Treatment of Intraosseous Ganglion Cyst of the Lunate: A Systematic Review

Ganglions in the Hand and Wrist: Advances in 2 Decades

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.

Outcomes of Surgical Management of Intraosseous Ganglia of the Carpal Bones: A Case Series

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.

Application of 3 dimension-printed injection-molded polyether ether ketone lunate prosthesis in the treatment of stage III Kienböck’s disease: A case report

BACKGROUND

Polyether ether ketone (PEEK) is a high-performance medical polymer, and there are some clinical cases of PEEK prosthesis implantation. However, application of 3D-printed injection-molded PEEK lunate prosthesis for treatment of stage III Kienböck’s disease has not been reported. This study’s purpose was to analyze the clinical efficacy of 3D-printed injection-molded PEEK lunate prosthesis in the treatment of stage III Kienböck’s disease and thus provide a good therapeutic choice for Kienböck’s disease.

CASE SUMMARY

We report a patient with stage III Kienböck’s disease. With the healthy lunate bone as reference, 3D lunate reconstruction was performed using a mirroring technique. A PEEK lunate prosthesis was prepared by 3D printing and injection molding, and then it was inserted into the original anatomical position after removing the necrotic lunate bone. Wrist pain and function, anatomical suitability of the lunate prosthesis, and complications were evaluated and analyzed postoperatively. At the last visit (one year after surgery), the range of motion, grasp force, visual analog scale score and Cooney score of the affected wrist were significantly improved, and postoperative X-ray examination indicated that the lunate prosthesis had good anatomical suitability for adjacent bony structures.

CONCLUSION

The 3D-printed injection-molded PEEK lunate prosthesis demonstrated definite efficacy in treating stage III Kienböck’s disease.

Arthroscopic Treatment of Intraosseous Ganglion Cysts of the Carpus

Objective

To investigate the application and the clinical efficacy of wrist arthroscopy in the treatment of carpal intraosseous ganglion cysts (IGCs).

Methods

A retrospective case study method was adopted to analyze the clinical data of 28 patients with carpal IGCs admitted to the Sixth Hospital of Ningbo from April 2012 to January 2019. A hypodensity in the bone was shown by X-ray before the operation, with hypodensity and cystic change in the bone being confirmed by computed tomography and magnetic resonance imaging. Arthroscopic open window of the wrist, cystectomy, and autologous iliac bone graft implantation were conducted. Regular postoperative X-ray combined with CT follow-ups were conducted to observe the healing after bone implantation. Patients were followed up regularly and assessed by the Modified Mayo Wrist Score in four aspects of the postoperative pain, wrist mobility, grip, and function to provide an objective overall assessment of the therapeutic outcome.

Results

All 28 patients were followed up for 8–16 months, with an average follow-up duration of 10 months. After the operation, pain disappeared completely for 25 patients, and 3 cases showed significant improvement. All cases were pathologically confirmed as ganglion cysts and had first-stage bony healing after bone grafting with an average healing time of 10.8 weeks. The grip returned to normal for all patients, and wrist flexion and extension were the same as the healthy wrist for 25 patients, with a Modified Mayo Wrist Score of excellent in 19 cases and good in 9 cases. No recurrence was observed.

Conclusion

In patients with symptomatic carpal IGCs, the application of arthroscopic open window, cystectomy, and autologous bone graft implantation could achieve satisfactory clinical therapeutic effects.

Arthroscopic Bone Graft for Intraosseous Lunate Bone Ganglion

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.

Acupuncture treatment of dorsal wrist ganglion: Case report

Ganglion cysts are benign soft tissue tumors most commonly encountered in the hand. The most widely used approaches are watchful waiting, non-operative aspiration, steroid injection and surgical removal, but these are often associated with high recurrence rates and complications. We report the case of a 38-year-old female graphic designer who presented to the acupuncture outpatient department with chief complaint of an enlarging, painless lump on the left wrist for 5 months. Ultrasound analysis demonstrated a 1.8 * 1.07 cm mass lesion on the dorsum of the left wrist. Her wrist range of motion was approximately 40° active flexion and 30° active extension. Discomfort was the maximum during wrist extension. For each acupuncture treatment, three needles (0.30 mm in diameter, 40 mm in length) were inserted transversely at an angle of 15° and to a depth of 15-20 mm. When the needles were removed after the first treatment, ultrasound analysis showed that the mass lesion decreased in size from 1.8 cm to 1.72 cm, and further to 1.55 cm the following day. The patient underwent treatment every other day for a total of six treatments over a three-week period. By the end of the sixth visit, the cyst had become insignificant in size. The treatment outcome suggests that acupuncture may have effects in perforating the cyst wall and promoting the absorption of the gelatinous fluid within the cyst. Acupuncture may be a viable treatment option with reduced complications and potential faster recovery time for dorsal wrist ganglions.

Unusual multiloculated serpiginous ganglion of the foot

Ganglions are cystic lesion more commonly seen around the wrist joint. Gangliomas of plantar aspect of the foot are rare. We have presented a case of an unusual serpiginous ganglioma of the plantar aspect of the foot. Less literature is available regarding plantar foot gangliomas. The treatment is challenging because of occurrence of the lesion at weight bearing zone. Available options for treatment includes conservative with splint, intralesional injection,arthroscopic excision and open excision.

Effect of fire needle for ganglion cysts: A protocol of systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Ganglion cysts (GCs) are tumor-like lesions that often occur in the soft tissues, which are mostly caused by the degeneration of mucin produced by the joint capsule and tendon sheath on the carpal dorsal joints of extremities. GCs may appear asymptomatic as benign tumors, but some patients also seek treatment because of the pain caused by these fluid-filled cysts. As a kind of complementary and alternative therapy, there have been some studies published in China which have proved that the fire needle has a better therapeutic effect on ganglion cyst. The purpose of this systematic review is to evaluate the efficacy of fire needle in the treatment of GCs.

METHODS

PubMed, EMBASE, the Cochrane Library, Chinese National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database were searched by 2 reviewers from the inception until August 2020. The original study that randomised control trials of fire needle for GCs will be selected and is not limited by country or language. In addition, researches in progress, the reference lists and the citation lists of identified publications will be retrieved similarly. Study selection, data extraction, and assessment of the quality will be performed independently by 2 reviewers who have been trained prior to data extraction. A meta-analysis will be conduct if the quantity and quality of the original studies included are satisfactory; otherwise, a descriptive analysis will be conducted. Review Manager V5.4: (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) software will be using for data synthesis and assessment the risk of bias according by Cochrane Handbook.

RESULT

This study will provide a comprehensive review of current evidence for the treatment of fire needle on GCs.

CONCLUSION

The conclusion of this study will provide a judging basis that whether the treatment of GCs with fire needle is effective.

INPLASY REGISTRATION NUMBER

INPLASY202080032.