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Phadke SV, Dalal C, Seetharaman R, Parsons AS. Lessons in clinical reasoning - pitfalls, myths, and pearls: a case of tarsal tunnel syndrome caused by an intraneural ganglion cyst. Diagnosis (Berl) 2024; 11:337-342. [PMID: 38401131 DOI: 10.1515/dx-2023-0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 01/15/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Intraneural ganglionic cysts are non-neoplastic cysts that can cause signs and symptoms of peripheral neuropathy. However, the scarcity of such cases can lead to cognitive biases. Early surgical exploration of space occupying lesions plays an important role in identification and improving the outcomes for intraneural ganglionic cysts. CASE PRESENTATION This patient presented with loss of sensation on the right sole with tingling numbness for six months. A diagnosis of tarsal tunnel syndrome was made. Nerve conduction study revealed that the mixed nerve action potential (NAP) was absent in the right medial and lateral plantar nerves. The magnetic resonance imaging (MRI) found a cystic lesion measuring 1.4×1.8×3.8 cm as the presumed cause of the neuropathy. Surgical exploration revealed a ganglionic cyst traversing towards the flexor retinaculum with baby cysts. The latter finding came as a surprise to the treating surgeon and was confirmed to be an intraneural ganglionic cyst based on the histopathology report. CONCLUSIONS Through integrated commentary by a case discussant and reflection by an orthopedician, this case highlights the significance of the availability heuristic, confirmation bias, and anchoring bias in a case of rare disease. Despite diagnostic delays, a medically knowledgeable patient's involvement in their own care lead to a more positive outcome. A fish-bone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic delay. Finally, this case provides clinical teaching points in addition to a pitfall, myth, and pearl related to availability heuristic and the sunk cost fallacy.
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Affiliation(s)
- Sanjay Vishnu Phadke
- Visiting Orthopaedic Surgeon, 29491 Indian Institute of Technology , Mumbai, India
| | - Chirag Dalal
- Visiting Orthopaedic Surgeon, Madhu Polyclinic and Nursing Home, 29491 Indian Institute of Technology , Mumbai, India
| | - Rajmohan Seetharaman
- Department of Pharmacology & Therapeutics, 29549 Seth GS Medical College & KEM Hospital , Mumbai, India
| | - Andrew S Parsons
- Department of Medicine and Public Health, 12349 University of Virginia School of Medicine , Charlottesville, VA, USA
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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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Patankar AG, Avendano JP, Gencarelli P, Tawfik AM, Alter TH, Katt BM. Effects of Postoperative Splinting on Outcomes following Digital Mucous Cyst Excision: A Retrospective Review. J Hand Microsurg 2024; 16:100039. [PMID: 38855529 PMCID: PMC11144640 DOI: 10.1055/s-0043-1768583] [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: 06/11/2024] Open
Abstract
Background Digital mucous cysts (DMCs) are masses on the fingers that can be definitively managed with surgical excision. Though uncommon, surgical site infections can develop into septic arthritis. We sought to determine whether postoperative splinting decreases rates of postoperative infection and the need for postoperative antibiotics. We also explored the effect of age, gender, obesity, and preoperative antibiotic administration on infectious complications. Methods Patients who underwent DMC excision between 2011 and 2021 were retrospectively identified. Chi-squared and Fisher's exact tests were used to analyze the complication rates including documented infection, postoperative antibiotic administration, mass recurrence, and return to operating room. Associations were analyzed between both preoperative antibiotic administration and postoperative splinting with respect to postsurgical complications. Results The database search identified 373 patients who underwent 394 DMC excisions. Postoperative antibiotics were given in splinted patients at lower rates than their nonsplinted counterparts with a small-to-moderate effect size, but the difference was not statistically significant (2.7 vs. 7.5%). Preoperative antibiotic administration was not found to significantly affect the prescription of postoperative antibiotics. Splinting did not reduce rates of DMC recurrence. Patients who were splinted were more likely to have also received preoperative antibiotics. Males were given postoperative antibiotics more frequently than females (12.6 vs. 4.0%). Conclusions Though not statistically significant, splinted patients were prescribed postoperative antibiotics less frequently. Postoperative antibiotics were utilized more frequently than the rate of infections typically reported following this procedure, possibly indicating overcautious prescription habits or underreported suspected infections.
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Affiliation(s)
- Aneesh G. Patankar
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - John P. Avendano
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Pasquale Gencarelli
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Amr M. Tawfik
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Todd H. Alter
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Brian M. Katt
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
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Shirodkar K, Hussein M, Balogh P, Azzopardi C, Botchu R. Painless knee mass in a young adult: answer. Skeletal Radiol 2024:10.1007/s00256-024-04682-8. [PMID: 38642303 DOI: 10.1007/s00256-024-04682-8] [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: 02/08/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Affiliation(s)
- K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - M Hussein
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - P Balogh
- Department of Musculoskeletal Pathology, University Hospitals of Birmingham, Birmingham, UK
| | - Christine Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Fernandes CJ, Yee HK, Fishman FG. The Limited Utility of Routine Pathologic Examination of Ganglion Cyst Excision From the Hand and Digits. Hand (N Y) 2024:15589447241231292. [PMID: 38379165 DOI: 10.1177/15589447241231292] [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: 02/22/2024]
Abstract
BACKGROUND It is routine practice at many institutions to send surgically excised ganglion cysts for pathologic analysis. This adds significant cost to the procedure with questionable benefit. The purpose of this study was to determine the necessity of routine pathologic examination of ganglion cysts excised from the hand. METHODS We conducted a retrospective review of 443 patients who underwent ganglion excision from the hand with routine pathologic examination between 2012 and 2022. The final pathologic diagnosis was compared with the treating surgeon's clinical diagnosis, and the rates of concordant, discrepant, and discordant diagnoses were identified. Discrepant diagnoses were defined as differing clinical and pathologic diagnoses that did not change clinical management. Discordant diagnoses were defined as differing clinical and pathologic diagnoses that altered the treatment plan. RESULTS The prevalence of a concordant diagnosis was 96.2% (426 of 443; 95% confidence interval, 94.4%-98.0%). The prevalence of a discrepant diagnosis was 3.8% (17 of 443; 95% confidence interval, 2.1%-5.6%), and the prevalence of a discordant diagnosis was 0. The odds ratio was 0.04 for a discrepant diagnosis and 0 for a discordant diagnosis. CONCLUSIONS Our study suggests abandoning routine pathologic analysis in patients undergoing ganglion cyst excision from the hand will not compromise quality of care when the surgeon is able to make a confident diagnosis. Discrepant diagnoses were rare and discordant diagnoses that did not occur. We recommend pathologic evaluation only when there is uncertainty in the clinical diagnosis.
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Affiliation(s)
- Carlton J Fernandes
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Heather K Yee
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Felicity G Fishman
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA
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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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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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Dearden ME, Belardo ZE, Chang B, Ty JM, Lin IC, Hoxha M, Shah AS. Natural History of Pediatric Hand and Wrist Ganglion Cysts: Longitudinal Follow-Up of a Prospective, Dual-Center Cohort. J Hand Surg Am 2023; 48:1018-1024. [PMID: 37598325 DOI: 10.1016/j.jhsa.2023.07.002] [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] [Received: 12/22/2022] [Revised: 06/13/2023] [Accepted: 07/04/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE This investigation describes the outcomes of pediatric ganglion cysts in a prospective cohort that elected not to undergo cyst aspiration or surgical treatment. Our primary aim was to investigate the rate of spontaneous resolution over time among the subset of patients who did not undergo specific treatments. METHODS Children (aged ≤18 years) who presented to the clinic with ganglion cysts of the hand or wrist were enrolled in a prospective two-center registry between 2017 and 2021. Enrolled subjects who never elected to undergo cyst aspiration or surgical treatment were analyzed. The data collected included age, sex, cyst location and laterality, hand dominance, Wong-Baker pain scale scores, and Patient-Reported Outcome Measurement Information System upper-extremity scores. Follow-up surveys were completed for up to 5 years. RESULTS A total of 157 cysts in 154 children, with an average age of 9.4 years and a female-to-male ratio of 1.4:1, were eligible. The most common ganglion location was dorsal wrist (67/157, 42.7%), followed by volar wrist (49/157, 31.2%), the flexor tendon sheath (29/157, 18.5%), and the extensor tendon synovial lining (8/157, 5.1%). The average follow-up duration was 2.5 years after initial presentation to the clinic, and 63.1% (99/157) of the patients responded to follow-up surveys. Among them, 62.6% (62/99) of cysts spontaneously resolved; the resolution rates ranged from 51.9% of volar wrist ganglions to 81% of flexor tendon sheath cysts, with an average time to resolution of 14.1 months after cyst presentation. Cysts were more likely to resolve in the hand than in the wrist (84.0% vs 55.4%, respectively). Cysts present for >12 months at initial evaluation were less likely to resolve spontaneously (41.2% vs 67.1%). CONCLUSIONS Of children who elected not to undergo aspiration or surgical treatment, approximately two-thirds of families reported that their child's ganglion cyst resolved spontaneously. Cysts that resolve spontaneously usually do so within 2 years of presentation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Zoe E Belardo
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Benjamin Chang
- The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jennifer M Ty
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Ines C Lin
- The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Melissa Hoxha
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Apurva S Shah
- The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Avery EC, McCabe SJ. A Simple Physical Exam Maneuver to Distinguish Trigger Digit, Dupuytren's Nodule, and Flexor Sheath Ganglion. Hand (N Y) 2023; 18:1051-1052. [PMID: 36131596 PMCID: PMC10470242 DOI: 10.1177/15589447221109644] [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
Trigger digit, Dupuytren's disease, and ganglion cysts are 3 common disorders treated by hand surgeons. Despite the varying nature of their pathology, these 3 entities can all present as a mass at the flexor crease in the distal palm. The regional similarity of these presentations can make diagnosis more difficult. In this paper, we describe a simple clinical exam method that can assist in distinguishing between trigger digit, Dupuytren's disease, and flexor sheath ganglion cysts.
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Affiliation(s)
- Emma C. Avery
- Division of Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Ontario, Canada
| | - Steven J. McCabe
- Division of Plastic, Reconstructive and Aesthetic Surgery, University of Toronto, Ontario, Canada
- Toronto Western Hospital, University Health Network, Ontario, Canada
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Saleh ES, De Carvalho AF, Hasan S, Abdelgawad A, Thabet AM, Moneim MS. Soft Tissue Benign Hand Masses in the First Web Space: A Retrospective Case Series. Cureus 2023; 15:e37847. [PMID: 37213983 PMCID: PMC10198707 DOI: 10.7759/cureus.37847] [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] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Hand masses are fairly common. While most of these masses are either ganglion cysts or benign tumors, masses in the first web space are not rare, and they may in fact represent a variety of lesions. These include both benign and malignant tumors, metastases, or congenital and anomalous structures, and may involve nerves, vascular structures, connective tissue, and joints. METHODS In this retrospective case series, data on 12 cases of first dorsal web space hand mass treated at our center over a period of five years were collected and analyzed. RESULTS Twelve consecutive patients presenting with a first dorsal web space hand mass over a period of five years were reviewed. This represented a group of nine females and three males, with a mean age of 53 years (range = 16-70 years). Seven patients had a mass on the right side and five on the left side. The surgical approach to resect the mass in all 12 patients was dorsal. The most common diagnosis was ganglion cyst (50%), followed by lipoma (25%) and aneurysm (16.6%). There was one case of eccrine spiradenoma. CONCLUSION First dorsal web space hand masses can encompass multiple different pathologies, and the first web space has an intricate anatomy. Both of these factors mandate a careful approach that includes meticulous preoperative planning with appropriate advanced imaging studies, which helps to make the surgical procedure more efficient and accurate.
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Affiliation(s)
- Ehab S Saleh
- Department of Orthopedic Surgery, Oakland University William Beaumont School of Medicine, Rochester, USA
| | | | - Sazid Hasan
- Department of Medicine, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Amr Abdelgawad
- Department of Orthopedic Surgery, Maimonides Medical Center, New York, USA
| | - Ahmed M Thabet
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, El Paso, USA
| | - Moheb S Moneim
- Department of Orthopedic Surgery, University of New Mexico Health Sciences Center, Albuquerque, USA
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Choi JY, Lee SS, Jung YH, Suh JS. Operative outcome of mucous cyst of lesser toes: A comparison between cyst excision with osteophytectomy and distal interphalangeal fusion. Foot Ankle Surg 2023; 29:256-260. [PMID: 36806441 DOI: 10.1016/j.fas.2023.02.003] [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: 10/29/2022] [Revised: 12/18/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND To date, the optimal operative treatment for mucous cysts of the lesser toes (MCLT) has not been discussed in detail, although many previous studies have focused on treating finger lesions. Therefore, we evaluated the operative outcomes of two different procedures for MCLT: cyst excision with osteophytectomy and cyst excision with distal interphalangeal (DIP) fusion. METHODS We retrospectively reviewed and compared the clinico-radiographic outcomes of patients who underwent cyst excision with osteophytectomy (group 1, 22 cases) or cyst excision with DIP fusion (group 2, 16 cases) for MCLT between January 2010 and August 2021. The minimum follow-up duration for inclusion in the study was 12 months. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) lesser toes metatarsophalangeal-interphalangeal scale and the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) subscale. We also collected information on postoperative recurrence and operation-related complications. RESULTS The preoperative and postoperative AOFAS and FAAM-ADL scores were not significantly different between the two groups (P > 0.05, each). However, the postoperative recurrence rate was 31.8 % in group 1 (7 of 22 cases), whereas no recurrence was observed in group 2. Every recurrence occurred within 8 postoperative weeks (mean, 4.8 weeks; range, 3-8 weeks). Nonunion of the fusion site was observed in one patient (6.3 %). CONCLUSION We confirmed that postoperative recurrence was significantly lower in the case of cyst excision with DIP fusion than in cyst excision with osteophytectomy for the treatment of MCLT. Clinical outcomes were not significantly different between the two procedures. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Sung Sahn Lee
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Young Ho Jung
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea.
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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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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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14
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Park JJ, Seok HG, Yan H, Park CH. Recurrence of intratendinous ganglion due to incomplete excision of satellite lesion in the extensor digitorum brevis tendon: A case report. World J Clin Cases 2022; 10:13373-13380. [PMID: 36683628 PMCID: PMC9851001 DOI: 10.12998/wjcc.v10.i36.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/27/2022] [Accepted: 12/09/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Intratendious ganglions are rare lesions, especially on the foot and ankle. Although several studies have presented the intratendinous ganglion of the foot and ankle, there are only few reported cases, and no cases of recurrence or secondary surgery have been reported.
CASE SUMMARY We present the case of a 32-year-old man with an intratendinous ganglion of the second extensor digitorum brevis (EDB) tendon that recurred after ganglion excision. Magnetic resonance imaging (MRI) performed before the first surgery was reviewed to analyze the causes of the recurrence. We confirmed that there was a lack of satellite detection. After recurrence, MRI revealed an extra-tendinous lesion, tenosynovitis, and intratendinous ganglion of the second EDB tendon. Since the second EDB tendon can compensate for the extrinsic muscle, en bloc resection was performed alone. In addition, meticulous excision and synovectomy were performed for extra-tendinous lesions and tenosynovitis, respectively. The patient returned to daily life without any functional problems or recurrence.
CONCLUSION If removal of the affected tendon is not fatal, en bloc resection should first be considered to prevent incomplete excision and intraoperative leakage. When planning surgical excision, it is necessary to evaluate the presence of satellite lesions along the course of the affected tendon.
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Affiliation(s)
- Jeong Jin Park
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, Korea, Daegu 42415, South Korea
| | - Hyun Gyu Seok
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, Korea, Daegu 42415, South Korea
| | - Hongfei Yan
- Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, Korea, Daegu 42415, South Korea
| | - Chul Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu 42415, South Korea
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15
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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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16
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Chen C, Baker L. Unlikely cause of primary upper limb venous thrombosis. J Med Imaging Radiat Oncol 2022; 66:1087-1088. [PMID: 36208027 DOI: 10.1111/1754-9485.13483] [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: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 10/10/2022]
Abstract
Primary upper limb venous thrombosis is a rare disease usually caused by external compression of the proximal deep upper limb veins from aberrant musculoskeletal anatomy such as cervical ribs, abnormal tendon insertions and hypertrophy of the anterior scalene or subclavius muscles. We present an unusual case of primary upper limb thrombosis caused by compression of the brachiocephalic vein from a sternoclavicular ganglion cyst. This case illustrates the importance of considering a wide differential when searching for a cause of primary upper limb venous thrombosis.
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Affiliation(s)
- Christopher Chen
- Department of Nuclear Medicine, PET and Ultrasound, Westmead Hospital, Sydney, New South Wales, Australia
| | - Luke Baker
- Department of Radiology, Westmead Hospital, Sydney, New South Wales, Australia
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17
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Hanson ZC, Lourie GM. Middorsal Wrist Pain in the High-Level Athlete: Causes, Treatment, and Early Return to Play. Orthop J Sports Med 2022; 10:23259671221088610. [PMID: 35480067 PMCID: PMC9036339 DOI: 10.1177/23259671221088610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
Wrist injuries in the competitive athlete are a common reason for evaluation related to an acute injury or after symptoms have become chronic. While radius- and ulna-sided wrist pain are common topics covered in the literature, middorsal wrist pain is more common than the available literature would suggest. Missed diagnoses and inadequate treatment can significantly increase athlete morbidity and delay return to play. The goal of this article was to review the differential diagnosis of middorsal wrist pain in the athlete and discuss the diagnosis, treatment, and early return to play for each condition.
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Affiliation(s)
- Zachary C. Hanson
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Gary M. Lourie
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
- The Hand & Upper Extremity Center of Georgia, Atlanta, Georgia, USA
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18
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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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19
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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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20
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Cost Implications of Varying the Surgical Setting and Anesthesia Type for Dorsal Wrist Ganglion Cyst Excision Surgery. Plast Reconstr Surg 2022; 149:240e-247e. [PMID: 35077419 PMCID: PMC8797019 DOI: 10.1097/prs.0000000000008725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Minimizing expenses attributed to dorsal wrist ganglion cyst excisions, a common minor surgical procedure, presents potential for health care cost savings. Varying the surgical setting (operating room versus procedure room) and type of anesthesia (local-only, monitored anesthesia care, or monitored with regional or general anesthesia) may affect total operative costs. METHODS Patients who underwent an isolated unilateral dorsal wrist ganglion cyst excision between January of 2014 and October of 2019 at a single academic medical center were identified by CPT code. The total direct costs for each surgical encounter that met inclusion criteria were calculated. The relative total direct costs were compared between surgical setting and anesthesia type groups. Univariate and multivariable gamma regression models were used to identify factors associated with surgical costs. RESULTS A total of 192 patients were included; 26 cases (14 percent) were performed in the procedure room and 166 cases (86 percent) were performed in the operating room. No significant differences in demographic factors were identified between groups. Univariate analysis demonstrated that use of operating room/monitored anesthesia care, operating room/monitored anesthesia care with regional anesthesia, and operating room/general anesthesia groups, as compared to procedure room/local-only, yielded significantly greater median costs (1.76-, 2.34-, and 2.44-fold greater, respectively). Multivariable analysis demonstrated 1.80-, 2.10-, and 2.31-fold greater costs with use of operating room/monitored anesthesia care, operating room/monitored anesthesia care with regional anesthesia, and operating room/general anesthesia relative to procedure room/local-only, respectively. CONCLUSION Performing dorsal wrist ganglion cyst excisions in a procedure room with local-only anesthesia minimizes operative direct costs relative to use of the operating room and other anesthetic types.
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21
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Fan Z, Chang L, Su X, Yang B, Zhu Z. Treatment of Mucous Cyst of the Distal Interphalangeal Joint With Osteophyte Excision and Joint Debridement. Front Surg 2022; 8:767098. [PMID: 35145989 PMCID: PMC8821517 DOI: 10.3389/fsurg.2021.767098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Mucous cyst of the distal interphalangeal joint (DMC) or interphalangeal connection of the thumb is common in middle-aged and elderly people, and it often occurs in the fingers of people with osteoarthritis (OA). Although there are many conservative treatments, DMC is usually treated by surgery. The common complications of surgical treatment are recurrence of DMC and skin necrosis. This article introduces the method and clinical effect of osteophyte excision and joint debridement in the treatment of DMC of the distal interphalangeal (DIP) joint. Methods In total, 19 cases of affected fingers made an 'S' incision in the DIP joint under local anesthesia to remove the osteophyte of the DIP joint, clean the dorsal joint capsule, wash the joint, and retain only the bilateral collateral ligament and extensor tendon device. It is suspected that the injured finger of the extensor tendon should be protected by external fixation. Results Out of 15 patients, 1 patient presented with partial skin necrosis that healed after dressing changes while the other patients recovered well. The visual analog scale (VAS) scores of all affected fingers after surgery were lower than those before the surgery (VAS score: 4.93 ± 0.88 vs. 4.07 ± 1.03, p < 0.05). The range of motion (ROM) of the affected finger decreased in one patient, and the post-operative activity of the other fingers increased in varying degrees (ROM: 67.60 ± 5.40 vs. 71.27 ± 7.06, p > 0.05). Conclusions Using osteophyte excision and joint debridement to treat DMC can avoid skin necrosis caused by cyst removal and can avoid the recurrence of DMC to the greatest extent, so it is a safe and effective way of treatment.
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Affiliation(s)
- Zhiyi Fan
- Department of Hand Surgery, The Second Hospital of the Jilin University, Changchun, Jilin, China
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Li Chang
- Department of Pathology, The Second Hospital of Jilin University, Jilin, China
| | - Xing Su
- Department of Thrombosis and Hemostatic, State Key Laboratory of Experimental Hematology, Tianjin Clinical Research Center of Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Binbin Yang
- Office of Academic Research, Wenzhou Medical University, Wenzhou, China
| | - Zhe Zhu
- Department of Hand Surgery, The Second Hospital of the Jilin University, Changchun, Jilin, China
- *Correspondence: Zhe Zhu
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22
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Yousaf A, Muhammad S, Zahra U, Ghaffar F, Atiq A, Elsayed N, Ghaffar MS, Yousaf S, Elsyaed AM, Alam SI. Intratendinous Ganglionic Cyst of Semimembranosus: A Rare Cause of Thigh Swelling. Cureus 2022; 14:e20959. [PMID: 35154938 PMCID: PMC8815441 DOI: 10.7759/cureus.20959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/05/2022] Open
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23
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Park E, Jeong S, Hyeong J, Min S, Kim K, Kim K. A case of digital mucous cyst occurred after organising thrombus. Indian J Dermatol 2022; 67:95. [PMID: 35656259 PMCID: PMC9154174 DOI: 10.4103/ijd.ijd_391_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Choi JY, Park HJ, Kim JN, Kim MS, Choi YJ, Shin HK, Son ES. Intra- and extra-capsular ganglia at the gastrocnemius origin and association with meniscal tears and severity of osteoarthritis of the knee joint. Acta Radiol 2021; 64:237-243. [PMID: 34962181 DOI: 10.1177/02841851211068268] [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: 11/17/2022]
Abstract
BACKGROUND The association between size of ganglia or type of ganglia (intra-articular or extra-articular) and meniscal tears or severity of the osteoarthritis (OA) is not evaluated. PURPOSE To evaluate the prevalence, size, and location of intra- and extra-capsular ganglia at the gastrocnemius origin and to assess their associations with meniscal injury and grades of OA. MATERIAL AND METHODS This study included 301 consecutive patients who had knee pain and had undergone magnetic resonance imaging (MRI) of the knee. We evaluated presence of ganglia at the gastrocnemius muscle origin site and diagnosed whether it was an intra-capsular located or mixed-capsular located (intra-capsular and extra-capsular) and then measured the diameter of each ganglion. After two weeks, we evaluated whether articular cartilage injury existed. The presence of a meniscal tear was also recorded. RESULTS A total of 186 patients (93%) had intra- and extra-capsular ganglia. Intra-capsular ganglia were found in 183 cases (91%) and mixed-capsular ganglia were found in 16 cases (8%). In cases with intra- and extra-capsular ganglia, more meniscal tears were found (P = 0.029). Intra-capsular ganglia showed more meniscal tears (P = 0.021). Intra-capsular ganglia were more likely to have high-grade OA (P = 0.043). Patients who had a meniscal tear displayed larger-sized ganglia, especially of the intra-capsular type (P = 0.044). CONCLUSION Patients with intra- and extra-capsular ganglia, especially of the intra-capsular type, are more likely to have meniscal injury and more severe OA. Patients with a meniscal tear or OA are more likely to have larger intra- and extra-capsular ganglia, especially of the intra-capsular type.
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Affiliation(s)
- Jin Young Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hun Kyu Shin
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Seok Son
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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25
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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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26
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Thapa P, Lakhey RB. Successful Outcome of Transfixation Technique with Linen in Dorsal Wrist Ganglion: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:1150-1154. [PMID: 35199766 PMCID: PMC9124335 DOI: 10.31729/jnma.6574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Ganglion is a commonly encountered soft tissue tumor. Most commonly patients seek treatment for cosmetic issues. There are a variety of treatment options available but very few are effective and cosmetically acceptable. Common treatment techniques have either high recurrence rates or have complications. Treatment by transfixation with linen suture under local anaesthesia on an outpatient basis is an upcoming treatment. The objective of the study is to find out the prevalence of successful outcome of transfixation techniques in treatment of dorsal wrist ganglion. METHODS This study is a descriptive cross-sectional study undertaken at a tertiary care center from November 2018 to May 2020. Ethical approval was taken from the same institution. Convenient sampling method was used. Patients presenting with dorsal wrist ganglion and consenting for the transfixation underwent the procedure. All the patients were operated under local anesthesia. Statistical analysis was done using Statistical Package for Social Sciences version 24.0. Point estimate was done at 95% Confidence Interval and frequency and percentage were calculated. RESULTS Out of 30 cases, 29 (96.66%) have got successful outcomes with transfixation techniques. Among 30 patients, recurrences were seen in 2 (6.66%) cases. Patient satisfaction was high in 27 (90 %) cases. No complication was encountered. CONCLUSIONS Transfixation technique had good results in terms of low recurrence rate, percentage resolution in size and high patient satisfaction.\ Keywords: ganglion cyst; treatment; minimally invasive.
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Affiliation(s)
- Pralhad Thapa
- Department of Orthopedics and Trauma Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine Maharajgunj, Kathmandu, Nepal
| | - Rajesh Bahadur Lakhey
- Department of Orthopedics and Trauma Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine Maharajgunj, Kathmandu, Nepal
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Mohty KM, Lashkari N, Gittings DJ, Bell JA, Stevanovic M, Nicholson LT. Utilizing Google Trends to Track Online Interest in Elective Hand Surgery During the COVID-19 Pandemic. Cureus 2021; 13:e17313. [PMID: 34567866 PMCID: PMC8451539 DOI: 10.7759/cureus.17313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Elective hand surgery encompasses a large volume of orthopaedic cases annually. Carpal tunnel syndrome, ganglion cysts, and trigger digits are some of the most common pathologies treated by hand surgeons. In the midst of the COVID-19 pandemic, patient's interest in elective hand surgery for these conditions is uncertain. The objective of this study is to use Google Trends to track online interest in elective hand surgery in the United States during the COVID-19 pandemic. Methods Online search trends regarding elective orthopaedic hand surgery were obtained via Google Trends from November 2019 to November 2020. Three common hand pathologies in lay terms ("carpal tunnel," "‘ganglion cyst’ + ‘wrist cyst,’" and "trigger finger") and three hand surgery-specific keywords ("hand surgery," "carpal tunnel surgery," and "trigger finger surgery") were used as search terms. The search volume index (SVI) graphs for the United States for both sets of search terms were then generated from the Google Trends data and compared to the seven-day average of new COVID-19 cases per day as reported by the CDC. A separate SVI graph was then created for the search term "coronavirus” and was compared against both sets of search terms as above. Results Search trends for all elective hand pathologies and surgery-specific keywords remained constant from November 2019 to the beginning of March 2020 and then decreased significantly within a one-month period following the peak in COVID-19 cases the week of March 15, 2020. Search trends for these keywords increased to baseline levels over the next few months. The search trend for "coronavirus" demonstrated a small search volume index peak of 13 during January 2020 followed by the maximum peak of 100 during the week of March 15, 2020, corresponding to the decrease in search trends of elective hand surgery at that time. Conclusions Online interest in elective hand surgery remained constant prior to the COVID-19 pandemic; however, there was a marked decrease in search trends of elective hand surgery with the rise in daily reported COVID-19 cases, suggesting that patient's interest in elective hand surgery decreased with the onset of the pandemic.
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Affiliation(s)
- Kurt M Mohty
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - Nassim Lashkari
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - Daniel J Gittings
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - Jennifer A Bell
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - Milan Stevanovic
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA
| | - Luke T Nicholson
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, USA
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Unusual Presentation of Extensor Tendon Rupture Caused by a Dorsal Wrist Synovial Cyst. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3664. [PMID: 34422510 PMCID: PMC8376377 DOI: 10.1097/gox.0000000000003664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Abstract
Synovial cysts are juxta-articular-fluid–filled collections that are lined by synovial cells, distinguishing them from a very close cystic lesion, which is the ganglion cyst. They usually present with pain and unpleasant appearance; here we present a case of wrist synovial cyst that caused extensor tendon rupture. A 50-year-old woman presented to our clinic with a cystic lesion on the dorsum of her wrist, with an inability to extend her index finger. The lesion was found intraoperatively engulfing the extensors of the index and causing a rupture. The cyst was excised and the tendon was reconstructed; pathology report confirmed the lesion as synovial cyst. Synovial cysts and ganglion cysts are two different entities but they have been used interchangeably in the literature; pathology is the only way to differentiate between them because they usually present with identical scenarios. None of them were reported to cause extensor tendon rupture, as presented in our article. Synovial cysts can cause rupture to extensor tendons if they arise from the sheath, and it is better to anticipate synovial cyst and remove it surgically before causing any further damage, if the lesion appeared to rise from the tendon sheath on further imaging.
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Percutaneous ultrasound-guided ganglion fenestration in children: initial results. Skeletal Radiol 2021; 50:1169-1175. [PMID: 33156396 DOI: 10.1007/s00256-020-03662-y] [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: 06/23/2020] [Revised: 10/17/2020] [Accepted: 10/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate our pediatric experience with percutaneous ultrasound-guided fenestration of ganglia (PUGG). MATERIALS AND METHODS Retrospective study of pediatric patients who underwent PUGG from June 2016 to October 2018 at a free-standing tertiary referral academic children's hospital with a minimum of 6 months follow-up. Electronic medical records, picture archiving system, and post-procedural calls were utilized for patient demographics, lesion characteristics, procedure details, and recurrence. The procedure itself consisted of assessment by Child Life, application of topical anesthetic cream, sterile preparation and draping, and intra-procedural ultrasound guidance for local anesthetic instillation, ganglion aspiration, fenestration, and intra-remnant steroid instillation. Post-procedure care included an ice pack, compression dressing for 48 h, and 4 weeks of brace wear and activity restriction. RESULTS Forty-five patients met the inclusion criteria, ages 3-18 years, mean 13.5 years, and female to male ratio of 2:1. Ganglion locations consisted of 80% (36/45) in the wrist and 20% (9/45) in other locations (elbow, ankle, and foot). Ninety-eight percent (44/45) of procedures were performed non-sedated, including 20% (9/44) between ages 7 and 11 years. 28.9% (13/45) of ganglia recurred, the earliest at 3 weeks, the latest at 10 months, and an average of 3 months' time. No complication occurred and no patients required post-procedural narcotics or Emergency Department visitation for pain control. CONCLUSION Percutaneous ultrasound-guided fenestration of ganglia (PUGG) is a safe, minimally invasive alternative to surgical excision in the pediatric population, which can be performed without sedation and does not leave a scar.
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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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Miyazawa R, Miyawaki S, Yamada K, Amemiya S, Ikemura M, Hinata M, Uchikawa H, Shiode T, Kin T, Takai K, Nakatomi H, Saito N. Retro-odontoid Pseudotumor: Two Cases of Intradural Ganglion Cysts Arising From the Odontoid Process with Syringobulbia. World Neurosurg 2020; 144:148-153. [PMID: 32827740 DOI: 10.1016/j.wneu.2020.08.120] [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: 06/09/2020] [Revised: 08/16/2020] [Accepted: 08/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ganglion cysts mostly occur in the knuckles and wrists, but they rarely present in the odontoid process and can cause neurological symptoms by compressing the spinal cord. They are mostly localized in the epidural space, but may very rarely appear in the intradural space. There are no reports of cases of intradural ganglion cyst involving syringobulbia. CASE DESCRIPTION We report the presentation and management of 2 cases of an intradural ganglion cyst of the odontoid process. Several treatment options for ganglion cysts of the odontoid process have been reported, such as rest and use of a neck collar, posterior decompression and fusion, and transoral anterior decompression. Because our 2 cases progressed rapidly and had severe neurological symptoms, surgical treatment was performed for rapid decompression and definitive pathological diagnosis. The mass was resected as much as possible using the lateral occipital fossa approach, and the operation was completed without dissection of the brain stem or manipulation of the syringobulbia. Postoperatively, neurological symptoms promptly improved, and the syringobulbia reduced. CONCLUSIONS For intradural ganglion cysts with syringobulbia, we suggest relief of the compression by resection of the mass and treatment of the syringobulbia in 2 stages, if necessary, to avoid the risk of damage to the brainstem.
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Affiliation(s)
- Ryota Miyazawa
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Miyawaki
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Keisuke Yamada
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiori Amemiya
- Department of Radiology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masako Ikemura
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Munetoshi Hinata
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Uchikawa
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketo Shiode
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taichi Kin
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Abstract
INTRODUCTION Ganglion cysts represent the most common benign soft-tissue masses of the hand and wrist, most are treated nonoperatively, with relatively few local recurrences. Few studies have identified risk factors for recurrence in the pediatric population. The aim of this study is to identify risks of cyst recurrence and to establish if ultrasonographic imaging aids in the prediction of recurrence. METHODS A single-center retrospective chart review was performed, identifying patients diagnosed with a ganglion cyst of the hand or wrist. Demographic information, cyst characteristics, and ultrasound examination reports were documented. Standard statistical and logistic regression analyses were performed. RESULTS A total of 132 cysts were identified in 126 patients and the average age was 8.5 years old. The most common location was the dorsal wrist (57/132, 43.2%). There were 14 recurrences [11/14, (79%) dorsal wrist, 3/14 (21%) volar wrist, 0/14 (0%) in nonwrist locations]. The risk of recurrence was significantly greater for dorsal wrist cysts than nonwrist locations (odds ratio=18.1; 95% confidence interval: 1.02, 316.65; P=0.048); there was no statistical difference in recurrence rates between dorsal and volar cysts (P=0.15). Recurrence was noted in older patients (12.2 vs. 8.1 y, P<0.001) and those patients with painful masses (P=0.02). Patients undergoing surgical excision had a higher risk of recurrence than those who did not undergo surgical excision (P<0.001). Cyst volume as measured by ultrasound was performed in 37 cysts, with repeat ultrasounds in 12 cases demonstrating a decreased volume of 0.85 cm at baseline to 0.35 cm with repeat examination (P=0.40). In patients that received at least 1 ultrasound, there were no differences in cyst volume between those that recurred and those that did not (P=0.40). CONCLUSIONS Risk factors for recurrence in pediatric patients with a ganglion cyst include older age, symptomatic masses, cysts located around the wrist, and those requiring surgical excision. Ultrasound examination of cyst volume did not predict recurrence. LEVEL OF EVIDENCE Level III-therapeutic.
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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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Bonney's blue dye for occult ganglion cyst removal: Technical Note. JPRAS Open 2020; 24:77-78. [PMID: 32426443 PMCID: PMC7225368 DOI: 10.1016/j.jpra.2020.03.006] [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: 03/14/2020] [Accepted: 03/27/2020] [Indexed: 11/26/2022] Open
Abstract
We describe a technique using Bonney's blue dye for occult ganglion cyst removal that can help reduce incision size, extent of dissection and operative time, as well as predicting the likely success of surgery based on location of the ganglion relative to the blue dye.
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Ganglion of the Sternoclavicular Joint: A Rare Location of an Uncommon Pediatric Mass. Case Rep Radiol 2020; 2020:2035756. [PMID: 32280551 PMCID: PMC7140122 DOI: 10.1155/2020/2035756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/12/2020] [Indexed: 11/17/2022] Open
Abstract
This is a case of a two-year-old boy with a ganglion arising from the sternoclavicular joint. Ganglia are rare in the pediatric population, with less than 2% occurring under the age of 2 years old. Additionally, sternoclavicular joint ganglia are also exceedingly rare. The case illustrates the importance of keeping ganglion within the differential diagnosis for palpable subcutaneous masses, even in young children, especially when they are seen to connect to the joint.
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Kamer AP, Bonnin JM, Spinner RJ, Cohen-Gadol AA. Ganglion cyst of the temporomandibular joint with intradural extension: case report. J Neurosurg 2020; 132:700-704. [PMID: 30738406 DOI: 10.3171/2018.10.jns182665] [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: 09/13/2018] [Accepted: 10/26/2018] [Indexed: 11/06/2022]
Abstract
Intracranial extension of temporomandibular joint (TMJ) ganglion cysts is very rare. Two previously reported cases presented clinically due to effects on cranial nerves and had obvious association with the TMJ on imaging. To the authors' knowledge, intracranial extension of a TMJ ganglion cyst presenting with seizures and mimicking a primary brain tumor has not been previously reported. The patient underwent resection of a presumptive primary cystic temporal lobe tumor, but the lesion had histopathological features of a nonneoplastic cyst with a myxoid content. He was followed with serial imaging for 5 years before regrowth of the lesion caused new episodes of seizures requiring a repeat operation, during which the transdural defect was repaired after the adjacent segment of the TMJ was curetted. A thorough review of all imaging studies and the histopathological findings from the repeat operation led to the correct diagnosis of a TMJ ganglion cyst. This case highlights an unusual presentation of this rare lesion, as well as its potential for recurrence. TMJ ganglion cysts should be included in the differential diagnosis of cystic tumors involving the anterior temporal lobe, presenting with or without seizures. Focused imaging evaluation of the TMJ can be helpful to rule out the possible role of associated TMJ lesions.
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Affiliation(s)
| | - Jose M Bonnin
- 2Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert J Spinner
- 3Department of Neurologic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and
| | - Aaron A Cohen-Gadol
- 4Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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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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Abstract
Benign peripheral nerve tumors encompass a wide range of neoplasms and non-neoplastic tumor like lesions. Some of these lesions if not encountered in the setting of genetic syndromes, are occurring sporadically. The principles of oncology should be respectfully followed in every step of diagnostic approach and surgical management. Albeit, classified as benign, some of them do have different level of malignant potential, thus the treating physicians should be aware of that to avoid possible pitfalls with devastating outcomes. This article reviews the most common benign peripheral nerve tumors discussing the clinicopathological findings, imaging appearance and the current trend in their approach.
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Affiliation(s)
- Zinon T Kokkalis
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Rio-Patras, Greece.
| | - Nikolaos A Stavropoulos
- Second Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Konstantopouleio General Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Andreas Panagopoulos
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Rio-Patras, Greece
| | - Panayotis N Soucacos
- "Panayotis N. Soucacos" Orthopaedic Research & Education Center (OREC), National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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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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Zhang A, Falkowski AL, Jacobson JA, Kim SM, Koh SH, Gaetke-Udager K. Sonography of Wrist Ganglion Cysts: Which Location Is Most Common? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2155-2160. [PMID: 30592543 DOI: 10.1002/jum.14912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The literature states that wrist ganglion cysts are most commonly dorsal; however, our experience suggests a volar location is more common. The purpose of this study was to identify the locations of ganglion cysts of the wrist as imaged with sonography. METHODS After Institutional Review Board approval with informed consent waived, retrospective review of wrist sonography reports from January to April 2016 was completed. Only patients who had a comprehensive evaluation that included the dorsal and volar wrist were included. Ultrasound images were reviewed to characterize wrist ganglion cysts. RESULTS The study group consisted of 98 subjects (78% female, 22% male) (median age, 51 years; range 13-79) with 124 wrist ganglion cysts, where 69% (86 of 124) were volar and 31% (38 of 124) were dorsal. Ganglion cysts were located between the radial artery and flexor carpi radialis in 63% (78 of 124), followed by a dorsal location superficial to the scapholunate ligament in 20% (25 of 124), other dorsal locations in 11% (13 of 124), and other volar locations in 6% (8 of 124). With dorsal ganglion cysts, the scapholunate ligament when imaged appeared normal in 91% (20 of 22). Ganglion cysts were multilocular/multilobular in all subjects. CONCLUSIONS The most common location for wrist ganglion cysts is in the volar wrist, particularly between the radial artery and flexor carpi radialis tendon, appearing multilocular or multilobular with a mean largest dimension of 1.0 cm. Given the propensity of ganglion cysts to occur at this site, attention to this area when imaging the wrist with sonography or magnetic resonance imaging should be considered.
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Affiliation(s)
- Andrew Zhang
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna L Falkowski
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sung Moon Kim
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sung Hye Koh
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiology, Hallym Sacred Heart Hospital, Hallym University, College of Medicine, Gyeonggi-do, South Korea
| | - Kara Gaetke-Udager
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
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Gitto S, Lee SC, Miller TT. Ultrasound-guided percutaneous treatment of volar radiocarpal ganglion cysts: Safety and efficacy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:339-344. [PMID: 30888684 DOI: 10.1002/jcu.22724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE To determine the safety and efficacy of ultrasound (US)-guided percutaneous treatment of volar radiocarpal ganglion cysts. METHODS The institutional review board approved the retrospective study of patients referred for US-guided percutaneous treatment of a volar radiocarpal ganglion cyst over a 5-year period. Treatment consisted of a combination of aspiration, lavage using anesthetic, wall fenestration, and steroid injection. Intraprocedural imaging and procedure notes were reviewed. Followup information was retrieved from postprocedure electronic medical records. RESULTS Eighty-eight patients comprised our study group. Complete decompression of the ganglion cyst was achieved in 92% of cases immediately after treatment. There were no instances of hematoma or infection. Of 38 patients with available followup information, 66% had a ganglion cyst recurrence at a median time of 9 months, regardless of their initial size or the injection of steroids. Cysts with internal septa had a statistically significantly higher rate of recurrence (P = 0.033). CONCLUSIONS US-guided percutaneous treatment of volar radiocarpal ganglion cysts is safe and ensures immediate decompression in most cases. However, cysts may recur, even after steroid injection or lavage.
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Affiliation(s)
- Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Susan C Lee
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
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Sconfienza LM, Chianca V, Messina C, Albano D, Pozzi G, Bazzocchi A. Upper Limb Interventions. Radiol Clin North Am 2019; 57:1073-1082. [PMID: 31351537 DOI: 10.1016/j.rcl.2019.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ultrasound has been reported to be a quick, cheap, and effective imaging modality to guide the interventional procedures in the musculoskeletal system. The use of ultrasound results in increased accuracy of needle placement associated with a reduction of complications. In the upper limb, ultrasound-guided procedures are applied to joints and soft tissues around the shoulder, elbow, wrist, and hand. This article reviews the clinical and technical aspects of the most common procedures performed in this anatomic area.
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, Milano 20122, Italy.
| | - Vito Chianca
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, Milano 20122, Italy
| | - Domenico Albano
- Università degli Studi di Palermo, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Via del Vespro, 129, 90127 Palermo, Italy
| | - Grazia Pozzi
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milano 20161, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
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Weinheimer K, Patrick N, Darowish M. Treatment of Distal Interphalangeal Ganglion Cysts by Volar Corticosteroid Injection. Hand (N Y) 2019; 14:381-385. [PMID: 29239251 PMCID: PMC6535951 DOI: 10.1177/1558944717744336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Various options exist for operative and nonoperative treatment of symptomatic distal interphalangeal (DIP) ganglion cysts. We describe the technique and efficacy of a novel treatment of DIP ganglion cysts using a volar, transtendon, intra-articular injection of corticosteroid. METHODS This was a single center, retrospective study (2010-2015) of 21 patients who received a volar, intra-articular corticosteroid injection for treatment of DIP ganglion cysts. The patients were contacted via mailing with a short survey. For those potential study participants who did not respond to the mailing or were not seen in follow-up, contact was made via telephone. The primary study outcome was resolution of the cyst; secondary outcomes included pain and postinjection complications. RESULTS A total of 21 patients (14 female; 7 male) with 23 DIP ganglion cysts were treated in this study. The dominant hand was involved in 56.5% cases. Twelve (52.2%) resolved or had near complete resolution following injection at an average follow-up of 20 months. CONCLUSIONS For patients with DIP ganglion cysts, this newly described technique of volar, transtendon, intra-articular injection of corticosteroid provides a safe and effective treatment. This technique allows for ease and consistency of needle placement for intra-articular corticosteroid delivery while minimizing the potential soft tissue and infection concerns described with other techniques.
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Affiliation(s)
- Kent Weinheimer
- Penn State Health Milton S. Hershey
Medical Center, Hershey, PA, USA
| | - Nathan Patrick
- Penn State Health Milton S. Hershey
Medical Center, Hershey, PA, USA
| | - Michael Darowish
- Penn State Health Milton S. Hershey
Medical Center, Hershey, PA, USA,Michael Darowish, Department of Orthopaedic
Surgery, Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive, PO
Box 859, Hershey, PA 17033, USA.
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Interventional therapeutic procedures to treat degenerative and inflammatory musculoskeletal conditions: state of the art. Radiol Med 2019; 124:1112-1120. [PMID: 30828775 DOI: 10.1007/s11547-019-01018-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
Imaging-guided interventional procedures have become increasingly popular in the treatment of several pathologic conditions in the musculoskeletal system. Besides oncological treatments, musculoskeletal procedures can be performed to treat different degenerative or inflammatory conditions. This paper is aimed to review clinical indications and technical aspects of these kinds of procedures. In particular, we revise the general aspects common to most procedures and the different imaging-guided interventions which can be performed around joints, soft tissues, and spine.
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Wu CH, Chiu YC, Yu SW, Kao FC, Tu YK, Ma CH. Arthroscopic excision of wrist ganglions: does trans-cystic or cystic-sparing portal technique affect clinical outcomes? Arch Orthop Trauma Surg 2019; 139:361-367. [PMID: 30225565 DOI: 10.1007/s00402-018-3036-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The preliminary results of arthroscopic wrist ganglionectomy were contradictory. The approach used for the arthroscopic excision of wrist ganglions may play an important role. We analyzed two surgical approaches for arthroscopic excision of wrist ganglions. MATERIALS AND METHODS Between April 2009 and October 2014, 49 patients with wrist ganglions who underwent arthroscopic excision in our institute were retrospectively classified into two treatment groups, namely the trans-cystic portal technique (TCP) and cyst-sparing portal technique (CSP). The visual analog scale (VAS), Mayo wrist scores, and disabilities of the arm, shoulder, and hand (DASH) scores were measured for clinical assessment. Recurrence, residual pain, and complications were evaluated at follow-up. RESULTS No significant differences were found between the groups in terms of demographic data, and preoperative clinical assessment, as well as with regard to postoperative VAS score (p = 0.898), Mayo wrist score (p = 0.526), DASH score (p = 0.870), recurrence (p = 0.491), residual pain (p = 0.690), and complications (p = 0.352). Recurrence was found in 2 of the 47 patients and they were both in the CSP group. At the final follow-up, residual pain was found in four patients in the TCP group and three in the CSP group. CONCLUSIONS For performing arthroscopic resection of wrist ganglions, both techniques are safe regarding the complication rates. In recurrence rate, no significant difference was found between the two groups, but no recurrence was observed when the TCP technique was used.
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Affiliation(s)
- Chin-Hsien Wu
- Department of Orthopedics, E-Da Hospital/I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung, 824, Taiwan, Republic of China
| | - Yen-Chun Chiu
- Department of Orthopedics, E-Da Hospital/I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung, 824, Taiwan, Republic of China
| | - Shang-Won Yu
- Department of Orthopedics, E-Da Hospital/I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung, 824, Taiwan, Republic of China
| | - Feng-Chen Kao
- Department of Orthopedics, E-Da Hospital/I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung, 824, Taiwan, Republic of China
| | - Yuan-Kun Tu
- Department of Orthopedics, E-Da Hospital/I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung, 824, Taiwan, Republic of China
| | - Ching-Hou Ma
- Department of Orthopedics, E-Da Hospital/I-Shou University, No. 1, E-Da Road, Yan-Chau District, Kaohsiung, 824, Taiwan, Republic of China.
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Lewallen LW, Spinner RJ, Amrami KK, Kakar S. Adventitial cysts of the radial artery are joint connected. Clin Anat 2018; 32:201-205. [DOI: 10.1002/ca.23271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/03/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Laura W. Lewallen
- Department of OrthopedicsMayo Clinic, Division of Hand Surgery Rochester Minnesota
| | - Robert J. Spinner
- Department of OrthopedicsMayo Clinic, Division of Hand Surgery Rochester Minnesota
- Department of NeurosurgeryMayo Clinic Rochester Minnesota
| | | | - Sanjeev Kakar
- Department of OrthopedicsMayo Clinic, Division of Hand Surgery Rochester Minnesota
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Isolated medial plantar neuropathy caused by a large ganglion cyst diagnosed with MRI: A case report. Int J Surg Case Rep 2017; 42:200-203. [PMID: 29274601 PMCID: PMC5773471 DOI: 10.1016/j.ijscr.2017.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 11/21/2022] Open
Abstract
Compression neuropathy caused by a ganglion cyst is a rare entity. MRI remains an excellent diagnostic modality to evaluate the masses in the foot. This is a very rare report of isolated medial plantar neuropathy by a ganglion cyst.
Introduction Although ganglion cysts are common soft tissue tumors, nerve compression syndrome caused by a ganglion cyst in the lower extremities is very rare. Herein, we report a 57-year-old man who presented with hypoesthesia in the sole of his right foot for 6 months. We believe that reporting this rare case will help clinicians update their knowledge on possible causes of the plantar neuropathy, and avoid diagnostic delay. Presentation of case The patient had pain and numbness in the inner right sole, as well as a tingling and dull sensation. Tenderness around the area of abnormal sensation was not evident. Percussion at the abductor tunnel gave a positive Tinel’s sign in the medial plantar nerve. No mass was palpable in the right foot. Based on the electrophysiological findings, we diagnosed medial plantar nerve entrapment in the right foot. Magnetic resonance imaging (MRI) was conducted to identify a 5.5-cm long elongated cystic lesion as the cause of entrapment. The patient underwent surgical removal of the cystic mass, with histologic examination confirming the diagnosis of a large ganglion cyst. Discussion The feasibility of nerve conduction studies and electromyography for detection of nerve entrapment is still controversial. MRI is considered the best diagnostic modality, if biopsy is not feasible. Conclusion We suggest that foot imaging and electrophysiological studies should be considered for patients with isolated median plantar neuropathy to exclude the presence of space-occupying lesions, especially when conservative treatment is not effective.
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Ganglión de la articulación radiocubital distal: un cistadenoma apocrino. REPERTORIO DE MEDICINA Y CIRUGÍA 2017. [DOI: 10.1016/j.reper.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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49
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Tumors of the hand. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:747-762. [DOI: 10.1007/s00590-017-1984-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/30/2017] [Indexed: 12/15/2022]
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50
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Takahisa O, Yasuhiro S, Shinichi S. Arthroscopic ganglionectomy of a toe with color-aided visualization of the ganglion stalk. Foot (Edinb) 2017; 31:40-43. [PMID: 28544913 DOI: 10.1016/j.foot.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/11/2016] [Accepted: 02/16/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Ogawa Takahisa
- Suwa Central Hospital, Department of Orthopedics, 4300 Tamagawa, Chino-City, Nagano 391-8503, Japan.
| | - Seki Yasuhiro
- Suwa Central Hospital, Department of Orthopedics, 4300 Tamagawa, Chino-City, Nagano 391-8503, Japan
| | - Shirasawa Shinichi
- Suwa Central Hospital, Department of Orthopedics, 4300 Tamagawa, Chino-City, Nagano 391-8503, Japan
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