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Zelenski NA, Corona J, Bishop AT, Shin AY. Outcomes of Surgical Management of Intraosseous Ganglia of the Carpal Bones: A Case Series. Hand (N Y) 2022; 17:893-898. [PMID: 33084381 PMCID: PMC9465773 DOI: 10.1177/1558944720963873] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraosseous ganglia of the carpal bones are uncommon with sparse publications to guide treatment. The purpose of this study was to review a single-institution experience to determine the outcomes of patients with surgically treated intraosseous carpal ganglia. METHODS Skeletally mature patients with intraosseous carpal ganglia between 1995 and 2016 treated operatively were identified. Demographic information, clinical data, and radiographic studies were evaluated. RESULTS Thirty-three ganglia in 31 patients were identified. Intraosseous ganglia were located in the lunate (23), scaphoid (9), and trapezoid (1). Patients who presented with pathologic fracture or collapse had larger intraosseus ganglia than those presenting with pain alone. Surgery significantly improved pain. Patients treated with debridement with autograft bone graft had a higher consolidation rate compared with allograft bone but no difference in pain. CONCLUSIONS Patients with large or symptomatic lesions can be treated successfully with curettage and debridement, which leads to relief of pain. The use of bone grafting remains controversial.
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Arthroscopic Bone Graft for Intraosseous Lunate Bone Ganglion. Arthrosc Tech 2021; 10:e2645-e2649. [PMID: 35004144 PMCID: PMC8719304 DOI: 10.1016/j.eats.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/05/2021] [Indexed: 02/03/2023] Open
Abstract
Intraosseous lunate bone ganglia (ILBG) are known to be a cause of chronic wrist pain and disability. Standard treatment consists of curettage and autologous bone grafting. Open procedures have shown good results with few recurrences, but with frequent stiffness or persistent pain. Arthroscopic techniques are more recent and seem very reliable. Several arthroscopic techniques have been reported for ILBG approach and treatment. The present study describes an approach that preserves all the lunate cartilage of both radiocarpal and midcarpal surfaces. The surgical technique allows easy and direct access to the bone ganglia, passing through the intermediate portion of the scapholunate ligament, with the scope in the 1-to-2 portal and instrumentation through the 3-to-4 portal. The rest of the procedure is straightforward: curettage and bone grafting are performed through this specific approach, similarly to other techniques. This an easy and accurate approach that avoids any damage to the major cartilage surfaces of the lunate, with easy and reliable access to the intraosseous lunate bone ganglion, allowing cyst curettage and autologous bone graft in a proper and noninvasive way.
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Li S, Sun C, Zhou X, Shi J, Han T, Yan H. Treatment of Intraosseous Ganglion Cyst of the Lunate: A Systematic Review. Ann Plast Surg 2018; 82:577-581. [PMID: 30059388 DOI: 10.1097/sap.0000000000001584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Intraosseous ganglion cyst (IGC) is a rare disease, particularly in lunate. The objective of this study was to summarize current knowledge on the treatment of IGC of the lunate, through a literature review, to provide a therapeutic strategy for this rare disease. METHODS The PubMed, ISI Web of Science, Cochrane Library, EMBASE, Science Direct database were searched with a set of predefined inclusion and exclusion criteria. Manual searches for references were performed to find potential relevant studies. The authors extracted data from the articles selected. RESULTS Different treatment modalities of IGC of the lunate were described, all of which were divided into 3 categories: conservative treatment, classical surgical procedures, and novel surgical procedures. An overview on the main treatment modalities for IGC of the lunate was provided. CONCLUSIONS Conservative treatments can be the doctors' first choice for patients with IGC. Surgical procedure is advised when conservative treatment fails. Traditional surgical curettage with autologous bone grafting is the mainstay of treatment with satisfactory outcomes; however, novel surgical techniques like arthroscopically assisted minimally invasive technique or filling with bone cement are considered as more promising attempts with less trauma and shorter recovery period. Nonetheless, studies with high levels of evidence are guaranteed for developing widely accepted clinical treatment guidelines.
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Yu K, Shao X, Tian D, Bai J, Zhang B, Zhang Y. Therapeutic effect of bone cement injection in the treatment of intraosseous ganglion of the carpal bones. Exp Ther Med 2016; 12:1537-1541. [PMID: 27588074 DOI: 10.3892/etm.2016.3487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 04/19/2016] [Indexed: 12/21/2022] Open
Abstract
The aim of the present study was to treat intraosseous ganglia of the carpal bones with injectable bone cement grafting. Between January 2012 and December 2013, 4 patients (3 men and 1 woman) presenting with wrist pain and activity limitation were diagnosed with intraosseous ganglion of the carpal bones by radiography. The patients were treated with minimal invasive curettage and bone cement injection surgery. All patients were followed up for a mean time of 17 months (range, 12-22 months). The wrist pain was significantly reduced in all patients following surgery. In addition, the activity range and grip strength were also improved compared with the preoperative parameters. Subsequent to treatment, the Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score presented mean values of 78.8 (range, 75-80) and 11 (range, 7.7-15.0), respectively. These results suggested that the patients showed a good recovery. All patients were satisfied with the postoperative results and returned to work within 4 weeks. In conclusion, bone cement injection is an effective and safe therapeutic strategy for the treatment of intraosseous ganglia of the carpal bone.
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Affiliation(s)
- Kunlun Yu
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Xinzhong Shao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Dehu Tian
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Jiangbo Bai
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Bing Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
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Abstract
Intraosseous ganglion cyst of the carpal bones represents a rare cause of wrist pain. We report a case of a 42 year-old, right-handed female, who presented with pain of the right wrist following a fall on the palm of the hand. Clinical study revealed a moderate swelling over the mid-section of the palmar face and pain through extreme ranges of motion of the wrist. Plain radiographs and CT-scan of the wrist have revealed an intraosseous ganglion cyst of the lunate bone. Curetting-filling by Kuhlman's vascularized radial bone graft allowed a good functional recovery. The clinical, radiological and therapeutic aspects are discussed.
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Affiliation(s)
- Mohamed Ali Sbai
- Trauma Department, Maamouri University Hospital, Nabeul 8000, Tunisia,Corresponding author. Tel.: +216 98344100.
| | - Sofien Benzarti
- Trauma Department, Maamouri University Hospital, Nabeul 8000, Tunisia
| | - Monia Boussen
- Emergency Department, La Marsa Hospital, Tunis 1000, Tunisia
| | - Hichem Msek
- Trauma Department, Maamouri University Hospital, Nabeul 8000, Tunisia
| | - Riadh Maalla
- Plastic Surgery Department, Rabta Hospital, Tunis 1000, Tunisia
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Lao LF, Li QY, Zhong GB, Liu ZD. Intraosseous ganglion of the scaphoid: a case report and review of published reports. Orthop Surg 2014; 6:252-4. [PMID: 25179362 DOI: 10.1111/os.12121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/17/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Li-feng Lao
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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7
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Intraosseous ganglion cyst of the second cuneiform bone. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maurel B, Le Corroller T, Bierry G, Buy X, Host P, Gangi A. Treatment of symptomatic para-articular intraosseous cysts by percutaneous injection of bone cement. Skeletal Radiol 2013; 42:43-8. [PMID: 22526875 DOI: 10.1007/s00256-012-1392-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/06/2011] [Accepted: 02/27/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the technique and clinical outcome of percutaneous injection of bone cement in the treatment of symptomatic para-articular intraosseous cysts. MATERIALS AND METHODS Five patients (three men, two women; mean age 35 years) with painful para-articular intraosseous cysts were treated by percutaneous injection of bone cement under combined fluoroscopic and computed tomography (CT) guidance. The lesions were all located in weight-bearing bones, involving the acetabulum, proximal tibia, distal tibia, talus, and calcaneus, respectively. RESULTS The average amount of bone cement injected was 2.1 ml (range, 0.6-3.5 ml). Calcium phosphate cement was used in four cases and acrylic cement in one case. There were no immediate or delayed complications. Full pain relief was obtained between 1 and 4 weeks after treatment. All patients made a complete recovery and were pain-free at their last visit. CONCLUSIONS Percutaneous injection of bone cement was a safe and efficient technique in the management of symptomatic para-articular intraosseous cysts in our population.
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Affiliation(s)
- Boris Maurel
- Service de Radiologie Interventionnelle non Vasculaire, Nouvel Hôpital Civil, 1 Place de L'Hôpital, BP 426, 67 091, Strasbourg Cedex, France.
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Burgess RA, Pavlosky WF, Thompson RT. MRI-identified abnormalities and wrist range of motion in asymptomatic versus symptomatic computer users. BMC Musculoskelet Disord 2010; 11:273. [PMID: 21108817 PMCID: PMC2998464 DOI: 10.1186/1471-2474-11-273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 11/25/2010] [Indexed: 11/20/2022] Open
Abstract
Background Previous work has shown an association between restricted wrist range of motion (ROM) and upper extremity musculoskeletal disorders in computer users. We compared the prevalence of MRI-identified wrist abnormalities and wrist ROM between asymptomatic and symptomatic computer users. Methods MR images at 1.5 T of both wrists were obtained from 10 asymptomatic controls (8 F, 2 M) and 14 computer users (10 F, 4 M) with chronic wrist pain (10 bilateral; 4 right-side). Maximum wrist range of motion in flexion and radioulnar deviation was measured with an electrogoniometer. Results Extraosseous ganglia were identified in 66.6% of asymptomatic wrists and in 75% of symptomatic wrists. Intraosseous ganglia were identified in 45.8% of asymptomatic wrists and in 75% of symptomatic wrists, and were significantly (p < .05) larger in the symptomatic wrists. Distal ECU tendon instability was identified in 58.4% of both asymptomatic and symptomatic wrists. Dominant wrist flexion was significantly greater in the asymptomatic group (68.8 ± 6.7 deg.) compared to the symptomatic group (60.7 ± 7.3 deg.), p < .01. There was no significant correlation between wrist flexion and intraosseous ganglion burden (p = .09) Conclusions This appears to be the first MRI study of wrist abnormalities in computer users. This study demonstrates that a variety of wrist abnormalities are common in computer users and that only intraosseous ganglia prevalence and size differed between asymptomatic and symptomatic wrists. Flexion was restricted in the dominant wrist of the symptomatic group, but the correlation between wrist flexion and intraosseous ganglion burden did not reach significance. Flexion restriction may be an indicator of increased joint loading, and identifying the cause may help to guide preventive and therapeutic interventions.
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Affiliation(s)
- Ronald A Burgess
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada.
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Abstract
An intraosseous ganglion is a relatively uncommon, benign cystic lesion that occurs in young and middle-aged adults. Bilateral and symmetrical lesions of the wrist are rare. Intraosseous ganglia of the carpal bones are uncommon causes of chronic wrist pain. Isolated cases of intraosseous ganglion have been reported most commonly in the lunate and scaphoid. The lunate was most frequently affected, followed by the capitate, scaphoid, and triquetrum bones. Radiolucent lesions in the carpal bones are not uncommon and are often seen incidentally in asymptomatic patients. The differential diagnosis of a lytic lesion in a carpal bone includes unicameral bone cyst, degenerative cyst, fibrous developmental defect, osteomyelitis, and intraosseous ganglion cyst. This article describes a case of bilateral lunate intraosseous ganglia. A review of the literature revealed that bilateral and symmetrical intraosseous ganglia of the wrist are rare, with only 3 other reported cases of bilateral lunate lesions.
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Affiliation(s)
- Cemal Kural
- Haseki Training Hospital Orthopedic and Traumatology Clinic, Istanbul, Turkey.
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11
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Pain and deformity of the index finger in a 41-year-old woman. Clin Orthop Relat Res 2009; 467:1387-91. [PMID: 18340501 PMCID: PMC2664407 DOI: 10.1007/s11999-008-0208-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Accepted: 02/25/2008] [Indexed: 01/31/2023]
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Bain GI, Turner PC, Ashwood N. Arthroscopically assisted treatment of intraosseous ganglions of the lunate. Tech Hand Up Extrem Surg 2008; 12:202-207. [PMID: 19060679 DOI: 10.1097/bth.0b013e31817fd44f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Intraosseous ganglia (IOGs) of the lunate are a relatively rare, but by no means insignificant, condition because treatment by traditional open curettage and bone grafting can lead to ongoing pain and stiffness of the wrist.An arthroscopically assisted minimally invasive technique of debridement and grafting of the lunate IOG is discussed, as well as the history of the condition, indications and contraindications, surgical technique with postoperative rehabilitation, and potential complications.The outcomes of 8 patients with persistent symptoms and typical radiographic and bone scan findings were assessed independently preoperatively and postoperatively by using a modified Green and O'Brien wrist score. The intraosseous cyst was drilled under arthroscopic and fluoroscopic guidance via either a volar or dorsal portal, depending on the position identified on the computed tomography scan. Average follow-up time was 3.8 years (range, 1-5.6 yrs). All patients returned to employment within 4 months. Wrist scores improved 34 points, from 51 to 85 points, by 1 year after surgery, with trabeculation being noted within the grafting lunate. The greatest improvements were seen in visual and analog pain scores, reducing from 68.3 to 11.2, and flexion-extension arcs, which increased from 98 to 114 degrees.The technique of arthroscopically assisted debridement of IOGs of the lunate is safe, with minimal morbidity and recurrence of symptoms during the follow-up period.
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Affiliation(s)
- Gregory I Bain
- Modbury Public Hospital and University of Adelaide, South Australia, Australia.
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13
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Chen YC, Wang SJ, Shen PH, Huang GS, Lee HS, Wu SS. Intraosseous ganglion cyst of the capitate treated by intralesional curettage, autogenous bone marrow graft and autogenous fibrin clot graft. J Chin Med Assoc 2007; 70:222-6. [PMID: 17525002 DOI: 10.1016/s1726-4901(09)70363-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We report a very rare case of intraosseous ganglion cyst of the capitate in a 54-year-old female who complained of a painful right wrist mass for 1 year. Computed tomography study showed an expansile osteolytic lesion with sclerotic margin and thinning of the cortex. Combined soft tissue ganglion cyst was also noted at operation and confirmed by pathologic study. The case was treated by a new method of autogenous bone marrow and fibrin clot graft after intralesional curettage. After a 2-year follow-up, the capitate revealed complete bony union and the symptoms were relieved with good functional results.
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Affiliation(s)
- Ying-Chieh Chen
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Calcagnotto G, Sokolow C, Saffar P. [Intraosseus synovial cysts of the lunate bone: diagnostic problems]. ACTA ACUST UNITED AC 2004; 23:17-23. [PMID: 15071962 DOI: 10.1016/j.main.2003.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Intraosseous ganglia is one of the most frequent lytic defect at the wrist. Its location in the lunate may be discovered by chance on an X-ray performed for another reason, or because of wrist pain and very rarely for a lunate fracture. A.P., lateral and oblique X-rays are mandatory. Bone scan, CT scan and MRI may be of help. Differential diagnosis may exist with an ulnar abutment syndrome with a lunate defect and with all the lytic bone tumours, a systemic disease or multiple defects as in overuse syndromes. In some cases, there is a condensation around the defect and a Kienböck's disease may be suspected. Thirty-seven patients have been operated on between 1978 and 2001, of which 70% were females. Average age was 34 years (16-58). Clinical presentation was always wrist pain. In seven cases, another carpal localization was present. Surgical treatment consisted in bone curettage and cancellous bone grafting. In four cases, a ganglia emerging from the scapholunate space in soft tissues was combined. Pain disappeared after the procedure. A few patients had a 20-30 degrees wrist flexion decrease but without functional impairment. Several theories have tried to explain the onset of these intraosseous ganglia. In conclusion, these lesions are another cause of wrist pain. One has to be sure that this is this lesion which is the real cause of wrist pain. A systematic X-ray has to be performed for painful soft tissue wrist ganglia.
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Affiliation(s)
- G Calcagnotto
- Institut français de chirurgie de la main, 5, rue du Dôme, 75116 Paris, France
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15
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Abstract
An intraosseous ganglion of the lunate treated operatively, is reported. The patient suffered 2 years of pain in the left wrist and a cystic lesion in the lunate. Curettage and bone grafting resulted in complete relief of pain.
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Affiliation(s)
- Murat Uzel
- Department of Orthopedic Surgery, Medical Faculty, University of Kahramanmaras Sutcu Imam, Yorukselim mh, Hastane cd. No. 32, 46050 Kahramanmaras, Turkey.
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Ashwood N, Bain GI. Arthroscopically assisted treatment of intraosseous ganglions of the lunate: a new technique. J Hand Surg Am 2003; 28:62-8. [PMID: 12563639 DOI: 10.1053/jhsu.2003.50027] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE A minimally invasive technique of debridement and grafting the intraosseous ganglions of the lunate was investigated. MATERIALS AND METHODS Eight patients with persistent symptoms and typical radiographic and bone scan findings were assessed independently pre- and postoperatively by using a modified Green and O'Brien wrist score. The intraosseous cyst was drilled under arthroscopic and fluoroscopic guidance via either a volar or dorsal portal, depending on the position identified on the computed tomography scan. Average follow-up time was 3.8 years (range, 1-5.6 years). RESULTS All patients returned to employment within 4 months. Wrist scores improved 34 points, from 51 to 85 points, by 1 year after surgery with trabeculation being noted within the grafting lunate. The greatest improvements were seen in visual and analog pain scores, reducing from 68.3 to 11.2, and flexion-extension arcs, which increased from 98 degrees to 114 degrees. CONCLUSIONS The technique of debridement of intraosseous ganglions of the lunate is safe, with minimal morbidity and recurrence of symptoms during the follow-up period.
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Affiliation(s)
- Neil Ashwood
- Department of Surgery and Trauma, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
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Schrank C, Meirer R, Stäbler A, Nerlich A, Reiser M, Putz R. Morphology and topography of intraosseous ganglion cysts in the carpus: an anatomic, histopathologic, and magnetic resonance imaging correlation study. J Hand Surg Am 2003; 28:52-61. [PMID: 12563638 DOI: 10.1053/jhsu.2003.50032] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the morphology, topography, frequency, and etiology of intraosseous carpal ganglions. METHOD Two hundred and eighty formalin fixed cadaveric wrists (mean age 80.3 +/- 9.7 years, range 40 to 101 years) were radiographed. Fifty specimens suspicious for cyst-like bone lesions underwent magnetic resonance imaging (T1w and proton density-fat-saturated images, 1.5T). Dissection, articular surface assessment, and histological examination were performed. Cystic lesions with adjacent destruction of the hyaline cartilage were classified as degenerative and were excluded. RESULTS In 27 of the 50 specimens, 48 ganglion cysts (GC) were found. Prevalence of GC was 9.6%. Of 48 intraosseous carpal GC, 41 (85%) were in a peripheral location; 27/48 (56%) were located at the palmar carpus. GC had a macroscopic and microscopic relationship to the insertion of degenerated ligaments. They developed near longitudinally orientated bone surfaces, which serve as insertion for ligaments and are exposed to tension loading. CONCLUSIONS Unlike degenerative cysts, ganglion cysts do not erode the hyaline articular cartilage and almost always have a continuity with the capsular ligaments. Intraosseous carpal ganglion cysts are probably the result of mucoid degeneration of adjacent ligaments.
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Abstract
Intraosseous ganglia are occasionally found affecting the carpal bones of the hand and should be considered in the differential diagnosis of chronic wrist pain. They have characteristic radiographic findings of a cyst with a thin sclerotic rim. This case report illustrates an unusual presentation of a cyst in the lunate with successful treatment. Standard of care includes curettage and bone grafting with minimal recurrence reported.
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Affiliation(s)
- Della C Bennett
- Department of Surgery, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA
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van Vugt RM, Bijlsma JW, van Vugt AC. Chronic wrist pain: diagnosis and management. Development and use of a new algorithm. Ann Rheum Dis 1999; 58:665-74. [PMID: 10531069 PMCID: PMC1752796 DOI: 10.1136/ard.58.11.665] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Chronic wrist pain can be difficult to manage and the differential diagnosis is extensive. To provide guidelines for assessment of the painful wrist an algorithm was developed to encourage a structured approach to the diagnosis and management of these patients. METHODS A review of the literature on causes of chronic wrist pain was undertaken; history taking, physical examination and imaging studies were evaluated systematically to determine which of the many potential conditions was the cause of the wrist pain. Chronic wrist pain was subdivided into pain of probable intra-articular or extra-articular origin. By means of this classification a clinical algorithm was developed to establish a diagnosis and its clinical usefulness was tested in a prospective study of 84 patients presenting to our outpatient clinic. RESULTS A definite diagnosis could be established in 59% (49 of 84) of the cases by careful history taking, extensive physical examination, plain radiographs, ultrasound examination and bone scintigraphy. In 19% of the cases (16 of 84) a probable diagnosis was made resulting in a total figure 78% (65 of 84). Additional imaging studies (arthrography, magnetic resonance imaging and computed tomography) increased the definite diagnoses to 70% (59 of 84). CONCLUSION The algorithm proved easy to use and by the use of careful history taking, thorough physical examination and simple imaging techniques (ultrasonography and scintigraphy) a diagnosis was made in 78% of cases.
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Affiliation(s)
- R M van Vugt
- Department of Rheumatology and Clinical Immunology, F02.127, University Medical Centre Utrecht, POBox 85500, 3508 GA Utrecht, the Netherlands
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Vesely MJ, Burge PD. Intraosseous ganglion of the trapezium in communication with the flexor carpi radialis tendon sheath. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1999; 24:486-8. [PMID: 10473164 DOI: 10.1054/jhsb.1999.0159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of an intraosseous ganglion of the trapezium that communicated with the flexor carpi radialis tendon sheath. The findings support the hypothesis that intraosseous ganglia arise from penetration of bone by synovial tissue or fluid.
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Affiliation(s)
- M J Vesely
- Nuffield Orthopaedic Centre, Headington, Oxford, UK
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21
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Waizenegger M. Intraosseous ganglia of carpal bones. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1993; 18:350-5. [PMID: 8345266 DOI: 10.1016/0266-7681(93)90061-j] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
25 patients with 26 intraosseous ganglia in carpal bones are described, 14 in the scaphoid and 12 in the lunate. In most cases, attention was drawn to the lesion when X-rays were performed after a recent injury to the wrist. Typically, they occurred eccentrically and were surrounded by a radio-dense rim of bone. In a few cases the cortex was breached but never expanded by the lesion. Curettage and bone grafting were performed only if symptoms persisted and no other source for the pain could be found. Most contained the typical jelly-like material also found in soft tissue ganglia and the histology showed an identical structure. A suggested format for the management of these lesions is presented.
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