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Najjaar A, Kotzé J, Solomons M, McGuire D. Percutaneous puncture of flexor sheath ganglions: an assessment of recurrence. J Hand Surg Eur Vol 2022; 47:1168-1169. [PMID: 36065115 PMCID: PMC9727109 DOI: 10.1177/17531934221115983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Lee YK. Formation of multiple ganglion cysts along the flexor tendon after open A1 pulley release for trigger finger: A case report. Medicine (Baltimore) 2022; 101:e29663. [PMID: 35866807 PMCID: PMC9302314 DOI: 10.1097/md.0000000000029663] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE When surgical treatment is indicated for primary trigger finger, open A1 pulley release has traditionally been recommended with generally good results. However, ganglion cysts of the flexor tendon sheath as a complication after an open A1 pulley release were rarely reported. Therefore, the purpose of this study is to report a case of multiple ganglion cysts arising from the flexor tendon sheath in a patient undergoing an open A1 pulley release for trigger finger disorder with a review of the relevant literature. PATIENT CONCERNS AND DIAGNOSIS A 65-year-old right-handed farmer was referred to our hospital for swelling in the left long finger (LLF). One year before the visit, the patient was diagnosed with trigger finger in the LLF at other hospital and an open A1 pulley release was performed, but the swelling of the finger persisted. The patient had no history of trauma or evidence of systemic disease such as rheumatoid or other inflammatory arthritis. The patient was diagnosed with multiple ganglion cysts of flexor tendon sheath after investigation. INTERVENTION AND OUTCOMES We successfully excised cystic masses and debrided the partially ruptured flexor digitorum superficialis (FDS) tendon and sutured it using 5/0 prolene. At 12-month follow-up, the patient was completely asymptomatic with excellent range of motion in the distal interphalangeal (DIP) joint (0°-60°) of his LLF, showing no recurrence of ganglion cyst. LESSONS Trigger finger is a common condition that clinicians encounter frequently. However, this familiarity may lead to inattentive treatment. Nevertheless, through this case, clinicians should devote careful attention when performing open A1 pulley release to prevent partial rupture of the flexor tendon in the A1 pulley. If ganglion cysts occur, we believe that surgical excision can yield good results.
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Affiliation(s)
- Young Keun Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
- *Correspondence: Young Keun Lee, Department of Orthopedic Surgery, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, JeonJu 54907, Republic of Korea (e-mail: )
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Saran S, Gaur M. Small stiff swelling over the flexor aspect of the finger: Digital ganglion arising from the A2 pulley. J Med Ultrasound 2022; 30:69-70. [PMID: 35465583 PMCID: PMC9030349 DOI: 10.4103/jmu.jmu_176_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/19/2020] [Accepted: 01/04/2021] [Indexed: 11/20/2022] Open
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Altaf W, Attarde D, Sancheti P, Shyam A. Triggering of Thumb by a Ganglion Cyst of the Flexor Tendon Sheath at A1 Pulley: A Case Report. J Orthop Case Rep 2021; 11:10-12. [PMID: 34239820 PMCID: PMC8241247 DOI: 10.13107/jocr.2021.v11.i03.2064] [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] [Indexed: 11/30/2022] Open
Abstract
Introduction: Ganglions of the wrist and hand are commonly seen but the most common sites are in the dorsum of the wrist followed by the volar side in the distal forearm at the wrist crease. The Ganglion cysts arising from the flexor tendon sheath are rare and only a few are reported in the literature. Case Report: We report a rare case of a ganglion cyst of the flexor tendon sheath at A1 pulley of thumb in a 35-year-old male who came with the complaint of chronic triggering of the left thumb. The histopathological examination confirmed the ganglion which was removed from the A1 pulley area. Conclusion: A1 pulley ganglion causing trigger thumb is uncommon entity. Although, traditional treatment for this is conservative or aspiration. High recurrence is observed. When it comes to preservation of fine movements such as thumb, aggressive approach involving exploration and excision of cyst gives good functional outcome and reduces chance of recurrence.
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Affiliation(s)
- Warid Altaf
- Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Dheeraj Attarde
- Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Parag Sancheti
- Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Ashok Shyam
- Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India.,Indian Orthopaedic Research Group, Thane, Maharashtra, India
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Pediatric trigger thumb caused by a flexor tendon sheath ganglion. J Pediatr Orthop B 2020; 29:203-205. [PMID: 30395001 DOI: 10.1097/bpb.0000000000000561] [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: 11/25/2022]
Abstract
Pediatric trigger thumb is a common reason for toddlers to present to a pediatric orthopaedic surgeon. There is controversy over the precise etiology and optimal treatment method. Current accepted diagnostic and treatment algorithms in children have not varied based on etiology. This report describes the clinical presentation and care of a 3-year-old child with pediatric trigger thumb and surgical findings of a large flexor tendon sheath ganglion at the level of the annular pulley with no apparent nodule within the FPL. The potential implications for consideration of etiology in current diagnostic and treatment guidelines are discussed.
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Jang Y, Kang BS, Bang M, Lim S, Park GM, Lee TY, Kwon WJ. Ganglion cysts developed from the flexor tendon sheaths in the fingers: Clinical and sonographic features. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:9-13. [PMID: 31774183 DOI: 10.1002/jcu.22793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/23/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The purpose of this study was to assess the clinical and sonographic features of flexor tendon sheath ganglion cysts in the fingers. METHODS We retrospectively reviewed the clinical and sonographic features of 35 cases of flexor tendon sheath ganglion cysts in the fingers in 34 patients that were pathologically confirmed between 2003 and 2018. RESULTS The mean age of the patients was 44.2 years (range, 11-73 years). Lesions were located at the level of the metacarpophalangeal joint (n = 22 [63%]) and proximal phalanx (n = 11 [31%]), and involvement of the third finger was common (n = 19 [54%]). The mean lesion size was 6 mm and the mean volume was 90 mm3 . None of the lesions had a pedicle. Lesions were homogeneous (n = 24 [69%]) and anechoic (n = 23 [66%]). A septum was noted in 12 cases (34%). CONCLUSIONS Flexor tendon sheath ganglion cysts are most commonly located in the third finger and at the level of the metacarpophalangeal joint and proximal phalanx. It usually presents as a simple cyst without a pedicle, but occasionally exhibits a mixed echogenicity and contains a septum.
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Affiliation(s)
- Yeonjung Jang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Byeong S Kang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Minseo Bang
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Soyeoun Lim
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Gyeong M Park
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Tae Y Lee
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Woon J Kwon
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
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7
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Balakirski G, Löser CR. [Mucous pseudocysts-when and how to treat?]. Hautarzt 2018; 69:712-717. [PMID: 30046862 DOI: 10.1007/s00105-018-4233-3] [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] [Indexed: 11/26/2022]
Abstract
The treatment of mucous pseudocysts must consider their tendency for recurrence. There are numerous established treatment options available. The decision on the optimal therapy, however, depends on the clinical presentation and symptoms as well as on possible side effects. This review presents surgical as well as nonsurgical treatment options for digital mucous pseudocysts and an algorithm is suggested. For recurrent and symptomatic lesions with pain or deformation of the nail plate, surgical excision of the pseudocyst and closure with a flap can be considered.
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Affiliation(s)
- G Balakirski
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum der Rheinischen Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
| | - C R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen am Rhein, Deutschland.
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Lavalette D, Giddins G. The Outcome of Treatment of Flexor Sheath (seed) Ganglia by a Percutaneous Partial Pulley Release. J Hand Surg Asian Pac Vol 2017; 22:219-221. [PMID: 28506163 DOI: 10.1142/s0218810417500289] [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: 11/18/2022]
Abstract
BACKGROUND The aims of this study were to assess the safety and efficacy of a technique of partial percutaneous pulley release. METHODS A retrospective cohort study was undertaken treating adults with seed ganglia with a percutaneous pulley release. The patients were reviewed independently after a mean of 6 (range 6-36) months. RESULTS We treated 24 patients over a 3 year period. There were 14 women and ten men. The mean age was 39 (range 17-65) years. We were able to assess 21 patients with long term follow up. There was complete resolution in 14 (2/3) and partial resolution in four. The remaining three patients had persisting symptoms and requested open surgical excision. Apart from local tenderness and failure of resolution there were no complications of percutaneous pulley release. CONCLUSIONS Bursting or aspiration of flexor sheath ganglia appears to be the best primary treatment. If the ganglion recurs, this study suggests a percutaneous release is safe and will resolve the symptoms in most patients.
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Affiliation(s)
- David Lavalette
- 1 Department of Orthopaedic Surgery, Royal United Hospital, Bath, United Kingdom
| | - Grey Giddins
- 1 Department of Orthopaedic Surgery, Royal United Hospital, Bath, United Kingdom
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Jabbour S, Kechichian E, Haber R, Tomb R, Nasr M. Management of digital mucous cysts: a systematic review and treatment algorithm. Int J Dermatol 2017; 56:701-708. [DOI: 10.1111/ijd.13583] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Samer Jabbour
- Department of Plastic and Reconstructive Surgery; Faculty of Medicine; Saint Joseph University; Hotel Dieu de France Hospital; Beirut Lebanon
| | - Elio Kechichian
- Department of Dermatology; Faculty of Medicine; Saint Joseph University; Hotel Dieu de France Hospital; Beirut Lebanon
| | - Roger Haber
- Department of Dermatology; Faculty of Medicine; Saint Joseph University; Hotel Dieu de France Hospital; Beirut Lebanon
| | - Roland Tomb
- Department of Dermatology; Faculty of Medicine; Saint Joseph University; Hotel Dieu de France Hospital; Beirut Lebanon
| | - Marwan Nasr
- Department of Plastic and Reconstructive Surgery; Faculty of Medicine; Saint Joseph University; Hotel Dieu de France Hospital; Beirut Lebanon
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Senda H, Mizutani J, Okamoto H. Intratendinous ganglion of the hand: two case reports occurring in the extensor digitorum communis and the flexor digitorum superficialis tendon. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2017; 4:9-12. [PMID: 28164147 PMCID: PMC5253514 DOI: 10.1080/23320885.2016.1278170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/24/2016] [Indexed: 12/29/2022]
Abstract
An intratendinous ganglion of the hand is a rare entity, and only one case report of flexor tendon has been published in the English literature. We herein report two cases of an intratendinous ganglion occurring in the extensor digitorum communis and flexor digitorum superficialis tendon, respectively.
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Affiliation(s)
- Hiroya Senda
- Department of Orthopaedic Surgery, Nagoya City East Medical Center , Nagoya , Japan
| | - Jun Mizutani
- Department of Orthopaedic Surgery, Nagoya City University , Nagoya , Japan
| | - Hideki Okamoto
- Department of Orthopaedic Surgery, Nagoya City University , Nagoya , Japan
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Chia DSY, Kong JC, Teoh LC. An atypical presentation of a flexor intratendinous ganglion of the hand. Ann Plast Surg 2013; 74:306-7. [PMID: 24051457 DOI: 10.1097/sap.0b013e31829ba9c5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intratendinous ganglions of the hand are rare. We report an unusual case of a ganglion arising within the flexor tendon in the hand. The intratendinous ganglion arose from the flexor digitorium profundus tendon of the little finger, causing flexion deformity of the finger.
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Affiliation(s)
- Dawn Sinn Yii Chia
- From the Hand and Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Finsen V, Håberg O, Borchgrevink GE. Surgery for ganglia of the flexor tendon sheath. Orthop Rev (Pavia) 2013; 5:e6. [PMID: 23705064 PMCID: PMC3662258 DOI: 10.4081/or.2013.e6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/02/2013] [Accepted: 01/07/2013] [Indexed: 11/22/2022] Open
Abstract
There are very few reports in the literature on the results of surgery for ganglia of the flexor tendon sheaths of the digits. We reviewed 24 patients operated for flexor tendon sheath ganglia 8 (3-11) years previously. Two operations were for recurrences and one of these recurred again. There was one permanent digital nerve injury and one patient complained of cold sensibility. VAS (0=best; 100=worst) for mean general complaints from the hand was remembered as 51 before surgery and was 5 at review. Mean pain at review was reported as VAS 4 and general satisfaction with the operation as VAS 3. All stated that they would have consented to surgery if they had known the outcome in advance. We conclude that the results of surgery are good, although complications do occur.
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Affiliation(s)
- Vilhjalmur Finsen
- Department of Orthopaedic Surgery, St. Olav's University Hospital; ; Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Foret AL, Chhabra AB. Volar retinacular ganglions. J Hand Surg Am 2012; 37:566-7. [PMID: 21705156 DOI: 10.1016/j.jhsa.2011.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/07/2011] [Indexed: 02/02/2023]
Affiliation(s)
- Andrew L Foret
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
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Coffey MJ, Fazlur Rahman M, Thirkannad SM. Pediatric ganglion cysts of the hand and wrist: an epidemiologic analysis. Hand (N Y) 2008; 3:359-62. [PMID: 18780007 PMCID: PMC2584211 DOI: 10.1007/s11552-008-9122-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 06/20/2008] [Indexed: 10/21/2022]
Abstract
We analyzed all hand and wrist ganglions in patients aged 12 years and younger that were treated at our institution during a 3-year period. Our patients were predominately female (1.8:1). Volar ganglions were more common (1.2:1), whereas dorsal ganglions have been reported to be more common in adults. Ganglions had a higher incidence of arising from tendon sheaths in our patients (33%) compared to what has been previously reported for ganglions in studies of all age groups (5% to 16%). While observation and/or splinting alone will likely be helpful in resolution of a majority of pediatric hand and wrist ganglions, surgical excision should be employed in those that are symptomatic and/or do not resolve with observation.
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Affiliation(s)
- Michael J. Coffey
- Christine M. Kleinert Institute for Hand and Microsurgery, 225 Abraham Flexner Way, Suite 850, Louisville, KY 40202 USA
| | - M. Fazlur Rahman
- Christine M. Kleinert Institute for Hand and Microsurgery, 225 Abraham Flexner Way, Suite 850, Louisville, KY 40202 USA
| | - Sunil M. Thirkannad
- Christine M. Kleinert Institute for Hand and Microsurgery, 225 Abraham Flexner Way, Suite 850, Louisville, KY 40202 USA
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Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, Feydy A, Drapé JL. Sonographic appearance of trigger fingers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1407-1413. [PMID: 18809950 DOI: 10.7863/jum.2008.27.10.1407] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the sonographic appearance of the first annular (A1) pulley-flexor tendon complex in patients with trigger fingers. METHODS Thirty-three trigger fingers in 33 patients were examined with a 7- to 15-MHz probe. A control group consisted of 20 patients without trigger fingers. The study included systematic measurement of the thickness of the A1 pulley and a power Doppler assessment of the pulleys, tendons, and tendon sheaths. RESULTS Thickening and hypoechogenicity of the A1 pulley were found in all patients with trigger fingers. Measurements of A1 pulley thickness were significantly different (P < .0001) between the groups without trigger fingers (mean, 0.5 mm; range, 0.4-0.6 mm) and with trigger fingers (mean, 1.8 mm; range, 1.1-2.9 mm). Hypervascularization of the A1 pulley on power Doppler imaging was found in 91% of the trigger fingers but was never found in the healthy control group. Flexor tendinosis was found in 48% of the trigger fingers; tenosynovitis was found in 55%; and both were found in 39%. In the control group, tenosynovitis and tendinosis were not found. CONCLUSIONS Thickening and hyper-vascularization of the A1 pulley are the hallmarks of trigger fingers on sonography. Other frequently observed features include distal flexor tendinosis and tenosynovitis.
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Affiliation(s)
- Henri Guerini
- Department of Radiology B, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
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Schoffl I, Einwag F, Strecker W, Hennig F, Schoffl V. Impact of Taping after Finger Flexor Tendon Pulley Ruptures in Rock Climbers. J Appl Biomech 2007; 23:52-62. [PMID: 17585178 DOI: 10.1123/jab.23.1.52] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Flexor tendon pulley ruptures are the most common injury in rock climbers. Therapeutic standards usually include a prolonged use of taping applied as a replacement for the lost pulley in a circular fashion at the base of the proximal phalanx. Our biomechanical considerations, however, suggest a new taping method, the H-tape. The purpose of the study is to evaluate whether this new taping method can effectively change the course of the flexor tendon and therefore reduce the tendon–bone distance. In order to compare the effects of different taping methods described in the literature with the newly developed taping method, we performed standardized ultrasound examinations of 8 subjects with singular A2 pulley rupture and multiple pulley ruptures of A2 and A3 pulleys and determined the respective tendon–bone distance for the different taping methods, versus without tape at a preset position on the proximal phalanx. In a second approach, we evaluated the effect of the new taping method on the strength of the injured finger using a force platform on 12 subjects with different pulley ruptures with injuries older than 1 year. The new taping method decreased the tendon–bone distance in the injured finger significantly by 16%, whereas the other taping methods did not. The strength development was significantly better with the new tape for the crimp grip position (+13%), but there was no significant improvement for the hanging position. We recommend taping with the newly presented taping technique after pulley rupture.
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Affiliation(s)
- Isabelle Schoffl
- Institute of Medical Physics, University of Erlangen, Nuremberg, Germany
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