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Lee KH, Huang HK, Wang JP. A Modified Approach for Arthroscopic Excision of Dorsal Midcarpal Ganglion Cysts Using Radiocarpal Portals. Tech Hand Up Extrem Surg 2024; 28:12-15. [PMID: 37694879 DOI: 10.1097/bth.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Wrist arthroscopy could be a treatment option for dorsal ganglion cysts. To achieve a thorough dorsal capsulectomy for the removal of midcarpal ganglion cysts, it is commonly necessary to combine both the radiocarpal and midcarpal portals. We present a modified method using radiocarpal portals only for arthroscopically excising dorsal midcarpal ganglion cysts. No extra midcarpal portals are necessary, and the method potentially generates satisfactory results.
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Affiliation(s)
- Kun-Han Lee
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Departments of Orthopaedics
| | - Hui-Kuang Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi
- Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Departments of Orthopaedics
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2
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Çankal F, Demir BT. Infrapatellar ganglion cyst extending under the skin through a defect in the lateral patellar retinaculum. Br J Hosp Med (Lond) 2024; 85:1-3. [PMID: 38416521 DOI: 10.12968/hmed.2023.0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Fatih Çankal
- Faculty of Medicine, Department of Radiology, Pursaklar Hospital, Ankara, Turkey
- Faculty of Medicine, Department of Anatomy, Ankara Medipol University, Ankara, Turkey
| | - Berin Tuğtağ Demir
- Faculty of Medicine, Department of Anatomy, Ankara Medipol University, Ankara, Turkey
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3
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Domack AM, Regmi A, Leonetti JP. Ganglion Cyst Presenting as an External Auditory Canal Mass. Ear Nose Throat J 2024; 103:84-86. [PMID: 34409866 DOI: 10.1177/01455613211041414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A ganglion cyst of the temporomandibular joint is a benign lesion that may present as a mass on the anterior wall of the external auditory canal and should be differentiated from other skull base pathology prior to management.
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Affiliation(s)
- Aaron M Domack
- Department of Otolaryngology-Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Aayushma Regmi
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - John P Leonetti
- Department of Otolaryngology-Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA
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4
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Kim N. Intraneural ganglion cyst of the peroneal nerve occurring after coronavirus disease-19 vaccination: A case report. Hum Vaccin Immunother 2023; 19:2265657. [PMID: 37818712 PMCID: PMC10569341 DOI: 10.1080/21645515.2023.2265657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
Ganglion cysts are relatively common, but intraneural ganglion cysts (INGCs) within peripheral nerves are rare and poorly understood. We present the case of a 58-year-old woman who presented with acute right-foot drop. She experienced acute knee pain radiating from the lateral leg to the dorsal foot two days after the first coronavirus disease-19 (COVID-19) vaccination (BNT162b2, Pfizer-BioNTech). She had no history of trauma or medication use. Two weeks after the onset of symptoms, she developed a dorsiflexor weakness of the right foot (Medical Research Council grade, poor). The weakness worsened to a "trace" grade despite providing conservative management for one month. Ultrasonography revealed a fusiform echolucent structure within the course of the right common peroneal nerve around the fibular head. Magnetic resonance imaging revealed multiple intraneural cysts within the right common peroneal nerve. Nerve conduction and electromyographic studies revealed multiphasic motor unit action potentials accompanied by abnormal spontaneous activities in the innervated muscles, along with axonal degeneration of the deep peroneal nerves. Surgical removal of the cyst was performed, and the patient's symptoms gradually improved. Pathological examination revealed a cystic structure containing mucinous or gelatinous fluid and lined with flattened or cuboidal cells. The clinical course and sequential electromyographic findings relevant to this symptomatic cyst were temporally related to the vaccination date. The present case suggests that INGC-induced peroneal palsy is a possible complication after COVID-19 vaccination.
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Affiliation(s)
- Nackhwan Kim
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea
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5
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Krishnan P, Dineshkumar T, Divya B, Krishnan R, Rameshkumar A. Ganglion cyst of temporomandibular joint - A systematic review. Ann Diagn Pathol 2023; 67:152212. [PMID: 37748213 DOI: 10.1016/j.anndiagpath.2023.152212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
Ganglion cyst of the temporomandibular joint (TMJ) is an uncommon pathology with uncertain etiology. There is no consensus on their management. The current systematic review aimed to discuss the clinical and histopathological features of ganglion cysts of TMJ, to aid in appropriate treatment. A literature search was done and a total of 20 cases were retrieved from published databases such as PubMed, SCOPUS, and Google Scholar. The cyst presented with swelling in all the cases followed by pain (50 %) and trismus (35 %) as other common symptoms. Though CT and MRI proved helpful in determining the location of the cyst, a histopathological examination was essential in concluding its final diagnosis. It is a pseudocyst lined by dense fibro-connective tissue with myxoid tissue degeneration. Histologically, it is essential to distinguish them from the clinically and radiographically similar true cyst of TMJ, synovial cyst. The lining of ganglion cyst is devoid of epithelium and synovial cells. Surgical excision was found to be the treatment of choice with minimal recurrence (10 %) being reported.
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Affiliation(s)
- Padmajaa Krishnan
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
| | - Thayalan Dineshkumar
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
| | - Bose Divya
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India.
| | - Rajkumar Krishnan
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
| | - Annasamy Rameshkumar
- Department of Oral Pathology & Microbiology, SRM Dental College, Ramapuram, Chennai 600089, India
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Ayik Ö, Demirel M, Uğurlar M, Özçelik İB. Arthroscopic Dorsal Ligamentocapsulodesis in the Treatment of Occult Dorsal Wrist Ganglion Cysts Associated with Scapholunate Instability: Surgical Technique and Preliminary Clinical Results. J Hand Surg Asian Pac Vol 2023; 28:677-684. [PMID: 38084403 DOI: 10.1142/s2424835523500716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Background: This study aimed to evaluate our preliminary results and experience with the arthroscopic dorsal ligamentocapsulodesis in managing occult dorsal wrist ganglion cysts (ODGCs) associated with scapholunate (SL) instability. Methods: All patients who underwent arthroscopic dorsal ligamentocapsulodesis due to an ODGC with concomitant SL ligament tear were retrospectively reviewed. In addition to demographic data and length of follow-up, outcomes data that included range of motion, grip strength, modified Mayo wrist score (MMWS), complications and radiographs were collected. Results: The study included 18 patients (18 wrists; 10 female and 8 male). The mean age was 32 years (range: 19-48) and the mean follow-up was 34 months (range: 24-48). The mean preoperative extension deficit decreased from 5.5° (range: 0°-20°) to 2.7° (range: 0°-15°) at the final follow-up (p = 0.004). The mean preoperative flexion deficits decreased from 4.4° (range: 0°-15°) to 2.2° (range: 0°-10°) postoperatively (p = 0.003). The mean hand grip strength significantly increased from 27.7 kg (range: 22-36) to 38.3 kg (range: 31-46) at the final follow-up assessment (p < 0.001). The mean MMWS improved from 46 (range: 25-65) pre-operatively to 91 (range: 70-100) at the final follow-up (p = 0.0002). No major intra- or postoperative complications were observed. Conclusions: SL instability may have an important role in the aetiology of ODGCs, and arthroscopic dorsal ligamentocapsulodesis can provide pain relief and functional improvement without recurrence at the short- to mid-term follow-up in the treatment of ODGCs. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Ömer Ayik
- Department of Orthopedics and Traumatology, İstanbul School of Medicine, İstanbul University, Istanbul, Turkey
| | - Mehmet Demirel
- Department of Orthopedics and Traumatology, İstanbul School of Medicine, İstanbul University, Istanbul, Turkey
| | - Meriç Uğurlar
- Department of Orthopaedics and Traumatology, Kolan Hospital, İstanbul, Turkey
| | - İsmail Bülent Özçelik
- Department of Orthopedics and Traumatology, Gaziosmanpaşa Hospital, Yeni Yüzyıl University, Gaziosmanpaşa, Istanbul, Turkey
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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Tian H, Xia S, Zong B, Li P, Chai L. Clinical efficacy analysis of repairing the medial malleolus canal combined with double incision on the plantar surface for ankle-related ganglion cysts. Minerva Med 2023; 114:891-892. [PMID: 37326954 DOI: 10.23736/s0026-4806.23.08717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Haoran Tian
- Department of Traumatic Orthopedics, The Affiliated Bozhou Hospital of Anhui Medical University, Bozhou, China -
| | - Sheng Xia
- Department of Sports Trauma and Arthroscopic Surgery, The Affiliated Bozhou Hospital of Anhui Medical University, Bozhou, China
| | - Bangyong Zong
- Department of Traumatic Orthopedics, The Affiliated Bozhou Hospital of Anhui Medical University, Bozhou, China
| | - Peng Li
- Department of Traumatic Orthopedics, The Affiliated Bozhou Hospital of Anhui Medical University, Bozhou, China
| | - Leizi Chai
- Department of Traumatic Orthopedics, The Affiliated Bozhou Hospital of Anhui Medical University, Bozhou, China
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9
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Hameleers A, Walbeehm R, Kwee RM, Samijo SK. [Rupture of the flexor carpi radialis tendon after corticosteroid injection of a ganglion cyst]. Ned Tijdschr Geneeskd 2023; 167:D7597. [PMID: 37930170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND Although corticosteroid injections are frequently used in practice to treat tendinopathies, there are many adverse effects. CASE DESCRIPTION A 62-year-old woman received an aspiration and corticosteroid injection of a ganglion on the volar side of the left wrist. A few weeks later, she presented with severe pain and loss of function of the left wrist. On physical examination, here was a notable swelling with hematoma formation, along the course of the flexor carpi radialis. An MRI confirmed complete rupture of the flexor carpi radialis (FCR) tendon. She was treated non operatively with analgesics and a protective brace. During final check-up minimal loss of function was seen. CONCLUSION Cautiousness and judicious restraint are imperative when considering corticosteroid infiltrations targeting a volar ganglion at the level of the FCR. Aspiration combined with corticosteroid infiltration is not recommended for patients exhibiting (subclinical) STT-/CMC-1 osteoarthritis, as it may cause FCR tendon ruptures.
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Affiliation(s)
- Amber Hameleers
- ZuyderlandMedisch Centrum, Afd. Orthopedie, Heerlen
- Contact: Amber Hameleers
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Jover-Sánchez JJ, Cristóbal-Velasco L, Benza-Villarejo E, Maldonado-Morillo AA. Tarsal tunnel ganglion cyst: intraneural or extraneural site? Radiologia (Engl Ed) 2023; 65 Suppl 2:S74-S77. [PMID: 37858356 DOI: 10.1016/j.rxeng.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Intraneural ganglion cysts are very uncommon lesions, whose diagnosis has increased since the articular theory and the description of the MRI findings were established. We present a case report of a 59-year-old man with symptoms of tarsal tunnel syndrome. Foot and ankle MRI demonstrated the presence of an intraneural cystic lesion in the posterior tibial neve and its connection with the subtalar joint through an articular branch. The identification of the specific radiological signs like the «signet ring sign» allowed establishing an adequate preoperative diagnosis, differentiating it from an extraneural lesion and facilitating the articular disconnection of the nerve branch during surgery.
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Affiliation(s)
- J J Jover-Sánchez
- Servicio de Radiodiagnóstico, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
| | - L Cristóbal-Velasco
- Servicio de Cirugía Plástica, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - E Benza-Villarejo
- Servicio de Radiodiagnóstico, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - A A Maldonado-Morillo
- Servicio de Cirugía Plástica, Hospital Universitario de Getafe, Getafe, Madrid, Spain
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12
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Lovaglio AC, Mansilla B, Cejas C, Spinner RJ, Socolovsky M. Femoral intraneural ganglion cyst: the first confirmed case report. Br J Neurosurg 2023; 37:1251-1253. [PMID: 33151109 DOI: 10.1080/02688697.2020.1842853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ganglion cysts affecting nerve are rare causes of neuropathy. The formation of intraneural ganglion cysts, once controversial, has recently been clarified. We describe the first modern description of a femoral intraneural ganglion cyst at the hip region. METHODS A patient presented with a 1 year history of radiating pain, quadriceps weakness and anteromedial leg numbness was found to have a femoral intraneural cyst with a hip joint connection on MRI. RESULTS Surgical disconnection of the articular branch led to improvement of the neuropathy and resolution of the cyst on postoperative MRI. CONCLUSIONS The unifying articular (synovial) theory describes the joint origin of intraneural cysts, even when they occur in unusual locations, and their propagation into the parent nerve. Knowledge of this theory can improve outcomes; surgery needs to address the joint origin or capsulolabral defect lest recurrence ensue.
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Affiliation(s)
- Ana C Lovaglio
- Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Beatriz Mansilla
- Department of Neurosurgery, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Claudia Cejas
- Department of Diagnostic Imaging, Raúl Carrea Foundation for Neurological Research, FLENI, Buenos Aires, Argentina
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mariano Socolovsky
- Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
- Department of Neurosurgery, Raúl Carrea Foundation for Neurological Research, FLENI, Buenos Aires, Argentina
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13
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Lenartowicz K, Howe BM, Amrami KK, Desy NM, Houdek MT, Spinner RJ. Tibial intraneural ganglion cysts at the superior tibiofibular joint treated with joint resection alone: a proof of concept. Acta Neurochir (Wien) 2023; 165:2581-2588. [PMID: 37273006 DOI: 10.1007/s00701-023-05639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Intraneural ganglion cysts involving the tibial nerve are rare. Recent evidence has supported an articular (synovial) theory to explain the joint-related origin of these cysts; however, optimal operative treatment for cysts originating from the STFJ remains poorly understood. Therefore, we present a novel strategy: addressing the joint itself without addressing the articular branch and/or the cyst. METHODS Records of patients with tibial intraneural ganglion cysts with a connection to the STFJ who were treated with a joint resection alone at a single academic institution were reviewed. The clinicoradiographic features, operative intervention, and postoperative course were recorded. RESULTS We identified a consecutive series of 7 patients. These patients (4/7 male, 57%) were 43 (range 34-61) years of age and all presented with symptoms of neuropathy. The patients underwent resection of the synovial surfaces of the STFJ without disconnection of the articular branch or decompression of the cyst. Postoperatively, three patients regained partial motor function (43%, n=7), although four patients noted continued sensory abnormality (57%, 4/7). All six patients with postoperative MRIs had some evidence of regression of the cyst. CONCLUSIONS This novel surgical technique serves as a proof of concept-highlighting the fact that treating the primary source (the joint origin) can be effective in eliminating the secondary problem (the cyst itself). While this study shows that this simplified approach can be employed in select cases, we believe that superior results (faster, fuller recovery) can be achieved with combinations of disconnecting the articular branch, decompressing the cyst, and/or resecting the joint.
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Affiliation(s)
- Karina Lenartowicz
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - B Matthew Howe
- Departments of Radiology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Kimberly K Amrami
- Departments of Radiology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Nicholas M Desy
- Department of Orthopedics, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Matthew T Houdek
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Robert J Spinner
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, 55905, USA.
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, 55905, USA.
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14
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Kasapinova K, Kamiloski V, Atanasovska E, Spasovska K. Outcome Evaluation of Arthroscopic Resection of Dorsal Wrist Ganglia. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:145-153. [PMID: 36987765 DOI: 10.2478/prilozi-2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Goals: Arthroscopic ganglionectomy has become an increasingly popular surgical option for dorsal wrist ganglia. The aim of this study was to describe our technique for the arthroscopic treatment of dorsal wrist ganglia and to evaluate the clinical results as well as the recurrence rate in our patients. Methods: In a prospective study, 48 patients who underwent arthroscopic treatment of dorsal ganglion of the wrist were included. Patients were evaluated preoperatively and 3 and 24 months post arthroscopy. A presence of recurrence at 24 months was recorded. The subjective outcome was evaluated with The Patient-Rated Wrist Evaluation (PRWE) and the Visual analog scale (VAS). Objective outcomes included grip strength and range of movement measurements. Results: The mean age was 36 years; the majority were women (36/48). Mean grip strength and the average flexion and extension in the wrist showed improvement after 3 months. The total PRWE score improved from 26.7 preoperatively to 10.2 at three months and 2.4 two years after surgery. After 24 months follow-up, there were only two patients with recurrence (4.2%). Conclusion: The arthroscopic resection of the dorsal wrist ganglia is a procedure with a low recurrence rate and lowest scaring and stiffness; it should be considered as a golden standard for operative treatment of the dorsal wrist ganglia.
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Affiliation(s)
- Katerina Kasapinova
- 1Medical Faculty, University "St.Cyril and Metodius", University Surgery Clinic "St.Naum Ohridski", Department of Traumatology, Skopje, RN Macedonia
| | - Viktor Kamiloski
- 1Medical Faculty, University "St.Cyril and Metodius", University Surgery Clinic "St.Naum Ohridski", Department of Traumatology, Skopje, RN Macedonia
| | - Emilija Atanasovska
- 2Medical Faculty, University "St.Cyril and Metodius", Institute for pharmacology and toxicology, Skopje, RN Macedonia
| | - Katerina Spasovska
- 3Medical Faculty, University "St.Cyril and Metodius", University Clinic for Infectious Diseases, Skopje, RN Macedonia
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15
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Wong CR, Karpinski M, Hatchell AC, McRae MH, Murphy J, McRae MC. Immobilization of the Wrist After Dorsal Wrist Ganglion Excision: A Systematic Review and Survey of Current Practice. Hand (N Y) 2023; 18:254-263. [PMID: 34096351 PMCID: PMC10035098 DOI: 10.1177/15589447211014631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postoperative care after dorsal wrist ganglion (DWG) excision is highly varied. The effect of immobilization of the wrist on patient outcomes has not yet been examined. METHODS A systematic review of the literature was performed to determine whether wrist immobilization after DWG surgical excision is beneficial. A survey of hand surgeons in Canada was performed to sample existing practice variations in current immobilization protocols after DWG excision. RESULTS A systematic review yielded 11 studies that rigidly immobilized the wrist (n = 5 open excision, n = 5 arthroscopic excision, n = 1 open or arthroscopic excision), 10 studies that used dressings to partially limit wrist motion (n = 5 open, n = 5 arthroscopic), 1 study (open) that did either of the above, and 2 studies (arthroscopic) that did not restrict wrist motion postoperatively. This ranged from 48 hours to 2 weeks in open DWG excision and 5 days to 3 weeks in arthroscopic DWG excision. The survey of Canadian hand surgeons had a similarly divided result of those who chose to immobilize the wrist fully (41%), partially (14%), or not at all (55%). Most surgeons surveyed who immobilized the wrist postoperatively did so for 1 to 2 weeks. CONCLUSION The systematic review and survey of Canadian hand surgeons reveal that hand surgeons are divided regarding the need to immobilize the wrist after DWG excision. In terms of functional outcome, there is no compelling data to suggest 1 strategy is superior. The time frame for immobilization when undertaken was short at 2 weeks or less.The systematic review is registered in the PROSPERO database (PROSPERO 2016:CRD42016050877).
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Affiliation(s)
| | | | | | | | | | - Matthew C McRae
- McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
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16
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Federer AE, Yoo M, Stephens AS, Nelson RE, Steadman JN, Tyser AR, Kazmers NH. Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis. J Hand Surg Am 2023; 48:9-18. [PMID: 36402604 PMCID: PMC9812920 DOI: 10.1016/j.jhsa.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/19/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Dorsal wrist ganglions are treated commonly with aspiration, or open or arthroscopic excision in operating room (OR) or procedure room (PR) settings. As it remains unclear which treatment strategy is most cost-effective in yielding cyst resolution, our purpose was to perform a formal cost-minimization analysis from the societal perspective in this context. METHODS A microsimulation decision analytic model evaluating 5 treatment strategies for dorsal wrist ganglions was developed, ending in either resolution or a single failed open revision surgical excision. Strategies included immediate open excision in the OR, immediate open excision in the PR, immediate arthroscopic excision in the OR, or 1 or 2 aspirations before each of the surgical options. Recurrence and complications rates were pooled from the literature for each treatment type. One-way sensitivity and threshold analyses were performed. RESULTS The most cost-minimal strategy was 2 aspiration attempts before open surgical excision in the PR setting ($1,603 ± 1,595 per resolved case), followed by 2 aspirations before open excision in the OR ($1,969 ± 2,165 per resolved case). Immediate arthroscopic excision was the costliest strategy ($6,539 ± 264 per resolved case). Single aspiration preoperatively was more cost-minimal than any form of immediate surgery ($2,918 ± 306 and $4,188 ± 306 per resolved case performed in the PR and OR, respectively). CONCLUSIONS From the societal perspective, performing 2 aspirations before surgical excision in the PR setting was the most cost-minimal treatment strategy, although in reference to surgeons who do not perform this procedure in the PR setting, open excision in the OR was nearly as cost-effective. As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Economic Decision Analysis II.
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Affiliation(s)
- Andrew E Federer
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Minkyoung Yoo
- Department of Economics, University of Utah, Salt Lake City, UT
| | | | - Richard E Nelson
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Jesse N Steadman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
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17
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Konigsberg MW, Tedesco LJ, Mueller JD, Ball JR, Wu CH, Kadiyala RK, Strauch RJ, Rosenwasser MP. Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison. Hand (N Y) 2023; 18:133-138. [PMID: 33789496 PMCID: PMC9806526 DOI: 10.1177/15589447211003184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study directly compares the recurrence rates of dorsal wrist ganglion cysts in patients treated via open surgical excision versus arthroscopic surgical excision. We hypothesized that there would be no difference between recurrence rates with these 2 surgical options. METHODS We retrospectively reviewed the charts of all patients with a dorsal ganglion cyst undergoing either open or arthroscopic surgical excision at a single academic center with 3 fellowship-trained attending hand surgeons from 2012 to 2017. Charts were identified using Current Procedural Terminology codes and were reviewed using postoperative office notes for preoperative and postoperative symptoms, episodes of recurrence, time at which recurrence occurred, subsequent operations, and outcome at final follow-up. RESULTS The charts of 172 patients undergoing either arthroscopic or open dorsal ganglion excision were reviewed. Nine of 54 (16.7%) arthroscopic excisions resulted in cyst recurrence, while 8 of 118 (6.8%) open excisions resulted in cyst recurrence (P = .044). Two of 9 (22%) recurrences after arthroscopic ganglion excision versus 2 of 8 (25%) recurrences after open ganglion excision underwent repeat surgical intervention. Time to recurrence, as well as final follow-up, was not statistically different between groups. CONCLUSIONS Dorsal wrist ganglion cysts are the most common benign soft tissue mass of the upper extremity, but it remains unknown whether arthroscopic or open surgical excision leads to lower recurrence rate. Scant literature exists directly comparing these 2 methods of surgical excision. This study suggests that open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision.
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Affiliation(s)
| | - Liana J. Tedesco
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - John D. Mueller
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - Jacob R. Ball
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - Chia H. Wu
- Baylor College of Medicine, Houston,
TX, USA
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18
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Zhou J, Al-Ani S, Jester A, Oestreich K, Baldrighi C, Ting JWC. Wrist Ganglion Cysts in Children: An Update and Review of the Literature. Hand (N Y) 2022; 17:1024-1030. [PMID: 33174451 PMCID: PMC9608283 DOI: 10.1177/1558944720966716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ganglion cysts are the most common soft tissue tumor of the hand and wrist, affecting pediatric and adult populations. Despite their frequency, there is no consensus within the literature regarding the best management of pediatric wrist ganglia, and there are few recent publications examining this topic. We provide an up-to-date literature review examining the current issues and controversies in the management of pediatric wrist ganglia.
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Affiliation(s)
- Jieyun Zhou
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Monash Health, Melbourne, VIC, Australia
| | - Sami Al-Ani
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Andrea Jester
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Kerstin Oestreich
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Carla Baldrighi
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Jeannette W. C. Ting
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Monash Health, Melbourne, VIC, Australia
- Hands and Upper Limb Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
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19
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Vosoughi F, Kaseb MH, Malek M, Toofan H, Mortazavi SMJ. Intra-Articular Ganglion Cysts of the Knee. JBJS Rev 2022; 10:01874474-202209000-00002. [PMID: 36084018 DOI: 10.2106/jbjs.rvw.22.00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
➢ Magnetic resonance imaging (MRI) without contrast is sufficient to diagnose an intra-articular ganglion cyst of the knee. MRI with intravenous contrast may be considered for cysts in the infrapatellar fat pad, which are not a typical presentation. ➢ The current literature supports treating symptomatic cases or those discovered accidently during knee arthroscopy with arthroscopic excision. ➢ Although aspiration of these cysts results in a higher recurrence rate than excision, it is associated with quicker recovery. Thus, aspiration might be chosen as an initial treatment for anyone who would like to avoid surgery or requires a rapid recovery, including professional athletes. ➢ Open excision may be considered for infrapatellar fat pad cysts that are >4.5 cm in size.
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Affiliation(s)
- Farzad Vosoughi
- Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hasan Kaseb
- Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahrooz Malek
- Department of Radiology, Medical Imaging Center Complex, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hesam Toofan
- Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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20
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Lee YK. Formation of multiple ganglion cysts along the flexor tendon after open A1 pulley release for trigger finger: A case report. Medicine (Baltimore) 2022; 101:e29663. [PMID: 35866807 PMCID: PMC9302314 DOI: 10.1097/md.0000000000029663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE When surgical treatment is indicated for primary trigger finger, open A1 pulley release has traditionally been recommended with generally good results. However, ganglion cysts of the flexor tendon sheath as a complication after an open A1 pulley release were rarely reported. Therefore, the purpose of this study is to report a case of multiple ganglion cysts arising from the flexor tendon sheath in a patient undergoing an open A1 pulley release for trigger finger disorder with a review of the relevant literature. PATIENT CONCERNS AND DIAGNOSIS A 65-year-old right-handed farmer was referred to our hospital for swelling in the left long finger (LLF). One year before the visit, the patient was diagnosed with trigger finger in the LLF at other hospital and an open A1 pulley release was performed, but the swelling of the finger persisted. The patient had no history of trauma or evidence of systemic disease such as rheumatoid or other inflammatory arthritis. The patient was diagnosed with multiple ganglion cysts of flexor tendon sheath after investigation. INTERVENTION AND OUTCOMES We successfully excised cystic masses and debrided the partially ruptured flexor digitorum superficialis (FDS) tendon and sutured it using 5/0 prolene. At 12-month follow-up, the patient was completely asymptomatic with excellent range of motion in the distal interphalangeal (DIP) joint (0°-60°) of his LLF, showing no recurrence of ganglion cyst. LESSONS Trigger finger is a common condition that clinicians encounter frequently. However, this familiarity may lead to inattentive treatment. Nevertheless, through this case, clinicians should devote careful attention when performing open A1 pulley release to prevent partial rupture of the flexor tendon in the A1 pulley. If ganglion cysts occur, we believe that surgical excision can yield good results.
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Affiliation(s)
- Young Keun Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
- *Correspondence: Young Keun Lee, Department of Orthopedic Surgery, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, JeonJu 54907, Republic of Korea (e-mail: )
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21
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Eriksen JH, Kønig MJ, Balslev E, Søe NH. [Ganglion cysts on wrists and hands]. Ugeskr Laeger 2022; 184:V05210428. [PMID: 35781363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The ganglion cyst is the most common soft-tissue tumour of the hand and wrist. 60-70% are found dorsally on the wrist. Ultrasound and MRI-imaging can distinguish whether the tumour is cystic or solid and may be helpful in making a diagnosis. This article reviews the different treatment techniques and rates of recurrence. Arthroscopic excision has shown promising results, but open excision remains the gold standard. The aetiology and pathogenesis of the condition is still unknown and further research is needed especially in reducing the risk of recurrence.
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Affiliation(s)
| | - Merete Juhl Kønig
- Afdeling for Røntgen og Skanning, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Eva Balslev
- Patologisk Afdeling, Københavns Universitetshospital - Herlev og Gentofte Hospital
| | - Niels Henrik Søe
- Håndsektion, Ortopædkirurgisk Afdeling, Københavns Universitetshospital - Herlev og Gentofte Hospital
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22
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Krishnan P, Wolf JM. Pediatric Ganglions of the Hand and Wrist: A Review of Current Literature. J Hand Surg Am 2022; 47:554-560. [PMID: 35216864 DOI: 10.1016/j.jhsa.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/26/2021] [Indexed: 02/02/2023]
Abstract
The etiology, epidemiology, and treatment outcomes of ganglions in children have not been studied in depth. Most research has mainly focused on adults with this condition, with some research suggesting differing epidemiology and outcomes in the pediatric population. This review focuses on the existing literature on pediatric ganglions of the hand and wrist, highlighting 17 studies focused on prevalence and treatment outcomes. Within the pediatric population, epidemiology and outcomes differ depending on patient age. In children aged <10 years, cysts present on the volar aspect of the wrist and are generally amenable to observation, with spontaneous regression. For patients aged >10 years, ganglions resemble those in the adult population and present on the dorsal aspect of the wrist. Open surgical excision demonstrates a relatively low recurrence rate with minimal complications and is currently recommended for treatment.
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Affiliation(s)
- Pranav Krishnan
- Pritzker School Medicine, University of Chicago, Chicago, IL
| | - Jennifer Moriatis Wolf
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL.
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23
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Allison CM, Bonanos G, Varma A. Bilateral ganglion cysts at L4/5 causing central canal stenosis and producing sciatica and neurogenic claudication: a case report. Ann R Coll Surg Engl 2022; 104:41-43. [PMID: 35100857 DOI: 10.1308/rcsann.2021.1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Symptomatic bilateral juxtafacet ganglion cysts are relatively uncommon in the degenerated spine. The literature describes 16 cases of bilateral ganglion or synovial cysts, none reported sciatica and neurogenic claudication simultaneously. We present a case of a 60-year-old woman who presented with symptoms of bilateral sciatica and neurogenic claudication. Magnetic resonance imaging of the lumbar spine revealed bilateral lesions related to the facet joints at the L4/5 level, causing bilateral lateral recess stenosis and narrowing of the central canal due to encroachment of these bilateral lesions at the same level. She underwent an elective central canal decompression of the L4/5 level and excision of the facet cysts bilaterally with lateral recess decompression, which resulted in good relief of both the radicular and claudication symptoms.
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Affiliation(s)
- C M Allison
- James Cook University Hospital, Middlesbrough, UK
- Newcastle University Medical School, Newcastle upon Tyne, UK
| | - G Bonanos
- James Cook University Hospital, Middlesbrough, UK
| | - A Varma
- James Cook University Hospital, Middlesbrough, UK
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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Gokhale S, Mullaney P, Thomas P, Carpenter EC. Hip pain attributable to a ganglion of the psoas tendon: a common cyst in an uncommon region-the first case reported in a child. BMJ Case Rep 2021; 14:e244520. [PMID: 34697088 PMCID: PMC8547365 DOI: 10.1136/bcr-2021-244520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/04/2022] Open
Abstract
Ganglion cysts of the psoas tendon are uncommon and rarely reported in the literature. Often they remain asymptomatic and are found incidentally or can be a cause of atypical groin/hip pain. We present a rare case of ganglion cyst in a child arising from the psoas tendon, causing symptomatic hip pain, which failed non-surgical treatment and eventually successfully treated with surgical excision.
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Affiliation(s)
- Sandeep Gokhale
- Trauma and Orthopaedics, University hospital of Wales healthcare NHS trust, Cardiff, UK
| | | | - Phillip Thomas
- Trauma and Orthopaedics, University hospital of Wales, Cardiff, UK
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26
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Kristinsson J, Birkeland P. [Intraneural ganglioncyst from the "forgotten" knee joint]. Ugeskr Laeger 2021; 183:V04210335. [PMID: 34498579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Disorders in the proximal tibiofibular joint (PTFJ) is often missed or misinterpreted because healthcare professionals often do not consider it a source of pathology. This is a case report of the symptoms and treatment in a young man with intraneural ganglion cyst originating from the PTFJ. The diagnosis was verified by an MRI scan, since there were few objective findings. Treatment is decompression of the cyst, and to prevent recurrence it is important to disconnect the articular branch.
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27
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Yanagisawa S, Takagi T, Kodama M, Kobayashi Y, Watanabe M. Compression of the Median Nerve and Ulnar Nerve's Deep Palmar Branch by a Ganglion Cyst in the Carpal Tunnel: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00029. [PMID: 34264873 DOI: 10.2106/jbjs.cc.20.00692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 39-year-old woman presented with a ganglion cyst in the carpal tunnel simultaneously compressing the right median nerve and the deep palmar branch of the ulnar nerve. During surgery, the soft tissue was exposed under the median nerve and on the deep palmar branch of the ulnar nerve running transversely in the deep area of the carpal tunnel. CONCLUSION Simultaneous compression of the median nerve and deep palmar branch of the ulnar nerve is extremely rare; however, such a pathoanatomical relationship must be considered while examining a patient because these nerves are located close to each other.
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Affiliation(s)
- Sho Yanagisawa
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Takehiko Takagi
- Division of Orthopaedic Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Mitsuhiko Kodama
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Yuka Kobayashi
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
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28
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Winter J, Zhang Y, Clark TA, Giuffre JL. The Addition of a Nerve Transfer to the Treatment of Peroneal Neuropathy Secondary to Intraneural Ganglion: Case Series. Ann Plast Surg 2021; 86:674-677. [PMID: 33833176 DOI: 10.1097/sap.0000000000002810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Peroneal intraneural ganglia are rare, and their management is controversial. Presently, the accepted treatment of intraneural ganglia is decompression and ligation of the articular nerve branch. Although this treatment prevents recurrence of the ganglia, the resultant motor deficit of foot drop in the case of intraneural peroneal ganglia is unsatisfying. Foot drop is classically treated with splinting or tendon transfers to the foot. We have recently published a case report of a peroneal intraneural ganglion treated by transferring a motor nerve branch of flexor hallucis longus into a nerve branch of tibialis anterior muscle in addition to articular nerve branch ligation and decompression of the intraneural ganglion to restore the patient's ability to dorsiflex. We have since performed this procedure on 4 additional patients with appropriate follow-up. Depending on the initial onset of foot drop and time to surgery, nerve transfer from flexor hallucis longus to anterior tibialis nerve branch may be considered as an adjunct to decompression and articular nerve branch ligation for the treatment of symptomatic peroneal intraneural ganglion.
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Affiliation(s)
| | - Yiyang Zhang
- Section of Orthopaedic Surgery, Department of Surgery, Rady College of Medicine, University of Manitoba
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29
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Agarwal M. CORR Insights®: Ganglion Cysts of the Proximal Tibiofibular Joint: Low Risk of Recurrence After Total Cyst Excision. Clin Orthop Relat Res 2021; 479:543-545. [PMID: 32657808 PMCID: PMC7899727 DOI: 10.1097/corr.0000000000001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/12/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Manish Agarwal
- M. Agarwal, P. D. Hinduja Hospital and Medical Research Centre, Hinduja Clinic, Mumbai, India
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30
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Papanastassiou ID, Tolis K, Savvidou O, Fandridis E, Papagelopoulos P, Spyridonos S. Ganglion Cysts of the Proximal Tibiofibular Joint: Low Risk of Recurrence After Total Cyst Excision. Clin Orthop Relat Res 2021; 479:534-542. [PMID: 32773431 PMCID: PMC7899497 DOI: 10.1097/corr.0000000000001329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 05/08/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Peroneal nerve neuropathy due to compression from tumors or tumor-like lesions such as ganglion cysts is rare. Few case series have been published and reported local recurrence rates are high, while secondary procedures are frequently employed. QUESTIONS/PURPOSES (1) What are the demographics of patients with ganglion cysts of the proximal tibiofibular joint, and what proportion of them present with intraneural cysts and peroneal nerve palsy? (2) What Musculoskeletal Tumor Society (MSTS) scores do patients with this condition achieve after decompression surgery with removal of the ganglion cyst, but no arthrodesis of the tibiofibular joint? (3) What proportion of patients experience local recurrence after surgery? METHODS Between 2009 to 2018, 30 patients (29 primary cases) were treated for chronic peroneal palsy or neuropathy due to ganglion cysts of the proximal tibiofibular joint at two tertiary orthopaedic medical centers with total resection of the cystic lesion. MRI with contrast and electromyography (EMG) were performed preoperatively in all patients. The minimum follow-up for this series was 1 year (median 48 months, range 13 to 120); 14% (4 of 29) were lost to follow-up before that time. The MSTS score was recorded preoperatively, at 6 weeks postoperatively, and at most-recent follow-up. RESULTS A total of 90% of the patients were male (26 of 29 patients) and the median age was 67 years (range 20 to 76). In all, 17% (5 of 29) were treated due to intraneural ganglia. Twenty-eight percent (8 of 29) presented with complete peroneal palsy (foot drop). The mean MSTS score improved from 67 ± 12% before surgery to 89 ± 12% at 6 weeks postoperative (p < 0.001) and to 92 ± 9% at final follow up (p = 0.003, comparison with 6 weeks postop). All patients improved their scores. A total of 8% (2 of 25 patients) experienced local recurrence after surgery. CONCLUSION Ganglion cysts of the proximal tibiofibular joint occurred more often as extraneural lesions in older male patients in this small series. Total excision was associated with improved functional outcome and low risk of neurologic damage and local recurrence, and we did not use any more complex reconstructive procedures. Tendon transfers may be performed simultaneously in older patients to stabilize the ankle joint, while younger patients may recover after decompression alone, although larger randomized studies are needed to confirm our preliminary observations. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Ioannis D Papanastassiou
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| | - Konstantinos Tolis
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| | - Olga Savvidou
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| | - Emmanouil Fandridis
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| | - Panayiotis Papagelopoulos
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| | - Sarantis Spyridonos
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
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Park D, Kim DY, Eom YS, Lee SE, Chae SB. Posterior interosseous nerve syndrome caused by a ganglion cyst and its surgical release with intraoperative neurophysiological monitoring: A case report. Medicine (Baltimore) 2021; 100:e24702. [PMID: 33663080 PMCID: PMC7909167 DOI: 10.1097/md.0000000000024702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/21/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Intraoperative neurophysiological monitoring (IONM) has been utilized not only for the rapid detection of neural insults during surgeries, but also to verify the neurophysiological integrity of nerve lesions in the surgical field. PATIENT CONCERNS A 32-year-old woman presented with a wrist and finger drop that had lasted about 3 months. DIAGNOSES The result of the initial electrodiagnostic test was consistent with posterior interosseous nerve (PIN) syndrome. Ultrasonography and magnetic resonance imaging of the proximal forearm showed a cystic mass at the anterolateral aspect of the radial head, which was diagnosed as a ganglion cyst. INTERVENTIONS Surgical release of the ganglion cyst with IONM was performed. During the surgery, we induced nerve action potentials and compound motor action potentials across the ganglion cyst, which demonstrated neural continuity. OUTCOMES Three months after the surgery, the patient showed partial recovery of wrist and finger extensor muscle power. An electrodiagnostic test conducted 3 months after the surgery showed reinnervation potentials in PIN-innervated muscles. LESSONS IONM during peripheral nerve surgeries can support surgical decisions and confirm the location and degree of nerve damage.
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Affiliation(s)
| | - Dong Young Kim
- Department of Orthopedic Surgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang
| | - Yoon Sik Eom
- Department of Orthopedic Surgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang
| | | | - Seung Bum Chae
- Department of Orthopedic Surgery, Daegu Catholic University Hospital, Daegu, Republic of Korea
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Fener DK, Bartels EM, Koch CSEN, Wiegell BNE, Nielsen NHS. [Mucoid cysts on the fingers]. Ugeskr Laeger 2020; 182:V02200110. [PMID: 33215593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this review, we discuss mucoid cysts, which are common benign cysts, most often located dorsally or laterally to the distal interphalangeal joint. The origin of the cyst is suggested to be similar to that of a ganglion, or to be a degeneration of dermis, and it is often linked to osteoarthritis. Two types of mucoid cysts seem to exist, probably needing different treatment. A cyst is usually asymptomatic and needs no treatment, but limited joint movement, pain and nail deformity may occur. In the latter case, conservative or surgical treatment is asked for. If a cyst is atypical, pathology is needed.
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Abstract
RATIONALE Peroneal neuropathy is the most common type of peripheral neuropathy in the lower extremities. The peroneal nerve is usually compressed at the lateral aspect of the fibular head. Compression by ganglion cysts are one of the numerous underlying etiologies for peroneal nerve neuropathy and are most frequently located around the fibular neck and proximal tibiofibular joint. To the best of our knowledge, this is the first report of an extraneural ganglion cyst located at the level of the distal thigh that resulted in compressive peroneal neuropathy. PATIENT CONCERNS We report a case of a 56-year-old man with sudden onset of left foot drop and gait disturbance caused by an extraneural ganglion cyst located in the popliteal fossa. DIAGNOSIS Electrodiagnosis (EDX) suggested a peroneal nerve lesion. Subsequently, diagnostic ultrasonography (USG) revealed a cystic mass located within the left side of the supracondylar area of femur. Further magnetic resonance imaging confirmed that the mass was located at the proximal of popliteal fossa. INTERVENTIONS Surgical excision was performed using a direct posterior approach. The cystic mass was compressing the common peroneal nerve, and was carefully and completely removed ensuring that all nerve branches were protected. OUTCOMES A histopathologic evaluation confirmed the diagnosis of a ganglion cyst. There were no postoperative complications. Two months after the surgery, follow-up USG revealed no evidence of cyst recurrence or residual lesions. Six months after the surgery, the ankle dorsiflexor motor power improved and he experienced less pain and hypoesthesia. LESSONS Physicians should bear in mind that the peroneal neuropathy can occur because of the ganglion cyst in the distal thigh. The thorough evaluation of EDX and USG is crucial for the early diagnosis and surgical intervention, although there is no abnormal finding around the fibular neck.
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Affiliation(s)
- Jaehoon Sim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
- Rehabilitation and Regeneration Research Center, School of Medicine, Seongnam, Korea
| | - Hyunseok Kwak
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
- Rehabilitation and Regeneration Research Center, School of Medicine, Seongnam, Korea
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
- Rehabilitation and Regeneration Research Center, School of Medicine, Seongnam, Korea
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Landström JT. Arthroscopic Tenovaginotomy and Ganglion Excision of the Flexor Carpi Radialis Fibro-Osseous Tendon Sheath. Tech Hand Up Extrem Surg 2020; 25:20-24. [PMID: 32453273 PMCID: PMC8055192 DOI: 10.1097/bth.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of flexor carpi radialis (FCR) tendon stenosing tenosynovitis recalcitrant to nonsurgical intervention has been open or blind tenovaginotomy of the volar trapezial fibro-osseous sheath of the FCR tendon. The surgical literature has not reported arthroscopic tenovaginotomy of the FCR fibro-osseous tendon sheath with or without associated ganglia. This report describes a technique of arthroscopic tenovaginotomy for stenosing tenosynovitis of the FCR tendon at the trapezial fibro-osseous sheath with or without excision of any associated ganglion through a not previously described new volar radial trapezial arthroscopic portal.
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Lyon C, Eldred SV, Desanto K. What is the best treatment for wrist ganglion cysts? J Fam Pract 2020; 69:E23-E24. [PMID: 32017840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Corey Lyon
- University of Colorado Family Medicine Residency, Denver, USA
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Abstract
BACKGROUND The wrist, especially its dorsal surface, is the most common location of ganglion cysts in the human body. OBJECTIVES The purpose of this study was to present our experience in the treatment of wrist ganglions and to evaluate the results obtained with the operative management of this type of lesion. MATERIAL AND METHODS A total of 394 patients (289 females and 105 males, aged 10-83 years) treated operatively for wrist ganglions between 2000 and 2014 were included in the study. The results of surgical treatment were evaluated after a minimal 2-year-long follow-up in 69.4% of patients operated on for dorsal wrist ganglions and in 70.6% of patients after the excision of volar wrist ganglions. The shape and size of postoperative scar, range of motion of the wrist, grip strength, severity of pain, and presence/absence of ganglion recurrence were assessed. The influence of demographic factors on the risk of recurrence was statistically analyzed. RESULTS Persistent limitation of wrist palmar flexion was observed in 6 patients after the removal of dorsal wrist ganglions. There were no cases of postoperative grip strength weakening. An unesthetic scar developed in 15 patients after the excision of dorsal wrist ganglions and in 6 patients after the removal of volar wrist ganglions. Postoperative pain was observed in 7 patients with ganglion recurrence and in 17 patients without recurrence. Ganglion cysts recurred in 12.1% of patients treated for dorsal wrist ganglions and in 10.4% of patients operated on for volar wrist ganglions. No influence of patient gender, age, body side, or cyst location on ganglion recurrence was detected. CONCLUSIONS Operative treatment is a widely recognized method of management of wrist ganglions. The rate of resulting persistent complications is low. Recurrence of ganglion cysts is unpredictable and independent of patient demographic factors. It can be observed even in cases, in which a perfect surgical technique has been used.
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Affiliation(s)
- Sebastian Kuliński
- Clinic of Traumatology and Hand Surgery, Department of Traumatology, Wroclaw Medical University, Poland
| | - Olga Gutkowska
- Clinic of Traumatology and Hand Surgery, Department of Traumatology, Wroclaw Medical University, Poland
| | - Sylwia Mizia
- Division of Organization and Management, Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, Poland
| | - Jacek Martynkiewicz
- Clinic of Traumatology and Hand Surgery, Department of Traumatology, Wroclaw Medical University, Poland
| | - Jerzy Gosk
- Clinic of Traumatology and Hand Surgery, Department of Traumatology, Wroclaw Medical University, Poland
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Chang KV, Wu WT, Özçakar L. Extra-tunnel Compression Mimicking Tarsal Tunnel Syndrome: Ultrasound Imaging for a Plantar Ganglion Cyst. Med Ultrason 2018; 20:540-541. [PMID: 30534667 DOI: 10.11152/mu-1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We reported a 43-year-old man with right-foot numbness under the tentative diagnosis of tarsal tunnel syndrome. The initial ultrasound examination did not identify any remarkable findings at the level of the medial malleolus. Owing to the failure of conservative treatments, he was referred for US-guided injection of the tibial nerve. When tracking the entire course of the nerve, a ganglion cyst was observed on top of the tibial nerve, in proximity to the medial and lateral plantar branches. The symptom disappeared after surgical excision. The present case highlights the importance of sonoantomy and tracking of the entire course of affected nerve in peripheral nerve disorders and scout scanning prior to any perineural injections.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine Hacettepe University Medical School, Ankara, Turkey.
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Spinner RJ, Mikami Y, Desy NM, Amrami KK, Berger RA. Superficial radial intraneural ganglion cysts at the wrist. Acta Neurochir (Wien) 2018; 160:2479-2484. [PMID: 30377830 DOI: 10.1007/s00701-018-3715-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
Superficial radial intraneural ganglion cysts are rare. Only nine previous cases have been described. We provide two examples with a wrist joint connection and review the literature to provide further support for the unifying articular (synovial) theory for the pathogenesis and treatment of intraneural ganglia.
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Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
- Department of Orthopedics, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Yoji Mikami
- Department of Orthopaedic Surgery, Yokohama Rosai Hospital, Yokohama City, Kanagawa, 222-0036, Japan
| | - Nicholas M Desy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Richard A Berger
- Department of Orthopedics, Mayo Clinic, Rochester, MN, 55905, USA
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Kuliński S, Gutkowska O, Urban M, Gosk J. Volar retinacular ganglions (flexor tendon sheath ganglions) The results of surgical treatment. Acta Orthop Belg 2018; 84:526-530. [PMID: 30879459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Volar retinacular ganglions are the third most common group of all ganglions located in the hand and wrist region. The purpose of this work is to present our experience in management and the results of operative treatment of volar retinacular ganglions. One-hundred-and-seven patients were operated-on for volar retinacular ganglions between 2000 and 2014. One-hundred-and-eight ganglions were resected. Complications which were observed in five patients postoperatively (digital nerve irritation, restricted range of motion of digital joints) resolved within several weeks. At final follow-up, no ganglion recurrence, impairment of finger mobility, innervation or blood supply were observed in any of the patients.
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Gould D, Kulber D, Kuschner S, Dellamaggiorra R, Cohen M. Our Surgical Experience: Open Versus Endoscopic Carpal Tunnel Surgery. J Hand Surg Am 2018; 43:853-861. [PMID: 29759797 DOI: 10.1016/j.jhsa.2018.03.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/18/2018] [Indexed: 02/02/2023]
Abstract
Carpal tunnel release is one of the most common hand operations in the United States and every year approximately 500,000 patients undergo surgical release. In this article, we examine the argument for endoscopic carpal tunnel release versus open carpal tunnel release, as well as some of the literature on anatomical variants in the median nerve at the wrist. We further describe the experience of several surgeons in a large academic practice. The goals of this article are to describe key anatomic findings and to present several cases that have persuaded us to favor offering patients open carpal tunnel release.
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Affiliation(s)
- Daniel Gould
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA.
| | - David Kulber
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA; Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA; Division of Plastic Surgery, Cedars Sinai Medical Center, Los Angeles, CA
| | - Stuart Kuschner
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA; Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA
| | - Ryan Dellamaggiorra
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA; Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA
| | - Myles Cohen
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA; Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA; Division of Plastic Surgery, Cedars Sinai Medical Center, Los Angeles, CA
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Gunasagaran J, Sean ES, Shivdas S, Amir S, Ahmad TS. Perceived comfort during minor hand surgeries with wide awake local anaesthesia no tourniquet (WALANT) versus local anaesthesia (LA)/tourniquet. J Orthop Surg (Hong Kong) 2018; 25:2309499017739499. [PMID: 29141522 DOI: 10.1177/2309499017739499] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Minor hand surgeries can be done under field sterility in procedure rooms. Surgeons are still sceptical about the usage of wide awake local anaesthesia no tourniquet (WALANT) technique. They perceive that patients can tolerate tourniquet for a brief period while they perform minor surgeries under local anaesthesia (LA). We compared the perceived comfort experienced by patients during minor hand surgeries with WALANT and LA/tourniquet. We investigated the difference in preoperative preparation time, operating time and blood loss between the two groups. METHODS Between July and October 2016, a total of 72 patients were diagnosed with carpal tunnel syndrome, trigger finger or ganglion, at the University Malaya Medical Centre. Forty patients consented to participate in this study and were randomized into WALANT and LA/tourniquet groups. Anaesthesia was administered accordingly and tourniquet was applied. The time taken for preoperative preparation and surgery was recorded. Each surgeon estimated the blood loss. The perceived comfort level of each patient was quantified using a visual analogue score (VAS). Data were analysed using SPSS. RESULTS The mean VAS for the WALANT group was 2.33 ± 1.94, whereas it was 4.72 ± 3.05 for the LA/tourniquet group, and the difference was statistically significant ( p < 0.05). The mean time for preoperative preparation in WALANT group was 19.17 ± 12.61 min and LA/tourniquet group was 7.05 ± 3.44 min. The difference between these groups was statistically significant ( p < 0.01). There was no significant difference in operating time and blood loss. CONCLUSION WALANT technique was associated with better patient comfort. Tourniquet was the main reason for discomfort during surgeries. WALANT is an alternative in minor hand surgeries for a bloodless surgical field without the discomfort of tourniquet application.
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Affiliation(s)
- Jayaletchumi Gunasagaran
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Soon Sean
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Sachin Shivdas
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Shams Amir
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Tunku Sara Ahmad
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
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Yamamoto M, Kurimoto S, Iwatsuki K, Nishizuka T, Nolte MT, Hirata H. Sonography-guided arthroscopic excision is more effective for treating volar wrist ganglion than dorsal wrist ganglion. Acta Orthop Belg 2018; 84:78-83. [PMID: 30457504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to compare the treatment results of sonography-guided arthroscopic excision for volar and dorsal wrist ganglions. A total of 42 patients with wrist ganglions underwent sonography-guided arthroscopic resection. Clinical outcome measures included wrist range of motion, grip strength, patient-rated questionnaire Hand20, and numerical pain rating scale. All patients were assessed for recurrence throughout the follow-up period. Ganglions were located at the dorsal wrist in 26 cases and at the volar wrist in 16 cases. The mean Hand20 and pain scores were significantly improved after sonography-guided arthroscopic resection for both volar and dorsal wrist ganglions. Recurrence was seen in six cases (23%) of dorsal wrist ganglion but no cases of volar wrist ganglion (P < .05). The use of sonography-guided arthroscopic ganglion excision is better for treating volar wrist ganglion than dorsal wrist ganglion.
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Burnett RA, Westermann R, Bedard N, Liu S, Callaghan JJ. Ganglion Cyst as a Rare Complication of Hip Arthroscopy Resolved With THA: A Case Report. Iowa Orthop J 2018; 38:87-91. [PMID: 30104929 PMCID: PMC6047384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND A rare complication of hip arthroscopy is the development of a ganglion cyst. These cysts can affect structures surrounding the hip joint. In some cases, the femoral artery may be involved, leading to claudication or a pulsatile mass that can resemble an aneurysm. CASE DESCRIPTION We present the case of a 62 year-old male who complains of 3 months of right hip pain. Workup reveals a degenerative labrum with cam impingement. After a discussion of various treatment options, the patient elected for arthroscopy to correct the impingement. An anterior capsulotomy was created to establish access to the joint. Cam decompression was indicated to address the impingement. The patient developed a recurring ganglion cyst following the procedure that was not permanently prevented with cyst aspiration. Total hip arthroplasty with ganglion cyst decompression resolved the ganglion cyst and resolved the hip pain. CONCLUSIONS This is the first case report that describes the development of a ganglion cyst following hip arthroscopy. Arthroplasty and ganglion cyst decompression in the presence of degenerative joint disease presents a viable treatment option for these cysts. Additionally, this case suggests interportal capsulotomy closure may prevent ganglion cyst development and should be considered when performing hip arthroscopy.
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Affiliation(s)
- Robert A Burnett
- University Iowa, 200 Hawkins Dr, Iowa City, IA 52246, United States
| | | | - Nicholas Bedard
- University Iowa, 200 Hawkins Dr, Iowa City, IA 52246, United States
| | - Steve Liu
- University Iowa, 200 Hawkins Dr, Iowa City, IA 52246, United States
| | - John J Callaghan
- University Iowa, 200 Hawkins Dr, Iowa City, IA 52246, United States
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Abstract
INTRODUCTION Hand tumours are frequently encountered in clinical practice. A list of differential diagnoses of the most common hand tumours based on anatomical location would be helpful for clinicians. We aimed to determine the anatomical distribution of hand tumours seen at a hand surgery practice in Singapore. METHODS The medical records of 50 men and 65 women (mean age 41.7 [range 17-74] years) who underwent excision of hand tumours between 1 June 2010 and 31 December 2012 were reviewed. The histological diagnoses and anatomical locations of the tumours were analysed. The locations were divided into three main groups: (a) distal to the metacarpophalangeal joints (MCPJs); (b) between the MCPJs and carpometacarpal joints (CMCJs); and (c) between the CMCJs and the radiocarpal joint (RCJ). RESULTS Overall, the most common tumours excised from the hand were ganglions (n = 66/116, 56.9%) and giant cell tumours of the tendon sheath (GCTTSs; n = 11/116, 9.5%). However, distal to the MCPJs, GCTTSs (n = 11/39, 28.2%) were more common than ganglions (n = 7/39, 17.9%). Most of the ganglions (n = 59/66, 89.4%) arose from between the CMCJs and RCJ. CONCLUSION Most hand tumours were benign. Ganglions were the most common tumours between the CMCJs and RCJ, while GCTTSs were the most common tumours distal to the MCPJs.
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Affiliation(s)
- Zhi Hao Tang
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
| | | | - Vijayadwaja Desai
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
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45
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Gruber L, Loizides A, Klien S, Trieb T, Koller M, Löscher W, Gruber H. A rare case of an acute soleus arcade syndrome complicated by a ganglion cyst: diagnosis by dynamic ultrasound. Med Ultrason 2017; 19:447-450. [PMID: 29197923 DOI: 10.11152/mu-1003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The soleus arcade syndrome is a rare compression neuropathy of the tibial nerve that often remains undiagnosed due to low clinical awareness and difficult diagnosis. We present the case of a female patient admitted with acute worsening of a pre-existing sensory tibial neuropathy and acute tibial nerve palsy after knee joint injection. After a knee magnetic resonance imaging remained non-diagnostic, dynamic ultrasonography was performed. Constriction by the soleus arcade and proximal swelling of the tibial nerve could be demonstrated during plantarflexion of the ankle by means of a dynamic examination in the standing patient. The patient underwent surgery and recovered fully. This proposed diagnostic approach can be used to identify soleus arcade syndrome by ultrasound.
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Affiliation(s)
| | | | | | | | | | | | - Hannes Gruber
- Medical University Innsbruck, Department of Radiology.
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Abstract
PURPOSE Cost minimization analysis can be employed to determine the least costly option when multiple treatments lead to equivalent outcomes. We present a cost minimization analysis from the payers' perspective, of the direct per patient cost of arthroscopic versus open ganglion cyst excision. We tested the null hypothesis that there is no difference in cost between the 2 procedures from the payer perspective. METHODS We utilized data from a private payer administrative claims database comprising 16 million individuals from 2007 to 2015. Using Current Procedural Terminology codes to identify open and arthroscopic ganglion excisions, we extracted demographic data and fees paid to providers and facilities for the procedure. RESULTS We identified 5,119 patients undergoing open ganglion cyst excision and 20 patients undergoing arthroscopic ganglion excision. The average cost of an open excision was significantly lower than an arthroscopic excision ($1,821 vs $3,668). CONCLUSIONS Surgical costs from arthroscopic ganglion excision are significantly more than open excision. This data can inform health systems participating in value-based models. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and Decision Analysis IV.
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Affiliation(s)
- Eric Quan Pang
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Steven Zhang
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA
| | - Robin N Kamal
- Orthopaedic Surgery-North Campus, Stanford University, Redwood City, CA.
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Lee HLL, Lee KH, Koh KH, Won HJ, Cho HK, Park MJ. Excision of painful dorsal wrist ganglion by open or arthroscopic approach : a compariso n study. Acta Orthop Belg 2017; 83:315-321. [PMID: 30399997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Dorsal wrist ganglion can be removed through open or arthroscopic excision. The better method for relieving pain remains unknown. In this study, we addressed the following questions: (1) does open excision provide better pain relief than arthroscopic? (2) is there any difference in patient satisfaction, functional outcome, and re-operation rate? Forty-five patients with painful dorsal wrist ganglions underwent open or arthroscopic excision. Posterior interosseous neurectomy was performed during open excision. Clinical outcomes were assessed with a focus on pain relief. Patient satisfaction, recurrence, and reoperation due to residual pain were also assessed. The average pain scores improved significantly after both, open and arthroscopic excision. However, five patients who underwent arthroscopic excision reported the same or worse pain, whereas all patients who underwent open excision reported postoperative alleviation of pain. The recurrence rate was comparable. Patient satisfaction was better in those who underwent open excision. Reoperation was performed in four patients who had residual pain after arthroscopic excision. Both, open and arthroscopic methods can alleviate pain in patients with painful dorsal wrist ganglion. However, 20% of the patients who underwent arthroscopic excision reported residual or persistent pain.
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48
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Reyniers P, De Smet L, Degreef I. Fascial flap surgery for recurrent dorsal ganglion. Acta Orthop Belg 2017; 83:322-325. [PMID: 30399998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Recurrence after primary resection of a dorsal wrist ganglion may necessitate a reintervention. A technique was introduced in 2004 in which a flap of the extensor retinaculum is used to cover the defect left in the wrist capsule following repeat radical excision. This retrospective study presents the follow-up 4.6 years after this surgery in 20 patients. Recurrence, grip strength and possible flexion deficit are measured in 13 patients who attended clinic, as well as pain and satisfaction scores. Disability scores have been evaluated in 18 patients. One refractory patient was ascertained. A flexion deficit ≤ 10° was observed in 7 patients. Overall, mild pain, very mild disability, a flexion deficit of 14.2° and a loss of grip strength of 3.6 kg was observed. The retinaculum flap for recurrent dorsal wrist ganglion is a reliable procedure with limited risk for flexion deficit after surgery, high satisfaction rate and low recurrence risk.
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Tanaka S, Gotoh M, Mitsui Y, Shirachi I, Okawa T, Higuchi F, Shiba N. A Case Report of an Acromioclavicular Joint Ganglion Associated with a Rotator Cuff Tear. Kurume Med J 2017; 63:29-32. [PMID: 28163268 DOI: 10.2739/kurumemedj.ms6300002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report a case of subcutaneous ganglion adjacent to the acromioclavicular joint with massive rotator cuff tear [1-7]. An 81-year-old woman presented with a ganglion adjacent to the acromioclavicular joint that had first been identified 9 months earlier. The ganglion had recurred after having been aspirated by her local physician, so she was referred to our hospital. The puncture fluid was yellowish, clear and viscous. Magnetic resonance imaging identified a massive rotator cuff tear with multi- lobular cystic lesions continuous to the acromioclavicular joint, presenting the "geyser sign". During arthroscopy, distal clavicular resection and excision of the ganglion were performed together with joint debridement. At present, the ganglion has not recurred and the patient has returned to normal daily activity. In this case, the ganglion may have developed subsequent to the concomitant massive cuff tear, due to subcutaneous fluid flow through the damaged acromioclavicular joint.
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Affiliation(s)
- Suguru Tanaka
- Department of Orthopedic Surgery, Kurume University Medical Center
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center
| | - Yasuhiro Mitsui
- Department of Orthopedic Surgery, Kurume University Medical Center
| | - Isao Shirachi
- Department of Orthopedic Surgery, Kurume University Medical Center
| | - Takahiro Okawa
- Department of Orthopedic Surgery, Kurume University Medical Center
| | | | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University School of Medicine
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50
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Sillat T, Pivec C, Bernathova M, Moritz T, Bodner G. Unusual Cause of Anterior Tarsal Tunnel Syndrome: Ultrasound Findings. J Ultrasound Med 2017; 36:837-839. [PMID: 28039874 DOI: 10.7863/ultra.16.03092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 05/27/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Tarvo Sillat
- Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Radiology Department, North Estonia Medical Centre, Tallinn, Estonia
| | - Christopher Pivec
- Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Maria Bernathova
- Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Moritz
- Institute for Pediatric and Gynecologic Radiology, Kepler University Hospital, Linz, Austria
| | - Gerd Bodner
- Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Private Ultrasound Center Vienna, Vienna, Austria
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