Pritzker School Medicine, University of Chicago, Chicago, IL
| | - Jennifer Moriatis Wolf
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL.
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Ribau M, Ribeiro EFM, Barros CAS, Ribeiro JM, Varanda PMS, Rodrigues LFP. Dorsal Wrist Ganglia: Influence of Arthroscopic Dorsal Capsulodesis – A Pilot Study. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2022. [DOI: 10.1055/s-0042-1748852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Background Dorsal wrist ganglia are the commonest soft tissue tumor in the upper extremity. Management with arthroscopic excision yields good results and few complications, but recurrence is still a matter of concern.
Purpose To address the influence of dorsal capsulodesis in postoperative results.
Patients and Methods Two groups with eight patients each were evaluated: group A – simple arthroscopic resection (SAR), and group B – arthroscopic resection combined with dorsal capsulodesis (ARDC).
Results The mean age of group A was of 36.10 ± 7.96 (range: 28–53) years, and that of group B was of 34.17 ± 29.60 (range 18–44) years. The duration of the follow-up was of 30.67 ± 13.90 (range: 13.45–53.55) months and 29.60 ± 16.80 (range 12.68–62.13) months, respectively. Both groups achieved a a significant decrease in the postoperative score on the Visual Analog Scale (VAS) (of around 2/10), and the scores on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were below 5/100. All the functional parameters (range of motion and strength) were above 80% on the contralateral side, with no differences between groups. More than 75% of the patients were completely satisfied. Group A (37.5%) had a significantly higher recurrence rate than that of group B (12.5%).
Conclusions In conclusion, SAR and ARDC provided good clinical results, with no significant differences. Dorsal capsulodesis resulted in an important decrease in the recurrence rate.
Level of Evidence Level III (Retrospective Comparative Study).
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Affiliation(s)
- Melanie Ribau
- Department of Orthopedic Surgery and Trauma, Hospital de Braga, Braga, Portugal
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26
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Arshad Z, Iqbal AM, Al Shdefat S, Bhatia M. The management of foot and ankle ganglia: A scoping review. Foot (Edinb) 2022; 51:101899. [PMID: 35259579 DOI: 10.1016/j.foot.2021.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/18/2021] [Accepted: 12/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE A ganglion cyst is a benign soft tissue swelling filled with hyaluronic acid and other mucopolysaccharides. Whilst they most commonly present in the wrist region, their occurrence in the foot and ankle is not rare. This scoping review aims to systematically map and summarise current evidence regarding the management of ganglia of the foot and ankle, whilst identifying areas for further research. METHODS This scoping review follows the frameworks of Arksey and O'Malley, Levac and Peters. A comprehensive search strategy was used to identify relevant articles, before a two-stage screening process was performed independently by two reviewers. RESULTS A total of 2286 unique articles were identified, of which 12 were included in the review. A variety of conservative and surgical treatment strategies are reported, showing good outcomes. An overall pooled recurrence rate of 29.5% was seen across 8 studies. Aspiration alone showed the highest recurrence rate (78.1%), followed by aspiration and steroid injection (62%), steroid injection alone (37.5%) and surgical excision (17.6%). The pooled complication rate across six studies was 21/261 (8.0%), with the most common complication being paraesthesia, reported in 14/261 (5.4%) patients. CONCLUSIONS There is a lack of high-quality research currently regarding the treatment of foot and ankle ganglia. Limited evidence suggests that there could potentially be associations between time to treatment, ganglion location and extent of surgical resection and recurrence rate. However, further research is required before any definitive conclusions can be drawn.
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Affiliation(s)
- Zaki Arshad
- University of Cambridge School of Clinical Medicine, Box 111 Cambridge Biomedical Campus, Cambridge, CB2 0SP, United Kingdom.
| | - Adil M Iqbal
- University of Cambridge School of Clinical Medicine, Box 111 Cambridge Biomedical Campus, Cambridge, CB2 0SP, United Kingdom
| | - Sofyan Al Shdefat
- University of Cambridge School of Clinical Medicine, Box 111 Cambridge Biomedical Campus, Cambridge, CB2 0SP, United Kingdom
| | - Maneesh Bhatia
- Department of Trauma and Orthopaedic Surgery, University Hospitals Leicester NHS Trust, University Hospitals of Leicester Headquarters, Level 3, Balmoral Building, Leicester, United Kingdom
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27
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Shanks C, Schaeffer T, Falk DP, Nunziato C, Hogarth DA, Bauer AS, Shah AS, Gottschalk H, Abzug JM, Ho CA. The Efficacy of Nonsurgical and Surgical Interventions in the Treatment of Pediatric Wrist Ganglion Cysts. J Hand Surg Am 2022; 47:341-347. [PMID: 35168830 DOI: 10.1016/j.jhsa.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 10/25/2021] [Accepted: 12/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The treatment of ganglion cysts of the wrist remains understudied in the pediatric population, with the literature showing variable recurrence rates following different interventions. This study sought to determine whether surgical and nonsurgical management of pediatric ganglion cysts was associated with improved resolution rates when compared to observation alone. METHODS We identified 654 cases of pediatric ganglion cysts treated across 5 institutions between 2012 and 2017. The mean age at presentation was 11.6 ± 5.2 years. Of the patients, 315 had >2 years (mean, 50.0 months) of follow-up, either via chart review or telephone callbacks. There were 4 different treatment groups: (1) observation, (2) cyst aspiration, (3) removable orthosis, and (4) surgical excision. RESULTS For patients followed >2 years, the cyst resolved in 44% (72/163) of those observed. Only 18% (9/49) of those treated with aspiration resolved, and 55% (12/22) of those treated with an orthosis resolved. Surgical excision was associated with resolution of the cyst in 73% (59/81) of patients. Observation had higher rates of resolution compared to aspiration. Orthosis fabrication and observation had similar rates of cyst resolution. Surgery had the highest rates of resolution when compared to observation and aspiration. Patients older than 10 years were less likely to have the cyst resolve with observation (35%; 28/80) than those younger than 10 years (53%; 44/83) at >2 years of follow-up. CONCLUSIONS This study did not find evidence that nonsurgical treatments were associated with improved rates of cyst resolution compared to observation alone in a large pediatric sample. Surgical excision had the overall highest rate of resolution. Despite the costs and increased clinic time of orthosis fabrication and aspiration, these treatments were not associated with improved rates of cyst resolution in pediatric ganglion cysts compared to observation, with aspiration having higher rates of recurrence compared to observation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Carolyn Shanks
- University of Texas at Southwestern School of Medicine, Dallas, TX
| | | | - David P Falk
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Carl Nunziato
- Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Danielle A Hogarth
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Andrea S Bauer
- Department of Orthopaedics, Boston Children's Hospital, Boston, MA
| | - Apurva S Shah
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Joshua M Abzug
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Christine A Ho
- Scottish Rite for Children, Dallas, TX; Department of Orthopaedics, Children's Medical Center Dallas, Dallas, TX; Department of Orthopaedics, University of Texas Southwestern School of Medicine, Dallas, TX.
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de Villeneuve Bargemon JB, Prenaud C, Quérel D, Bismuth Y, de Keyzer PB, Gras M. Repair of the dorsal capsuloligamentous scapholunate septum during arthroscopic resection of painful dorsal wrist ganglion cyst: Comparative analysis of two techniques. HAND SURGERY & REHABILITATION 2022; 41:457-462. [DOI: 10.1016/j.hansur.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
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29
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Chen KP, Ma CH, Wu CH, Jou IM, Tu YK. Arthroscopic resection of recurrent wrist ganglions - A retrospective study of 17 patients. J Orthop Sci 2022; 27:389-394. [PMID: 33676789 DOI: 10.1016/j.jos.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/21/2020] [Accepted: 01/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Arthroscopic resection has become a favorable alternative for wrist ganglions. However, for recurrent wrist ganglions, arthroscopic resection is relatively contraindicated. The purpose of this study was to evaluate the clinical outcomes of arthroscopic resection for recurrent wrist ganglions and to identify their safety and efficacy. METHODS From June 2011 to February 2017, 17 patients with recurrent wrist ganglion were treated with arthroscopic resection. We evaluated the visual analog scale, modified Mayo wrist score, and Disabilities of Arm, Shoulder and Hand Outcome Measure preoperatively and at the final follow-up. Patients were questioned for pain reduction, pain during pushups, and any difficulty in returning to work. Recurrence and complications were also assessed at each follow-up visit. RESULTS We enrolled 17 patients and median follow-up was 58 months. The reduction in pain was significant. Only 2 of the 17 patients had residual pain after arthroscopic resection. One female patient showed recurrences 3 years later. Although 2 cases of stiffness were noted after the operation, no significant complication was present 3 months postoperatively. Most patients had good recovery and could resume work; however, 2 patients reported fair recovery. CONCLUSION The results of this study confirmed that arthroscopic excision could be an effective and safe treatment for recurrent ganglions; therefore, should not be contraindicated for treating recurrent wrist ganglions. Nevertheless, further prospective studies with larger patient numbers are needed to establish a stronger evidence for arthroscopic resection of recurrent wrist ganglions.
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Affiliation(s)
- Kuan-Po Chen
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan.
| | - Ching-Hou Ma
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
| | - Chin-Hsien Wu
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
| | - Yuan-Kun Tu
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Abstract
Background: The recurrence rate after open excision of ganglion cysts is approximately 20%. However, this literature is based on a small series of subjects. This study aims to determine the rate and risk of recurrence after open excision of ganglion cysts in a large patient series. Methods: This study included 628 patients who had ganglion cyst excision from 2010 to 2018. A retrospective chart review recorded the following: age, sex, laterality, volar/dorsal location, and recurrence. An overall recurrence rate was calculated. In addition, a 1-way analysis of variance test was used to compare recurrence rates among the individual surgeons, and unpaired t tests were used to compare age of recurrence, dorsal cyst recurrence, laterality of cyst, and recurrence based on sex. Finally, a comparison of recurrence rate over time was conducted for surgeon 3. Results: The overall recurrence rate was 3.8% (24 of 628). The recurrence rates for each surgeon were 3% (9 of 353), 2% (3 of 167), and 11% (12 of 107), P = .02. The age of those with and without a recurrence did not differ (32 years vs 38 years), P = .06. The recurrence rate of dorsal ganglion cysts was 4.1% (14 of 341) compared with 3.5% (10 of 286) for volar ganglion cysts, P = .69. Male patients had a recurrence in 6.4% (13 of 204) of cases compared with 2.6% (11 of 424) of female patients, P = 0.01. There was a decrease in the rate of recurrence from 42.9% to 5.3% over 5 years for surgeon 3. Conclusion: In our sample, male sex and surgeon experience were significant risk factors in ganglion cyst recurrence.
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Affiliation(s)
| | - John R. Fowler
- University of Pittsburgh Medical Center,
PA, USA,John R. Fowler, Department of Orthopaedics,
University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA
15213, USA.
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31
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Van Overstraeten L, Camus EJ, Moungondo F, Schuind F. Volar Ganglion Cyst and Echo-Guided Assistance for the Arthroscopic Removal. Hand Clin 2022; 38:101-107. [PMID: 34802602 DOI: 10.1016/j.hcl.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The ganglion of the wrist is very common but with uncertain prognosis. The arthroscopic resection seems to improve the result compared with open procedure, in decreasing recurrence and morbidity. Volar ganglions are close to the radial artery, the flexor pollicis longus tendon, and even the median nerve. Ultrasonography combined with arthroscopy offers incomparable safety for the resection of volar ganglions. The technical steps of this combined procedure are described, and the first published series are discussed.
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Affiliation(s)
- Luc Van Overstraeten
- Orthopedic and Traumatologic, University Hospital Erasme, Brussels, Belgium; Hand and Wrist Center, HFSU, AO Foundation, Tournai, Belgium.
| | - Emmanuel Jacques Camus
- Department of Orthopaedic and Traumatologic Surgery, University Clinical Center, Polyclinic Val de Sambre, Maubeuge, France
| | - Fabian Moungondo
- Orthopedic and Traumatologic, University Hospital Erasme, Brussels, Belgium
| | - Frédéric Schuind
- Orthopedic and Traumatologic, University Hospital Erasme, Brussels, Belgium
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Abstract
Background: The internet is becoming a common source of health information for hand surgery patients. This study evaluates the quality of web-based resources on ganglion cysts of the hand. Methods: We completed a search for "ganglion cyst" on 3 search engines (Google, Dogpile, and Yippy). The quality of the top-100 patient education websites was assessed using a validated internet rating tool. Websites were evaluated based on affiliation, accountability, currency, interactivity, website organization, readability, coverage, and accuracy. Results: Of the 100 websites, the majority (74%) had commercial affiliations. Only 34% of websites identified an author, and even fewer identified the authors' credentials (27%) or affiliations (26%). A third of the websites cited references, and less than half provided an update date. The average readability based on Flesch-Kincaid grade level was 9.2, and only 3% could be read at or below 6th grade reading level. Prevention was the most poorly covered topic at 13% due to omission. In all, 66% of the websites were completely accurate in terms of global accuracy. Websites were most likely to present inaccurate information on treatment, often failing to mention conservative treatment (watch-and-wait approach) or promoting the use of natural health products. We also found 5% of websites presented closed rupture of the ganglion cyst as a legitimate home remedy. Conclusions: The overall quality of online information on ganglion cysts is highly variable and may occasionally be harmful for patients. It is increasingly important for physicians to prompt patients about their internet use.
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Affiliation(s)
| | - Neil Wells
- University of British Columbia, Vancouver, Canada,St Paul’s Hospital, Vancouver, BC, Canada
| | - Paris-Ann Ingledew
- University of British Columbia, Vancouver, Canada,BC Cancer, Vancouver, Canada,Paris-Ann Ingledew, Radiation Oncology, BC Cancer, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada.
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Intelligent Automatic Segmentation of Wrist Ganglion Cysts Using DBSCAN and Fuzzy C-Means. Diagnostics (Basel) 2021; 11:diagnostics11122329. [PMID: 34943564 PMCID: PMC8700243 DOI: 10.3390/diagnostics11122329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Ganglion cysts are common soft tissue masses of the hand and wrist, and small size cysts are often hypoechoic. Thus, identifying them from ultrasonography is not an easy problem. In this paper, we propose an automatic segmentation method using two artificial intelligence algorithms in sequence. A density based unsupervised learning algorithm called DBSCAN is performed as a front-end and its result determines the number of clusters used in the Fuzzy C-Means (FCM) clustering algorithm for quantification of ganglion cyst object. In an experiment using 120 images, the proposed method shows a higher extraction rate (89.2%) and lower false positive rate compared with FCM when the ground truth is set as the human expert's decision. Such human-like behavior is more apparent when the size of the ganglion cyst is small that the quality of ultrasonography is often not very high. With this fully automatic segmentation method, the operator subjectivity that is highly dependent on the experience of the ultrasound examiner can be mitigated with high reliability.
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Bram JT, Falk DP, Chang B, Ty JM, Lin IC, Fazal FZ, Shah AS. Clinical Presentation and Characteristics of Hand and Wrist Ganglion Cysts in Children. J Hand Surg Am 2021; 46:1122.e1-1122.e9. [PMID: 33888379 DOI: 10.1016/j.jhsa.2021.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/10/2020] [Accepted: 02/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Ganglion cysts are the most common mass of the hand or wrist. In adults, ganglions have a female predilection and are commonly located in the dorsal wrist. However, their presentation in children has not been well reported. This investigation sought to describe the presentation of pediatric ganglion cysts in a prospective cohort. METHODS A multicenter prospective investigation of children (aged ≤18 years) who presented with ganglion cysts of the hand or wrist was conducted between 2017 and 2019. The data collected included age, sex, cyst location, hand dominance, pain, and patient-reported outcomes measurement information system (PROMIS) scores for upper-extremity (UE) function. The patients were divided into cohorts based on age, cyst location, and cyst size. Multivariable analyses were performed to identify factors predictive of worse UE function and higher pain scores. RESULTS A total of 173 patients with a mean age of 10.1 ± 5.3 years and female-to-male ratio of 1.4:1 were enrolled. The dorsal wrist was the most commonly affected (49.7%), followed by the volar wrist (26.6%) and flexor tendon sheath (18.5%). In older patients, dorsal wrist ganglions were more common than tendon sheath cysts (11.9 ± 4.1 years vs 6.2 ± 5.8 years) and were larger (86.7% were >1 cm) than cysts in other locations (34.5% were >1 cm). Patients aged >10 years reported higher pain scores, with 21.5% of older patients reporting moderate/severe pain scores versus 5.0% of younger children. This cohort of patients had an average PROMIS UE function score of 47.4 ± 9.5, and lower PROMIS scores were associated with higher pain scores. CONCLUSIONS Ganglions in pediatric populations, which most commonly affect the dorsal wrist, demonstrate a female predilection. In younger children, cysts are smaller and more often involve the volar wrist or flexor tendon sheath. Older children report higher pain scores. Pediatric ganglion cysts do not appear to result in a clinically meaningful decrease in UE function. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Joshua T Bram
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David P Falk
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Benjamin Chang
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jennifer M Ty
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Ines C Lin
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Faris Z Fazal
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Apurva S Shah
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Garg SP, Hassan AM, Patel AA, Perez MM, Stoehr JR, Ketheeswaran S, Chappell AG, Galiano RD, Ko JH. Outcomes of Tibial Nerve Repair and Transfer: A Structured Evidence-Based Systematic Review and Meta-Analysis. J Foot Ankle Surg 2021; 60:1280-1289. [PMID: 34366221 DOI: 10.1053/j.jfas.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023]
Abstract
Although nerve transfer and repair are well-established for treatment of nerve injury in the upper extremity, there are no established parameters for when or which treatment modalities to utilize for tibial nerve injuries. The objective of our study is to conduct a systematic review of the effectiveness of end-to-end repair, neurolysis, nerve grafting, and nerve transfer in improving motor function after tibial nerve injury. PubMed, Cochrane, Medline, and Embase libraries were queried according to the PRISMA guidelines for articles that present functional outcomes after tibial nerve injury in humans treated with nerve transfer or repair. The final selection included Nineteen studies with 677 patients treated with neurolysis (373), grafting (178), end-to-end repair (90), and nerve transfer (30), from 1985 to 2018. The mean age of all patients was 27.0 ± 10.8 years, with a mean preoperative interval of 7.4 ± 10.5 months, and follow-up period of 82.9 ± 25.4 months. The mean graft repair length for nerve transfer and grafting patients was 10.0 ± 5.8 cm, and the most common donor nerve was the sural nerve. The most common mechanism of injury was gunshot wound, and the mean MRC of all patients was 3.7 ± 0.6. Good outcomes were defined as MRC ≥ 3. End-to-end repair treatment had the greatest number of good outcomes, followed by neurolysis. Patients with preoperative intervals less than 7 months were more likely to have good outcomes than those greater than 7 months. Patients with sport injuries had the highest percentage of good outcomes in contrast to patients with transections and who were in MVAs. We found no statistically significant difference in good outcomes between the use of sural and peroneal donor nerve grafts, nor between age, graft length, and MRC score.
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Affiliation(s)
- Stuti P Garg
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Abbas M Hassan
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anooj A Patel
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Megan M Perez
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jenna R Stoehr
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ava G Chappell
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert D Galiano
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jason H Ko
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Shakya A, Garje V, Rathore A. The triple technique: A simple and effective outpatient procedure for the dorsal wrist ganglion. J Clin Orthop Trauma 2021; 23:101619. [PMID: 34650906 PMCID: PMC8498456 DOI: 10.1016/j.jcot.2021.101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dorsal ganglia are the most common types of wrist ganglia. Though largely asymptomatic, they can cause pain, stiffness and require treatment. The different methods described for the management have high recurrence rates even up to 70%. We describe a new method which combines 3 of these methods thus aiming to achieve the best from each of the techniques. METHODS A prospective observational study was undertaken to include patients requiring surgery for dorsal ganglion. The method involved a combination of aspiration, steroid instillation and tranfixation with silk suture for 3 weeks. Various demographic parameters, operative variables and functional criteria like QuickDASH Score and Numerical Pain Rating scale (NPRS) were used. The patients were followed up for atleast 24 months. Overall satisfaction rate was also recorded. RESULTS 83 patients were included with a mean age of 31.7 ± 12.4 years. The mean duration of surgery was 12.0 ± 4.9 min and follow up was 29.8 ± 7.1 months. 15 patients had complex multilobulated ganglia. The most common indication for surgery was cosmesis. 4 complications were encountered of which 2 were superficial infections, 1 whitish discoloration locally and 1 case of persistent pain. We achieved a success rate of 95.2% with only 4 recurrences with a mean reduction in size to be 82.2 ± 5.8%. NPRS and QuickDASH scores improved significantly. Mean satisfaction rate was 89% and 84.3% wished to have the surgery again for a similar complaint. The loss of work was 2.5 ± 1.4 days. CONCLUSIONS Triple Technique is an effective and safe technique with <5% recurrence at 2 years.
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Affiliation(s)
- Akash Shakya
- Department of Orthopaedics, ESIC Hospital, Mumbai, India,Corresponding author. Department of Orthopaedics, ESIC Hospital, Mumbai, India
| | - Vinayak Garje
- Department of Orthopaedics, ESIC Hospital, Mumbai, India
| | - Amisha Rathore
- Department of Obstetrics and Gynaecology, ESIC Hospital, Mumbai, India
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Coffey D, Redgrave N, Hudson-Phillips S, Clark C, Tahmassebi R, Vig S. Variation in the clinical commissioning of surgery for three common hand conditions in England. J Hand Surg Eur Vol 2021; 46:530-534. [PMID: 33249974 DOI: 10.1177/1753193420974244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The surgical referral policies for patients with trigger finger, ganglion removal and Dupuytren's disease were collected for all Clinical Commissioning Groups in England. The aim was to assess whether there was variation in the policies across England, resulting in inequality in patients' access to surgery. Data were collected between October 2018 and January 2019 and compared with national guidelines. Analysis of the results showed that for all three conditions, surgical commissioning policies varied depending on the locality. The results also show that despite the existence of national guidelines, they are not implemented. This has the potential to lead to variation in surgical referral and access to services for patients in different localities in England.Level of evidence: III.
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Oshima J, Imai Y, Sasaki K, Sekido M. Giant Ganglion Cyst Arising from Iliac Wing, an Atypical Site. Indian J Plast Surg 2021; 54:244-245. [PMID: 34239258 PMCID: PMC8257304 DOI: 10.1055/s-0041-1725225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Junya Oshima
- Department of Plastic, Reconstructive, and Hand Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yukiko Imai
- Department of Plastic, Reconstructive, and Hand Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kaoru Sasaki
- Department of Plastic, Reconstructive, and Hand Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mitsuru Sekido
- Department of Plastic, Reconstructive, and Hand Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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d'Ailly PN, Koopman JE, Selles CA, Rahimtoola ZO, Schep NW. Patient-Related Outcomes of Arthroscopic Resection of Ganglion Cysts of the Wrist. J Wrist Surg 2021; 10:31-35. [PMID: 33552692 PMCID: PMC7850802 DOI: 10.1055/s-0040-1716509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Background Ganglion cysts of the wrist can cause pain and loss of functionality. No consensus exist on optimal treatment. Arthroscopic resection shows promising results but is poorly studied. Furthermore, only few studies have used patient-related outcomes to evaluate arthroscopic treatment. Purpose The purpose of this study was to assess patient-related outcomes following arthroscopic resection of wrist ganglion cysts. Patients and Methods This was a retrospective study of all consecutive patients that underwent arthroscopic resection of a dorsal or volar wrist ganglion. Minimum follow-up was 6 months. The primary outcome was the patient-rated wrist evaluation (PRWE). Secondary outcomes were recurrence rate and complications. Results A total of 53 patients were included with a mean follow-up of 13 months (interquartile range: 6-23 months). Twenty-six patients (49%) presented with a recurrence following prior treatment. Mean PRWE was 13 (standard deviation [SD] = 1.8), with no difference between patients with dorsal or volar ganglion cysts. There were five recurrences (9%), of which three occurred in the first five patients who were operated. There were three patients with complications (6%), consisting of neuropraxia, extensor carpi ulnaris tendinitis, and painful scar tissue. Conclusion Arthroscopic resection results in good patient-related outcome and low complication and recurrence rates when performed by an experienced surgeon. Recurrence and complication rates are similar to arthroscopic resections described in literature and superior to open resection and needle aspiration. Well-designed randomized clinical trials will be necessary to confirm these findings. Level of Evidence This is a level IV, retrospective study.
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Affiliation(s)
- Philip N. d'Ailly
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jaimy E. Koopman
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Caroline A. Selles
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Zulfiquar O. Rahimtoola
- Department of Orthopaedic and Trauma Surgery, Royal Berkshire Hospital, Reading, United Kingdom
| | - Niels W.L. Schep
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Hrehová L, Mezian K, Özçakar L. Ultrasonographic approach for a foot ganglion after sewing masks in the COVID-19 pandemic: Blessing in disguise. Work 2021; 67:763-765. [PMID: 33325426 DOI: 10.3233/wor-203328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND During the coronavirus disease (COVID-19) pandemic, people volunteered for sewing hand-made face masks. However, sewing-machine operating might be associated with high ergonomic risk and a negative impact on musculoskeletal health. OBJECTIVE AND METHODS This paper describes an ultrasonographic diagnosis of a foot ganglion - after sewing 300 face masks within two months using a foot-operated sewing machine. RESULTS The patient significantly improved after an ultrasound-guided aspiration and corticosteroid injection. CONCLUSION In short, we highlight the importance of ultrasound examination in the management of work (overuse)-related disorders in occupational medicine practice.
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Affiliation(s)
- Laura Hrehová
- Institute of General Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kamal Mezian
- Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Nath A, Palit D. Homoeopathic management of wrist ganglion: Case series. INDIAN JOURNAL OF RESEARCH IN HOMOEOPATHY 2021. [DOI: 10.4103/ijrh.ijrh_29_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Choe S, Jerng UM, Park JH, Kim S, Kim S, Lee J, Lee JH, Shin M. Scolopendra Pharmacopuncture Combined with Electroacupuncture for the Treatment of Ganglion Cysts: A Retrospective Study. J Pharmacopuncture 2020. [DOI: 10.3831/kpi.2020.23.4.247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Seon Choe
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ui Min Jerng
- Department of Internal Medicine, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Jeong Hwan Park
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sungha Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sungchul Kim
- Department of Acupuncture & Moxibustion, Wonkwang University Gwangju Medical Hospital, Gwangju, Republic of Korea
| | - Jinbok Lee
- Lee Jinbok Korean Medicine Clinic, Jeonju, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Minseop Shin
- Shin Min Seop Korean Medicine Clinic, Jeonju, Republic of Korea
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Choe S, Jerng UM, Park JH, Kim S, Kim S, Lee J, Lee JH, Shin M. Scolopendra Pharmacopuncture Combined with Electroacupuncture for the Treatment of Ganglion Cysts: A Retrospective Study. J Pharmacopuncture 2020; 23:247-251. [PMID: 33408900 PMCID: PMC7772084 DOI: 10.3831/kpi.2020.23.4.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/16/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Ganglion cysts require a sustainable treatment that suppresses their frequent recurrence. This study aimed to explore the clinical effects of Scolopendra pharmacopuncture (SP) and electroacupuncture on ganglion cysts. METHODS We retrospectively reviewed the patient records and follow-up reports for 20 patients with wrist ganglion cysts who received SP and electroacupuncture from April 2016 to March 2017. The cyst diameter, recurrence, visual analog scale (VAS) scores for pain, the Korean version of the disabilities of arm, shoulder, and hand (K-DASH) score, and the Korean version of the patient-rated wrist evaluation (K-PRWE) score before and after treatment were noted. RESULTS After treatment, the cyst diameter decreased significantly from 13.61 ± 6.41 mm to 5.15 ± 6.18 mm (p < 0.001), and VAS score for pain decreased from 1.31 ± 1.77 to 0.41 ± 0.33 (p = 0.021). Further, the K-DASH score decreased significantly from 8.97 ± 12.66 to 2.21 ± 7.39 (p = 0.016), and score for the function subscale of K-PRWE decreased from 11.37 ± 4.48 to 9.1 ± 3.67 (p = 0.046). No recurrences were reported from the followed-up patients. Any complication related to SP or electroacupuncture was not observed, except mild rash, itching, and swelling at the injection site in four patients. CONCLUSION Combination of SP and electroacupuncture may be effective in treating ganglion cysts; further prospective studies with large population are needed to clarify the effect of SP and electroacupuncture.
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Affiliation(s)
- Seon Choe
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea,Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ui Min Jerng
- Department of Internal Medicine, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Jeong Hwan Park
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sungha Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sungchul Kim
- Department of Acupuncture & Moxibustion, Wonkwang University Gwangju Medical Hospital, Gwangju, Republic of Korea
| | - Jinbok Lee
- Lee Jinbok Korean Medicine Clinic, Jeonju, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea,Corresponding Author Minseop Shin Shin Min Seop Korean Medicine Clinic, Jeonju 55081, Republic of Korea Tel: +82-63-228-7579 E-mail:
Jun-Hwan Lee Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea Tel: +82-42-868-9693 E-mail:
| | - Minseop Shin
- Shin Min Seop Korean Medicine Clinic, Jeonju, Republic of Korea,Corresponding Author Minseop Shin Shin Min Seop Korean Medicine Clinic, Jeonju 55081, Republic of Korea Tel: +82-63-228-7579 E-mail:
Jun-Hwan Lee Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea Tel: +82-42-868-9693 E-mail:
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Sugiyama Y, Naito K, Goto K, Nagura N, Kaneko K. Intratendinous ganglion in the extensor digitorum communis. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2020; 7:120-123. [PMID: 33134430 PMCID: PMC7580778 DOI: 10.1080/23320885.2020.1833335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We encountered a patient with intratendinous ganglion which developed in the extensor digitorum communis tendon. Although its developmental mechanism is unclear, synovitis is considered the cause. For treatment, it may be necessary to prepare for tendon transfer and tendon grafting in consideration of the risk of tendon injury.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine Tokyo, Japan.,Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine Tokyo, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine Tokyo, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine Tokyo, Japan
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Pediatric Upper Extremity Trauma. PHYSICIAN ASSISTANT CLINICS 2020. [DOI: 10.1016/j.cpha.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Yen CY, Ma CH, Wu CH, Yang SC, Jou IM, Tu YK. A cost and efficacy analysis of performing arthroscopic excision of wrist ganglions under wide-awake anaesthesia versus general anaesthesia. BMC Musculoskelet Disord 2020; 21:459. [PMID: 32660448 PMCID: PMC7359493 DOI: 10.1186/s12891-020-03482-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022] Open
Abstract
Background Arthroscopic excision has currently become popular for the treatment of wrist ganglions. The objective of this study was to evaluate the clinical outcomes and cost effectiveness of arthroscopic wrist ganglion excisions under Wide-Awake Local Anaesthesia No Tourniquet versus general anaesthesia. Methods We retrospectively reviewed patients who underwent arthroscopic ganglionectomy from April 2009 to October 2016 at our institute. They were separated into two groups according to anaesthesia techniques: general anaesthesia and Wide-Awake Local Anaesthesia No Tourniquet. We compared the clinical outcomes and cost-effectiveness of the two groups. Results Seventy-four patients were included. Both groups were matched with regard to the demographics and preoperative clinical assessments. We found no significant differences between groups in postoperative visual analog scale, modified Mayo wrist score, Disabilities of Arm, Shoulder and Hand score, recurrence, residual pain, or complications. Recurrence was found in five of 74 patients, one (4.3%) in the Wide-Awake Local Anaesthesia No Tourniquet group and four (7.8%) in the general anaesthesia group. One extensor tendon injury and four extensor tenosynovitis cases occurred in the general anaesthesia group. Regarding cost effectiveness, the mean operating time in the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were 88.7 ± 24.51 and 121.5 ± 25.75 min, respectively (p < 0.001). The average total costs of the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were €487.4 ± 89.15 and €878.7 ± 182.13, respectively (p < 0.001). Conclusions For arthroscopic wrist ganglion resections, both anaesthesia techniques were effective and safe regarding recurrence rates, complications, and residual pain. The most important finding of this study was that arthroscopic ganglionectomy under Wide-Awake Local Anaesthesia No Tourniquet was superior to that under general anaesthesia for cost-effectiveness. Level of evidence Level III, Retrospective comparative study.
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Affiliation(s)
- Cheng-Yo Yen
- Department of Orthopedics, E-Da Cancer Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan
| | - Ching-Hou Ma
- School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.,Department of Orthopedics, E-Da Hospital, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan
| | - Chin-Hsien Wu
- School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan. .,Department of Orthopedics, E-Da Hospital, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.
| | - Shih-Chieh Yang
- School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.,Department of Orthopedics, E-Da Hospital, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan
| | - I-Ming Jou
- School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.,Department of Orthopedics, E-Da Hospital, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan
| | - Yuan-Kun Tu
- School of Medicine, College of Medicine, I-Shou University, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan.,Department of Orthopedics, E-Da Hospital, No.1, E-Da Road, Yan-Chau District, 824, Kaohsiung City, Taiwan
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Urits I, Smoots D, Anantuni L, Bandi P, Bring K, Berger AA, Kassem H, Ngo AL, Abd-Elsayed A, Manchikanti L, Urman R, Kaye AD, Viswanath O. Injection Techniques for Common Chronic Pain Conditions of the Hand: A Comprehensive Review. Pain Ther 2020; 9:129-142. [PMID: 32100225 PMCID: PMC7203307 DOI: 10.1007/s40122-020-00158-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION This compilation presents a comprehensive review of the literature on common chronic pain conditions of the hand. It briefly presents these common conditions with their biological background, diagnosis, and common management options. It then presents and compares the latest literature available for injection techniques to treat these diagnoses and compares the available evidence. METHODS A comprehensive literature review was performed in MEDLINE, PubMed, and Cochrane databases from 1996 to 2019 using the terms "hand pain", "injection techniques", "steroid injection", "chronic pain", "osteoarthritis", "rheumatoid arthritis", "carpal tunnel syndrome", "De Quervain's tenosynovitis", "ganglion cyst", "gout", "Raynaud's", and "stenosing tenosynovitis". RESULTS Hand pain is a common condition with 9.7% prevalence in men and 21.6% in women and can cause significant morbidity and disability. It also carries a significant cost to the individuals and the healthcare system, totaling in $4 billion dollars in 2003. Injection therapy is an alternative when conservative treatment fails. Osteoarthritis is the most common chronic hand pain syndrome and affects about 16% of the population. Its mechanism is largely mechanic, and as such, there is controversy if steroid injections are of benefit. Hyaluronic acid (HA) appears to provide substantial relief of pain and may increase functionality. More studies of HA are required to make a definite judgment on its efficacy. Similarly, steroid ganglion cyst injection may confer little benefit. Carpal tunnel syndrome is a compressive neuropathy, and only temporarily relieved with injection therapy. US-guidance provides significant improvement and, while severe cases may still require surgery, can provide a valuable bridge therapy to surgery when conservative treatment fails. Similar bridging treatments and increased efficacy under US-guidance are effective for stenosing tenosynovitis ("trigger finger"), though, interestingly, inflammatory background is associated with decreased effect in this case. When the etiology of the pain is inflammatory, such as in RA, corticosteroid (CS) injections provide significant pain relief and increased functionality. They do not, however, change the course of disease (unlike DMARDs). Another such example is De-Quervain tenosynovitis that sees good benefit from CS injections, and an increased efficacy with US-guidance, and similarly are CS injections for gout. For Raynaud's phenomenon, Botox injections have encouraging results, but more studies are needed to determine safety and efficacy, as well as the possible difference in effect between primary and secondary Raynaud's. CONCLUSIONS Chronic hand pain is a prevalent and serious condition and can cause significant morbidity and disability and interferes with independence and activities of daily living. Conservative treatment remains the first line of treatment; however, when first-line treatments fail, steroid injections can usually provide benefit. In some cases, HA or Botox may also be beneficial. US-guidance is increasing in hand injection and almost ubiquitously provides safer, more effective injections. Hand surgery remains the alternative for refractory pain.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Daniel Smoots
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Lekha Anantuni
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Prudhvi Bandi
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Katie Bring
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Amnon A Berger
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Anh L Ngo
- Department of Pain Medicine, Pain Specialty Group, Newington, NH, USA
- Harvard Medical School, Boston, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Richard Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
- Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ, USA
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Landström JT. Arthroscopic Tenovaginotomy and Ganglion Excision of the Flexor Carpi Radialis Fibro-Osseous Tendon Sheath. Tech Hand Up Extrem Surg 2020; 25:20-24. [PMID: 32453273 PMCID: PMC8055192 DOI: 10.1097/bth.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of flexor carpi radialis (FCR) tendon stenosing tenosynovitis recalcitrant to nonsurgical intervention has been open or blind tenovaginotomy of the volar trapezial fibro-osseous sheath of the FCR tendon. The surgical literature has not reported arthroscopic tenovaginotomy of the FCR fibro-osseous tendon sheath with or without associated ganglia. This report describes a technique of arthroscopic tenovaginotomy for stenosing tenosynovitis of the FCR tendon at the trapezial fibro-osseous sheath with or without excision of any associated ganglion through a not previously described new volar radial trapezial arthroscopic portal.
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Ozcanli H, Ozaksar K, Cavit A, Gurer EI, Cevikol C, Ada S. Deep palmar tumorous conditions of the hand. J Orthop Surg (Hong Kong) 2020; 27:2309499019840736. [PMID: 30955477 DOI: 10.1177/2309499019840736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Deep palmar tumors of the hand are very rare, and reported cases are usually benign. The most important issue is frequent anatomical variations with challenging surgical exposure and excision of these lesions. Some case reports or a small series of patients have been reported in the literature. The aim of this study was to present our experience with the deep palmar tumors of the hand. PATIENTS AND METHODS In the study, retrospective analyses of 43 patients treated with deep palmar tumors of the hand between January 1998 and June 2015 were evaluated. Tumors and tumor-like pathologies of the deep palmar space of the hand were retrospectively evaluated according to age, gender, localization, preoperative symptoms, size, site, treatment methods, histopathology, and early and late complications. Statistics and data analyses were also performed. RESULTS All 43 pathologies were benign, and histopathologic diagnoses were 10 lipomas, 8 ganglions, 5 giant cell tumor of the tendon sheath, 4 schwannomas, 3 hemangiomas, 3 palmar fibromatosis, 2 epidermal cysts, 2 neurofibroma, 1 angiolymphoid hyperplasia with eosinophilia, 1 granuloma, 1 calcifying aponeurotic fibroma, 1 digital fibroma, 1 foreign body granuloma, and 1 lipofibromatous hamartoma. The most common complication was temporary numbness and paresthesias of the digits. Marginal excision was performed in 40 patients, excision with nerve grafting in 2 patients (with neurofibroma) and carpal tunnel release in one patient with lipofibromatous hamartoma. CONCLUSION In the deep palmar space of the hand, pathologies are closely associated with tendons, muscles, and neurovascular structures. Preoperative magnetic resonance imaging is helpful for the preoperative diagnosis, evaluating tumor extension, and successful surgical planning. Level of Evidence: IV Therapautic.
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Affiliation(s)
- Haluk Ozcanli
- 1 Department of Orthopaedics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Kemal Ozaksar
- 2 Hand Microsurgery Orthopaedics and Traumatology (EMOT) Hospital, Izmir, Turkey
| | - Ali Cavit
- 1 Department of Orthopaedics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Elif Inanc Gurer
- 3 Department of Pathology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Can Cevikol
- 4 Department of Radiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Sait Ada
- 2 Hand Microsurgery Orthopaedics and Traumatology (EMOT) Hospital, Izmir, Turkey
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Uludağ A, Tosun HB, Yasar MM, Gunay A, Aydin Turk B, Uludağ Ö. The Effect of Tourniquet Usage and Anesthesia Method on Prognosis in the Treatment of Dorsal Wrist Ganglion Cysts by Open Surgery. Cureus 2019; 11:e5981. [PMID: 31803563 PMCID: PMC6874420 DOI: 10.7759/cureus.5981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Ganglion cysts are the most common soft tissue masses seen on the wrist, which often cause pain or cosmetic complaints. The treatment of these masses includes intra-cystic injections or surgery. Recurrence rates are very high in surgical or non-surgical treatment. Inadequate excision for recurrence after surgery is blamed; however, the reasons for the recurrence still remain mysterious. Objectives In this study, the effect of anesthesia selection and tourniquet use on the dorsal wrist ganglion cysts in open surgery was investigated. Materials and methods Patients with dorsal wrist ganglion cysts, who were operated with open surgery between 2015 and 2018 and who had at least six months after the surgery, were examined. The patients were divided into two groups: patients who underwent surgery without tourniquet with local anesthesia and patients operated with tourniquet with general or regional anesthesia. Age, sex, cause of operation, visual analog scale (VAS) scores before and after surgery, limitation of movement, postoperative complications, and recurrence were compared. Results There was no significant difference between the groups in terms of causes of surgery, recurrence rates, preoperative and postoperative limitations of movement, and complications. In terms of age, the group operated with local anesthesia and without tourniquet was significantly larger. There was also no significant difference between the groups in terms of preoperative pain. Postoperative pain was significantly less in the group operated by tourniquet with general-regional anesthesia. Conclusion There is no significant difference in the recurrence and complications between patients operated under local anesthesia without tourniquets and patients operated with tourniquets under general or regional anesthesia during the open excision of the dorsal wrist ganglion cysts. However, it should be kept in mind that postoperative pain does not diminish in later ages, especially in cases of ganglion cysts, and other pathologies may also potentially cause pain in the wrist.
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Affiliation(s)
- Abuzer Uludağ
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | | | - Mehmet Mete Yasar
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Abdussamed Gunay
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Bilge Aydin Turk
- Pathology, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Öznur Uludağ
- Anesthesiology and Reanimation, Adıyaman University Faculty of Medicine, Adıyaman, TUR
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