Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series / Ressecção artroscópica do cisto sinovial volar do punho: Técnica cirúrgica e série de casos

Abstract Objectives To describe the technique and results of the arthroscopic surgical treatment of volar ganglion cyst of the wrist. Materials and Methods The present study comprised 21 patients submitted to the arthroscopic treatment of volar ganglion cysts of the wrist from January 2015 to May 2017, with a full evaluation for at least 6 months. The technique was indicated for patients presenting pain and functional impairment for more than four months, with no improvement with the conservative treatment, or for those with cosmetic complaints and cyst present for more than three months. Results The mean age of the patients was 43.6 years; 16 (76%) patients were female, and 5 (24%) were male. The mean follow-up time from surgery to the final assessment was of 10.9 months. A total of 2 (9.6%) patients complained of mild pain after the procedure, and another patient presented slight motion restrictions. The 18 (90.4%) remaining patients reported cosmetic improvement, complete functional recovery, and pain improvement. There were no recurrences or infections. No patient required further surgery. Conclusions The arthroscopic resection of volar ganglion cysts is a useful and safe technique. It is a minimally-invasive procedure, with low morbidity and very few complications, representing a good alternative to the open technique.

Resumo Objetivo Descrever a técnica e os resultados da artroscopia no tratamento cirúrgico dos cistos sinoviais volares no punho. Materiais e Métodos Foram incluídos e analisados neste trabalho 21 pacientes submetidos a artroscopia para o tratamento de cisto sinovial volar no punho, no período entre janeiro de 2015 e maio de 2017, com avaliação completa e mínima de 6 meses. A técnica descrita foi indicada para os pacientes com dor e incapacidade funcional com duração de mais de quatro meses, sem melhora com o tratamento conservador, ou para aqueles com queixas estéticas e que apresentavam o cisto havia mais de três meses. Resultados A média de idade dos pacientes foi de 43,6 anos, sendo 16 (76%) do sexo feminino, e 5 (24%) do masculino. O tempo de seguimento médio entre a cirurgia e a avaliação final foi de 10,9 meses. Um total de 2 (9,6%) pacientes apresentaram dor leve e uma restrição da mobilidade no pós-operatório. Nos 18 (90,4%) pacientes restantes, houve melhora das queixas estéticas, recuperação funcional completa, e melhora completa da dor. Não houve recidivas ou infecções. Nenhum paciente necessitou ser submetido a nova cirurgia. Conclusões A ressecção artroscópica do cisto sinovial volar mostrou-se uma técnica útil e segura. É um procedimento minimamente invasivo, com baixa morbidade e poucas complicações, sendo uma boa alternativa à técnica aberta.

Resonancia magnética en el atrapamiento del nervio supraescapular por quiste supraglenoideo / Magnetic resonance in nerve entrapment suprascapular supraglenoid cyst

El síndrome de atrapamiento del nervio supraescapular es una causa infrecuente de dolor en el hombro y de difícil diagnóstico clínico. Puede ser consecuencia de traumatismo, infección, compresión extrínseca o estiramiento secundario a movimientos repetitivos. Los quistes supraglenoideos deben considerarse en el diagnóstico diferencial pues son una causa frecuente de compresión del nervio supraescapular que ocurre casi exclusivamente en hombres. Se evaluaron con resonancia magnética (RM) y en forma retrospectiva siete pacientes con diagnóstico de atrapamiento del nervio supraescapular por quiste supraglenoideo. La RM mostró la causa y localización de la compresión nerviosa así como la distribución del edema muscular en todos los casos. Puede evaluar el grado de severidad de la enfermedad y realizar el diagnóstico diferencial con otras causas que provocarían atrapamiento del nervio supraescapular. (AU)

Suprascapular nerve entrapment has been regarded as a relatively uncommon condition that is easily overlooked in the differential diagnosis of shoulder discomfort. The common feature is nerve damage, caused either by trauma, extrinsic compression or by stretching secondary to repeated movements. Ganglion cysts account for the majority of the masses causing entrapment and seem to occur exclusively in men. Seven cases of suprascapular nerve entrapment caused by supraglenoid cyst compression were reviewed with MRI. MRI showed the cause and location of nerve compression as well as the distribution of muscular edema in all cases. MR imaging also allows an evaluation of the severity of the disease. It is also very efficient in excluding several differential diagnoses. (AU)

Compression of Ulnar Nerve by Ganglionic Cyst in Guyon’s Canal: A Case Report.

Ulnar nerve compression at guyon’s canal is rare and very few cases have been reported in literature. It can be missed due to its rarity. Symptoms vary from pain and paresthesia to wasting and significant loss of muscle strength, with significant deformities of the hand. The diagnosis is made by detailed history and examination, electromyography, nerve conduction velocity test, ultrasound and magnetic resonance imaging. Early decompression of nerve is treatment of choice. Here we are presenting a case of compression of ulnar nerve in guyon’s canal due to ganglionic cyst.

Cystic Disease of the Groin Presenting as Compression of a Femoral Vessel

In this study, we describe our diagnosis and treatment of two patients who presented with femoral vessel compression caused by a cystic lesion in the groin. One case was diagnosed as adventitial cystic disease (ACD) of the common femoral artery resulting in leg claudication and the other was diagnosed as a ganglion cyst (GC) causing femoral vein compression and unilateral leg swelling. The operative findings differed between these two cases with respect to the dissection of the cyst and femoral vessel, but the postoperative histological examination results were similar. The pathogenesis of ACD and GC is not fully understood, and further investigation is needed to delineate the exact pathology of these uncommon conditions.

Complete Rupture of the Tibialis Anterior Tendon Due to Intratendinous Ganglion Cyst / 대한정형외과학회잡지

Spontaneous rupture of the tibialis anterior tendon is rare among ordinary people. The tendon rupture usually occurs in patients iatrogenically after local steroid injection to the tendon or with pre-existing systemic disease such as diabetes mellitus, gout, and rheumatic disease. However, no case of complete rupture of the tibialis anterior tendon due to an intratendinous ganglion cyst has been reported. We report on a case of a 39-year-old female with spontaneous rupture of the tibialis anterior tendon due to intratendinous ganglion cyst and her clinical results.

Extra-Articular Ganglion Cysts around the Knee Joint

PURPOSE: The purpose of this study was to report clinical results of open excision of extra-articular ganglion cysts around the knee joint combined with arthroscopic management of intra-articular pathologies if present. MATERIALS AND METHODS: Of the total 107 cases of cystic lesions around the knee, 23 cases of extra-articular ganglion cysts were reviewed between January 2006 and July 2011. There were 13 males and 10 females with a mean age of 48 years (range, 30 to 73 years). The mean follow-up duration was 40 months (range, 30 to 60 months). Preoperative magnetic resonance imaging (MRI) scan was done in all cases. Open surgical excision of the cyst was performed after arthroscopic management of intra-articular pathologies in all but 1 case. At the last follow-up, Lysholm and International Knee Documentation Committee (IKDC) scores were evaluated and MRI was conducted to detect recurrence. RESULTS: The mean Lysholm and IKDC scores showed significant improvement (p=0.005 and 0.013, respectively).The location of the cysts was anterior in 9, lateral in 7, medial in 6, and posterosuperior in 1. Intra-articular pathologies were found in 16/23 cases (69.6%). In 10/23 cases (43%), the cyst was connected to the knee joint. Three months postoperative MRI did not show any recurrence of ganglion cysts except for 1 case. CONCLUSIONS: In the treatment of extra-articular ganglion cysts, MRI can be useful for detecting intra-articular lesions and connecting orifices, and arthroscopic management of intra-articular pathologies with open excision of the cyst should be considered as a viable treatment option.

Sensory Neuropathy of the Common Palmar Digital Nerve Caused by Ganglion Cyst

Ganglion cysts that arise from the palm and compress the median nerve are rarely reported. Previous studies have described ganglion cysts compressing the motor branch of the median nerve, but no reports have described sensory neuropathy of the common palmar digital nerve as a result of ganglion cysts. We present a case of sensory neuropathy similar to carpal tunnel syndrome caused by a ganglion cyst that originated from the second carpometacarpal joint.

Ganglion of the Flexor Tendon Sheath between A1 Pulley and A2 Pulley

Few articles have been written about the flexor tendon sheath ganglion in the finger, especially, between A1 pulley and A2 pulley. We report on rare cases of flexor tendon sheath ganglion with one symptomatic and two asymptomatic. All masses were evaluated using real-time ultrasonography and well-defined anechoic cystic lesions with posterior enhancement were observed. A 17-year-old female had a small mass at the 4th metacarpophalageal joint of her right hand, with pain and triggering. The patient underwent simple excision and a ganglion measuring 1.0x0.8 cm in size was derived from Camper's chiasm, between A1 pulley and A2 pulley. In two asymptomatic cases, ganglia measuring less than 0.5 cm in size observed. Based on our experience, real-time ultrasonography would be an excellent diagnostic modality in determining the treatment method in flexor tendon sheath ganglia, and surgical excision is recommended in symptomatic, especially triggering patients.

Histopathological Findings of Hemorrhagic Ganglion Cyst Causing Acute Radicular Pain: A Case Report

Although juxtafacet cysts of the lumbar spine are being reported with increasing frequency, hemorrhage from a ganglion cyst is rare, and the pathophysiologic mechanism of the hemorrhage from the cyst is still unclear. A 75-year-old male presented with sudden radicular leg pain caused by hemorrhage from the ganglion cyst. Computed tomography revealed bony erosion of vertebral body and multiple punched-out lesions on facets. Magnetic resonance imaging showed the neural structure was compressed by a sharply delineating mass. Capsule and old hematoma with elastic consistency that extended to the epidural space were removed through a paramedian transforaminal approach, which led to the resolution of the patient's symptoms. Histopathologically, chronic inflammation with neovascularization and myxoid degeneration were present in the capsule. Alcian blue staining demonstrated the mixture of mucin and hematoma. The probable pathogenesis of hemorrhage from the cyst was discussed from the unique histopathological findings of surgical specimen.

Intramuscular Ganglion of the Quadriceps Femoris

Ganglion cysts are common lesions that are most often found around the joints of the hands and feet. Ganglia around the distal femur usually occur within the synovial membrane or tendon sheath, but rarely within muscles. Several cases of intramuscular ganglions in the hand and wrist have been reported, but a ganglion cyst in the quadriceps muscle has rarely been addressed in studies. In this report, we present a 17-year-old patient with a painful movable mass in the intramuscular area of the quadriceps femoris that was diagnosed by ultrasound and treated by excision and biopsy.

Bilateral Thoracic Ganglion Cyst : A Rare Case Report

Ganglion cysts usually arise from the tissues around the facet joints. It is usually associated with degenerative cahanges in facet joints. Bilateral thoracic ganglion cysts are very rare and there is no previous case that located in bilateral intervertebral foramen compressing the L1 nerve root associated with severe radiculopathy. We report a 53 years old woman who presented with bilateral groin pain and severe numbness. Magnetic resonance imaging revealed bilateral cystic mass in the intervertebral foramen between 12th thoracal and 1st lumbar vertebrae. The cystic lesions were removed after bilateral exposure of Th12-L1 foramens. The result of hystopathology confirmed the diagnosis as ganglion cyst. The ganglion cyst may compromise lumbar dorsal ganglion when it located in the intervertebral foramen. The surgeon should keep this rare entity in their mind for differential diagnosis.

A Fusiform Epineural Ganglion Encompassing the Ulnar Nerve in the Cubital Tunnel / 대한정형외과학회잡지

Cubital tunnel syndrome, caused by a ganglion, is rare and most ganglion cysts originate from the medial aspect of the ulnohumeral joint. We present an extremely rare case of a fusiform epineural ganglion, encompassing the ulnar nerve in the cubital tunnel. A 48-year-old man complained of a 6-month history of typical cubital tunnel syndrome symptoms. Electrophysiological studies were compatible with the compressive neuropathy of the ulnar nerve. A fusiform epineural ganglion cyst (1.4 cm in diameter and 7.2 cm in length), which encompasses the ulnar nerve in the cubital tunnel, was found with no connection to the elbow joint. The ganglion cyst was excised and the ulnar nerve anterior transmuscular transposition was performed. Six months postoperatively, the patient was free of pain, tingling sensations, and numbness. In addition, his grip and pinch strength improved, the muscle wasting showed recovery, and an electrophysiological study demonstrated some improvement.

Symptomatic Posterior Cruciate Ganglion Cyst Causing Impingement between Posterior Root of the Medial Meniscus and Anterior to the Posterior Cruciate Ligament

There are several reports of symptomatic ganglion cysts near the posterior cruciate ligament (PCL), but no reports of a symptomatic ganglion originating from the anterior aspect of the PCL in the deep recess between the posterior root of the medial meniscus and the PCL, bulging into the posteromedial joint space. In this report, we present the clinical features of a patient with a symptomatic ganglion cyst treated successfully by arthroscopic excision.

A Ganglion Cyst in the Second Lumbar Intervertebral Foramen

Ganglion cysts usually arise from the tendon sheaths and tissues around the joints. It is usually associated with degenerative arthritic changes in older people. Ganglion cyst in the spine is rare and there is no previous report on case that located in the intervertebral foramen and compressed dorsal root ganglion associated severe radiculopathy. A 29-year-old woman presented with severe left thigh pain and dysesthesia for a month. Magnetic resonance imaging revealed a dumbbell like mass in the intervertebral foramen between second and third lumbar vertebrae on the left side. The lesion was removed after exposure of the L2-L3 intervertebral foramen. The histological examination showed fragmented cystic wall-like structure composed of fibromyxoid tissue but there was no lining epithelium. A ganglion cyst may compromise lumbar dorsal root ganglion when it located in the intervertebral foramen. Although it is very rare location, ganglion cyst should be included in the differential diagnosis for intervertebral foraminal mass lesions.

Ulnar Nerve Compression in Guyon's Canal by Ganglion Cyst

Compression of the ulnar nerve in Guyon's canal can result from repeated blunt trauma, fracture of the hamate's hook, and arterial thrombosis or aneurysm. In addition, conditions such as ganglia, rheumatoid arthritis and ulnar artery disease can rapidly compress the ulnar nerve in Guyon's canal. A ganglion cyst can acutely protrude or grow, which also might compress the ulnar nerve. So, clinicians should consider a ganglion cyst in Guyon's canal as a possible underlying cause of ulnar nerve compression in patients with a sudden decrease in hand strength. We believe that early decompression with removal of the ganglion is very important to promote complete recovery.

The Follow Up Results of Residual Spinoglenoid Ganglion Cyst after Arthroscopic Decompression and Superior Labral Repair: Cases Report

PURPOSE: There are many known treatment modalities for spinoglenoid ganglion cyst accompanied by suprascapular nerve palsy. However, to the author's knowledge, there is no report on the follow-up outcomes focused on remnant cysts. MATERIALS AND METHODS: Six (n=6) patients with spinoglenoid ganglion cyst accompanied by suprascapular nerve palsy, with a mean follow-up of 15 months (12-23months) following arthroscopic cyst decompression and superior labral repair, were enrolled. Residual cyst was investigated by ultrasonography and MRI. RESULTS: Immediate postoperative ultrasonography revealed complete remission of ganglion cyst in one patient and reduced ganglion cyst size in five patients. Three-month follow-up ultrasonography showed spontaneous complete remission of the residual cysts in all patients. No recurrence on MRI was seen at one-year follow-up. CONCLUSION: Residual spinoglenoid ganglion cyst remaining after arthroscopic decompression and superior labral repair tends to resolve spontaneously within 3 months of surgery.

Ganglion Cyst of the Posterior Longitudinal Ligament Causing Lumbar Radiculopathy

Degenerated conditions such as herniated disc or spinal stenosis are common etiologies of lumbar radiculopathy. Less common etiologies include spinal extradural cyst such as synovial cysts and ganglion cysts. Ganglion cyst of the posterior longitudinal ligament (PLL) of the spine is a rare entity that can result in classical sciatica. Posterior longitudinal ligament cyst has no continuity with the facet joint and has no epithelial lining. Two young male patients presented with unilateral sciatica and were found to have intraspinal cystic lesions causing lumbar radiculopathy. Magnetic resonance imaging demonstrated rounded, cystic lesions (i.e., hypointense on T1- but hyperintense on T2-weighted images) adjacent to minimally dehydrated, nonherniated disc spaces in both cases. These patients underwent posterior decompression and cysts were excised, and their sciatic symptoms were completely resolved. Histological examination showed typical features of ganglion cysts in these cases.

Intramuscular Ganglion Cyst of the Gastrocnemius Muscle / 대한피부과학회지

Ganglion cysts are common lesions that are most often found around the hands and feet. Ganglia around the proximal tibiofibular joint usually occur within the synovial membrane, tendon sheath or peroneal nerve, but they rarely occur within muscle. We report here on a case of a 60-year-old man who complained of an asymptomatic deep seated mass in the proximal part of the right calf that he'd had for more than two years. On magnetic resonance imaging, the lesion appeared as a cystic lesion within the gastrocnemius muscle without communication with the knee joint. To the best of our knowledge, intramuscular ganglion cyst has never been reported in the Korean dermatologic literature.

Multiple Punctures and Steroid Injection in the Treatment of Ganglion Cyst

PURPOSE: Authors applied multiple punctures and steroid injection as a modified treatment of ganglion cyst and report objective and subjective outcomes. MATERIALS AND METHODS: We prospectively evaluated 40 patients with ganglion cysts of hands and wrists who underwent multiple punctures and steroid injection. Symptom improvement, recurrence rate and complications were evaluated after minimum follow-up period of 12 months. RESULTS: Pain and discomfort improved in 31 patients (78%), however, recurrence was observed in 32 patients (80%). The factors associated with low recurrence rate included ganglions located at the hand or palm, with small diameter, and with short period of symptoms. CONCLUSION: Multiple punctures and steroid injection resulted in relatively high recurrence rate of mass itself in the treatment of ganglion cyst. However, from the view point of symptom improvement, this procedure could be considered as a simple modified treatment before surgical excision.

Estudio por imágenes de los gangliones musculoesqueleticos / Imaging study of musculokeletal ganglia

The ganglion is a pseudo cyst that appears as a well defined nodule of firm consistence, formed by fibrous tissue walls and a layer of discontinuous pseudosynovial cells, with thick mucinous content, usually located near a joint a tendon sheath. According to location, different types of cysts, histologically similar, can be found. Their clinical manifestations may vary depending on location and size. They can evolve as an expansive process, displacing or compressing adjacent structure; sometimes they can be an asymptomatic entity that generates patients some embarracement from an aesthetic point of view, or just constitute an incidental radiological. Finding. Therefore, we attach great importance to knowing not only cysts imaging features but also their most common sites and the most appropriate examination techniques to be performed in each specific case. We present a review of the different types of ganglia and the imaging method of choice, according to the literature and to our clinical experience.

El ganglion es un pseudoquiste que se presenta como un nodulo bien definido, de consistencia firme, formado por paredes de tejido fibroso y una capa de células discontinuas pseudosinovlales, con contenido mucinoso espeso y que frecuentemente está cerca de una articulación o una vaina tendínea. Dependiendo de su ubicación, existen varios tipos histológicamente similares. Las manifestaciones clínicas varían dependiendo de su localización y tamaño: pueden comportarse como proceso expansivo, desplazando o comprimiendo estructuras vecinas, ser asintomáticos y a veces provocar una molestia estética al paciente o, ser un hallazgo radiológico incidental. Estimamos importante conocer sus características imaginológicas, localizaciones más frecuentes y el método de examen más útil acorde a su ubicación, para lo cual presentamos una revisión de los distintos tipos de gangliones y el estudio imaginológico de elección en cada caso, de acuerdo a la literatura y a nuestra experiencia clínica.