Sclerotherapy with 75% hypertonic glucose to treat dorsal synovial cysts of the wrist / Tratamento do cisto sinovial dorsal do punho com escleroterapia utilizando glicose hipertônica 75%

ABSTRACT Objective: To evaluate the cure rate for dorsal synovial cysts of the wrist with aspiration and percutaneous sclerotherapy using 75% hypertonic glucose. Methods: We enrolled 45 patients older than 18 years with untreated dorsal synovial cysts of the wrist. They underwent percutaneous aspiration and sclerotherapy with 75% hypertonic glucose 75%. A maximum of two procedures were conducted for each cyst at a 4-week interval. We analyzed age, sex, affected side, history of previous trauma, wrist goniometry, grip strength, wrist pain by the visual analogue scale, complications, and hand function questionnaire scores. Results: We evaluated 45 patients (30 female, 15 male, mean age 38.2 years with 47 cysts). Four weeks after the first procedure, 72.3% cysts were palpable and visible. At 24 weeks after the first procedure, 57.4% cysts evolved to cure and 42.6% persisted. Conclusion: Treatment of dorsal synovial cyst of the wrist with aspiration and percutaneous sclerotherapy using 75% hypertonic glucose achieved a 57.4% cure rate after 24 weeks. Level of Evidence IV, Case series

RESUMO Objetivo: Avaliar o índice de cura do cisto sinovial dorsal do punho, com aspiração e escleroterapia percutânea utilizando glicose hipertônica 75%. Métodos: Foram selecionados pacientes maiores de 18 anos, portadores de cisto sinovial dorsal do punho, sem tratamento prévio. Foram submetidos a aspiração e escleroterapia percutânea com glicose hipertônica 75%. Foi realizado no máximo dois procedimentos em cada cisto, em um intervalo de 4 semanas. Foram analisados idade, gênero, lado acometido, história de trauma prévio, goniometria, força de preensão, dor no punho pela escala visual analógica, complicações e os escores dos questionários funcionais. Resultados: Foram avaliados 45 pacientes com 47 cistos, houve perda de seguimento de 3 pacientes (3 cistos). A média de idade foi de 38,2 anos. Na quarta semana após o primeiro procedimento, tivemos cura em 23,4% cistos, 4,3% cistos apresentavam-se palpáveis porém não visíveis e 72,3% cistos se apresentavam palpáveis e visíveis. Os cistos visíveis e palpáveis foram submetidos ao segundo procedimento. Após 24 semanas do primeiro procedimento, 57,4% cistos foram curados e 42,6% cistos apresentaram persistência. Conclusão: O tratamento do cisto sinovial dorsal do punho com escleroterapia percutânea utilizando Glicose Hipertônica 75%, proporcionou cura de 57,4% após 24 semanas. Nível de Evidência IV, Série de casos

The feasibility of shear wave elastography for diagnosing superficial benign soft tissue masses

PURPOSE: The purpose of this study was to investigate the feasibility of shear wave ultrasound elastography for differentiating superficial benign soft tissue masses through a comparison of their shear moduli. METHODS: We retrospectively analyzed 48 masses from 46 patients from February 2014 to May 2016. Surgical excision, fine-needle aspiration, and clinical findings were used for the differential diagnosis. The ultrasonographic examinations were conducted by a single musculoskeletal radiologist, and the ultrasonographic findings were reviewed by two other radiologists who were blinded to the final diagnosis. Conventional ultrasonographic features and the median shear modulus were evaluated. We compared the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors using the Kruskal-Wallis test. Additionally, the Mann-Whitney U test was used to compare two distinct groups. RESULTS: Significant differences were found in the median shear moduli of epidermoid cysts, ganglion cysts, and lipomatous tumors (23.7, 5.8, and 9.2 kPa, respectively; P=0.019). Epidermoid cysts showed a greater median shear modulus than ganglion cysts (P=0.014) and lipomatous tumors (P=0.049). CONCLUSION: Shear wave elastography may contribute to the differential diagnosis of superficial benign soft tissue masses through a direct quantitative analysis.

Cubital Tunnel Syndrome by a Ganglion Cyst in an Amateur Tennis Player / 대한스포츠의학회지

Ganglion cyst is considered to be a usual cause of peripheral nerve compression. In this report, we present a rare case of ulnar nerve compression by a multi-septated ganglion cyst in the cubital tunnel. A 33-year-old left-handed male amateur tennis player developed progressive numbness and weakness in his right elbow, forearm, and hand for 1 year. Decrease of grip power was apparent in left hand. Clinical examination revealed a cystic mass at the posterior side of the elbow. Magnetic resonance imaging identified a ganglion cyst at the elbow. During surgery about 3 cm diameter epineural ganglion was observed compressing the ulnar nerve and was excised using microsurgery techniques. Three months postoperatively, the clinical recovery of the patient was very satisfactory and he restored his original performance in tennis match.

Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux

BACKGROUND: To describe the clinical and magnetic resonance imaging findings of ganglion cysts with effusion in the flexor hallucis longus tendon sheath around the hallux to evaluate their origin. METHODS: Patients with recurrent or painful ganglion cysts around the hallux with effusion in the flexor hallucis longus tendon sheath who underwent surgical treatment at St. Vincent's Hospital from February 2007 to August 2016 were investigated. Surgical indication was a painful or recurrent mass caused by the cystic lesions. Those without effusion of the flexor hallucis longus tendon sheath were excluded. We assessed the clinical and magnetic resonance imaging findings. RESULTS: Magnetic resonance imaging findings in all patients showed several ganglion cysts around the hallux and large fluid accumulations within the flexor hallucis longus tendon sheath. Regarding the location, six ganglion cysts were on the dorsomedial aspect, one on the plantar medial aspect, seven on the plantar lateral aspect, and one in the toe pulp. Ten patients showed joint effusions in both the metatarsophalangeal and interphalangeal joints, two in the metatarsophalangeal joints, and three in the interphalangeal joints. There were communication stalks with a tail shape or abutment between ganglion cysts with surrounding joint effusions. Intraoperatively, connections between ganglion cysts, the synovial cyst of the flexor hallucis longus tendon sheath, and surrounding joints were seen. CONCLUSIONS: Synovial fluid accumulation in the metatarsophalangeal or interphalangeal joint supplies the synovial cyst of the flexor hallucis longus tendon sheath and subsequently ganglion cysts in the hallux. In clinical practice, the surgeon should carefully check surrounding joints with tendon sheaths to prevent recurrence of the ganglion cysts around the hallux.

Ecografía del cuello de pie / Ultrasound of the Ankle

El ultrasonido es una herramienta eficiente y de bajo costo para la evaluación de la patología del cuello de pie. Mediante ecografía se pueden evaluar los tendones, las vainas tendinosas, los espacios articulares, las bursas, los ligamentos, la fascia plantar y los planos musculares, así como realizar un diagnóstico confiable de múltiples patologías relacionadas. El dominio de la técnica, de la anatomía normal y de las condiciones patológicas son fundamentales para el adecuado desempeño diagnóstico del examen. El propósito de esta revisión es describir los hallazgos ultrasonográficos de múltiples patologías que afectan el cuello de pie y resaltar la utilidad diagnóstica de la ecografía en los casos en que está indicada

In specific indications, ultrasound is an efficient and low cost tool for the evaluation of pathology of the ankle. Ultrasound can evaluate the tendons, tendon sheaths, joint spaces, bursae, ligaments, plantar fascia, muscle planes and perform reliable diagnosis of multiple related pathologies. The mastery of technique, normal anatomy and pathologic conditions are essential for the proper diagnosis performance test. The purpose of this review is to describe the ultrasound findings of multiple pathologies affecting the ankle and highlight the diagnostic value of ultrasonography in cases where it is indicated.

Clinical observation on wheat grain-sized cone moxibustion combined with fire needle for dorsal wrist ganglion / 针灸推拿医学（英文版）

Objective:To observe the clinical effect of wheat grain-sized cone moxibustion combined with fire needle therapy in the treatment of dorsal wrist ganglion (DWG). Methods:A total of 63 patients with DWG were randomized into a treatment group (n=32) and a control group (n=31). Cases in the control group were treated with fire needle therapy. Based on the therapy given to the control group, cases in the treatment group were additionally given wheat grain-sized cone moxibustion therapy. Then the therapeutic efficacies and recurrence rate were evaluated. Results:After treatment, the overall effective rate was 93.8% in the treatment group, versus 77.4% in the control group, and the between-group comparison showed a statistical significance (P<0.05); 6 months after the treatment, the recurrence rate in the treatment group was obviously lower than that in the control group (P<0.05). Conclusion:The long-term and short-term effects of wheat grain-sized cone moxibustion combined with fire needle therapy in the treatment of DWG are better than those of fire needle therapy alone, and therefore, worth popularizing.

Incidence and anatomical distribution of hand tumours: a Singapore study

<p><b>INTRODUCTION</b>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.</p><p><b>METHODS</b>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).</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>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.</p>

Radial Nerve Compression Caused by a Ganglion Cyst at the Elbow

Although ganglion cyst is a relatively common benign mass in soft tissues, there have been very few reports of intramuscular ganglion cyst. We encountered such a case located in the antecubital fossa originating from the supinator muscle. A 61-year-old woman presented with a painless mass in the antecubital fossa. However, the patient complained of a significant sensory deficit in the radial side of the thumb, index, and middle finger. She also had extensor weakness at the metacarpophalangeal joint. The mass was excised completely, with no post-surgical complications. Pathologic results revealed the ganglion cyst. The patient showed improvements in sensory dysfunction and extensor weakness. Intramuscular ganglion cyst can be misdiagnosed. This report might be useful for making an accurate diagnosis and rapidly initiating treatment for an intramuscular mass.

<b>A Case of Ganglion Cyst Disappearance and Urinary Tract Discomfort Improvement with Successful Goshajinkigan </b><b>Treatment</b> / 日本東洋医学雑誌

<p>Kampo <i>goshajinkigan </i>is effective for the improvement of urinary tract function. Moreover, the origin of ganglion cysts is said to be varied and is not clear.<br>We report a case of ganglion cyst disappearance, which was successfully achieved with <i>goshajinkigan </i>for urinary tract discomfort.<br>The patient, a 35-year-old woman, who complained of nocturia, had difficulty in urinating, and a feeling of incomplete emptying. There were no findings of note in the urine or blood tests, and she was negative for cystitis. The patient did however show symptoms of kidney yang-ki deficiency.<br>She was started on <i>goshajinkigan </i>7.5 g/day for cold of the hands and feet, edema, and nocturia ; her feeling of incomplete emptying gradually reduced, and the nocturia, and feeling of incomplete emptying disappeared after 6 weeks. At the same time, her right wrist ganglion cyst also disappeared.<br>This suggests that <i>goshajinkigan </i>is effective in alleviating ganglion cysts in cases with symptoms of kidney yang-ki deficiency.</p>

Pudendal Nerve Entrapment Syndrome due to a Ganglion Cyst: A Case Report

Pudendal nerve entrapment syndrome is an unusual cause of chronic pelvic pain. We experienced a case of pudendal neuralgia associated with a ganglion cyst. A 60-year-old male patient with a tingling sensation and burning pain in the right buttock and perineal area visited our outpatient rehabilitation center. Pelvis magnetic resonance imaging showed the presence of multiple ganglion cysts around the right ischial spine and sacrospinous ligament, and the pudendal nerve and vessel bundle were located between the ischial spine and ganglion cyst at the entrance of Alcock's canal. We aspirated the lesions under ultrasound guidance, and consequently his symptoms subsided during a 6-month follow-up. This is the first report of pudendal neuralgia caused by compression from a ganglion cyst around the sacrospinous ligament.

Porocarcinoma Arising in a Ganglion Cyst: A Case Report and Review of the Literature

Eccrine porocarcinoma is a rare malignant neoplasm of the eccrine sweat gland that often occurs in the lower extremities, and usually affects elderly individuals. Most cases of eccrine porocarcinoma arise de novo. We encountered a case of a large porocarcinoma arising in a pre-existing ganglion cyst in the knee. The malignant tumor was excised widely, and the defect was reconstructed using a free anterolateral thigh flap.

A Ganglion Cyst Formed after Anterior Transposition of the Ulnar Nerve: A Case Report

In this report, a case of a 70-year-old man with a large ganglion cyst formed after anterior transposition of the left ulnar nerve is presented. Three months after the index surgery, the patient presented with a painless superficial ovoid, soft mass measuring 5x4x2 cm in size located at the posteromedial aspect of the left elbow, the previously operated site. Magnetic resonance imaging showed a well demarcated cystic mass with a stalk connecting to the elbow joint. Excisional biopsy was performed and pathologic findings showed that the cystic wall had no definite lining cells with myxoid degeneration compatible with findings of ganglion cyst.

A Ganglion Cyst Formed after Anterior Transposition of the Ulnar Nerve: A Case Report

In this report, a case of a 70-year-old man with a large ganglion cyst formed after anterior transposition of the left ulnar nerve is presented. Three months after the index surgery, the patient presented with a painless superficial ovoid, soft mass measuring 5x4x2 cm in size located at the posteromedial aspect of the left elbow, the previously operated site. Magnetic resonance imaging showed a well demarcated cystic mass with a stalk connecting to the elbow joint. Excisional biopsy was performed and pathologic findings showed that the cystic wall had no definite lining cells with myxoid degeneration compatible with findings of ganglion cyst.

Type 2 Superior Labral Anterior to Posterior Lesion-Related Paralabral Cyst Causing Isolated Infraspinatus Paralysis: Two Case Reports

Type 2 superior labral anterior to posterior (SLAP) lesion is a common cause of shoulder pain requiring surgical operation. SLAP tears are often associated with paralabral cysts, but they rarely cause nerve compression. However, we experienced two cases of type 2 SLAP-related paralabral cysts at the spinoglenoid notch which were confirmed as isolated nerve entrapment of the infraspinatus branch of the suprascapular nerve by electrodiagnostic assessment and magnetic resonance imaging. In these pathological conditions, comprehensive electrodiagnostic evaluation is warranted for confirmation of neuropathy, while surgical decompression of the paralabral cyst combined with SLAP repair is recommended.

Arthroscopic Treatment of the Intratendinous Ganglion of the Long Head of Biceps Brachii: A Case Report

A ganglion is a benign cystic mass, commonly found around a joint or tendon sheath. It frequently occurs at the wrist, foot, ankle, and knee. Intratendinous ganglion has been rarely reported, and intratendinous ganglion of the long head of biceps brachii is extremely rare. According to our literature review, this is the third case of intratendinous ganglion of the long head of biceps brachii, and the first case of arthroscopic treatment. Therefore we report a case of an arthroscopic treatement for an intratendinous ganglion of the long head of biceps brachii.

Arthroscopic Treatment of the Intratendinous Ganglion of the Long Head of Biceps Brachii: A Case Report

A ganglion is a benign cystic mass, commonly found around a joint or tendon sheath. It frequently occurs at the wrist, foot, ankle, and knee. Intratendinous ganglion has been rarely reported, and intratendinous ganglion of the long head of biceps brachii is extremely rare. According to our literature review, this is the third case of intratendinous ganglion of the long head of biceps brachii, and the first case of arthroscopic treatment. Therefore we report a case of an arthroscopic treatement for an intratendinous ganglion of the long head of biceps brachii.

Ganglion Cyst of the Sternoclavicular Joint in an Adult

Ganglion cysts are most common on the dorsum of the hand or wrist, but they can occur in any part of the body. There have been few papers reporting ganglion cysts originating from the sternoclavicular joint, with most of these cases developing in children. A 76-year-old woman was referred to our department because of a painless mass over the right sternoclavicular joint. The mass was excised along with the portion of the sternoclavicular joint capsule surrounding the stalk. Histopathologic examination showed the cyst wall to be composed of compressed collagen fibers without evidence of an epithelial or synovial lining, which was consistent with ganglion cyst. To our knowledge, this is the first report of such a cyst in an adult. We consider this to be a useful report for surgeons that treat mass lesions occurring in almost any part of the body surface.

Therapeutic Approach of Wrist Ganglion Using Electroacupuncture: Two Case Reports

A ganglion cyst is a relatively common benign tumor on the wrist. Conservative and surgical approaches have been used for its treatment. Various conservative treatment methods have been suggested such as reassurance, aspiration, sclerosant injection, and direct compression. But, there is no acceptable treatment of choice yet because each suggested method has a relatively high recurrence rate. We want to report two cases in which the size of the wrist ganglion was decreased by using electroacupuncture. One patient presented with a chronic ganglion for six years and the other patient presented with a recently occurred acute ganglion. We applied electroacupuncture for 20 minutes once a week for eight weeks to both of them. Afterwards, the size of the wrist ganglion diminished in the follow-up sonography and the accompanying pain was also relieved. Herein we report both cases along with a review of the relevant literature.

Intraspinal Ganglion Cyst / 전남의대학술지

The pathogenesis of juxtafacet cysts is closely related to degenerative instability of the lumbar spine and degenerative changes in the ligamentum flavum and the facet joint. A 56-year-old man presented with severe right thigh pain and numbness for 1 month after a laminar fracture of the L4 spine. Magnetic resonance imaging revealed a heterogenous cystic mass surrounding the facet joint between the fourth and fifth lumbar vertebrae on the right side. Conservative therapy was unsuccessful and the lesion was removed by surgical decompression alone without fusion. The histological examination showed a fragmented, cystic wall-like structure composed of myxoid degenerative tissue without lining epithelium. Here we present this case of a ganglion cyst that appeared to be associated with facet joint instability.

Intraspinal Ganglion Cyst / 전남의대학술지

The pathogenesis of juxtafacet cysts is closely related to degenerative instability of the lumbar spine and degenerative changes in the ligamentum flavum and the facet joint. A 56-year-old man presented with severe right thigh pain and numbness for 1 month after a laminar fracture of the L4 spine. Magnetic resonance imaging revealed a heterogenous cystic mass surrounding the facet joint between the fourth and fifth lumbar vertebrae on the right side. Conservative therapy was unsuccessful and the lesion was removed by surgical decompression alone without fusion. The histological examination showed a fragmented, cystic wall-like structure composed of myxoid degenerative tissue without lining epithelium. Here we present this case of a ganglion cyst that appeared to be associated with facet joint instability.