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Intraosseous ganglia of the scaphoid and lunate bones: Report of 15 cases in 13 patients
Abstract
Thirteen patients with 15 intraosseous carpal ganglia (6 scaphoid and 9 lunate cases) are reported. Eleven cases had cortical defects communicating the bone cysts either with the joint space or a coexisting soft tissue ganglion. Nine cysts were primary or idiopathic; soft tissue ganglia were found in 6 secondary cases and anatomic continuity of the intraosseous and extraosseous components through cortical defects was present. Treatment consisted of curettage of the cyst wall and cancellous bone grafting. Approaching lunate cysts through a small opening in the scapholunate interosseous ligament is described. Results were analyzed in 12 cases with at least 1 year of follow-up; the average follow-up period in these cases was 47 months (range, 12-119 months). Results were very good in all but 1 patient, who suffered a partial lunate collapse, which resulted in mild lunocapitate osteoarthritis. No graft reabsorption or recurrence was seen in the control radiographs obtained throughout the follow-up period.
... The detected peak of IOG is in middle age, with 56% of the IOGs located at the palmar carpus. The lunate and scaphoid were more frequently affected than other carpal bones, including the metacarpals and phalanges [4]. IOG spanning both the lunate and scaphoid is uncommon. ...
... Uriburu et al. reported 15 cases of IOG that underwent surgery, with two of 13 patients having bilateral IOGs. Among them, six lunates and nine scaphoids were affected, and eight patients experienced wrist pain [4]. Three pathogeneses of IOG, including intramedullary metaplasia, penetration, and microvascular deterioration, were presented [2]. ...
... In the present case, the mechanical stress or degeneration of the insertion of the radioscapholunate ligament to the scaphoid and lunate might be a cause of this ganglion. There are two types of IOG: type 1, idiopathic or primary intraosseous lesion, and type 2, the penetrating type caused by the cortical penetration of a previously existing soft tissue ganglion [4,9]. The causes of type 1 IOG remain unclear, while type 2 is caused by the invasion of proximal cortical material. ...
Intraosseous ganglions (IOGs) are actually quite common but one spanning two adjacent carpal bones is uncommon. We report a case with an IOG spanning the scaphoid and lunate, which was treated surgically. A 16-year-old right-handed female noticed left wrist pain that started spontaneously five years previously. Physical findings indicated carpal instability in the left wrist. Posteroanterior radiographs of the left wrist showed small cysts in the lunate and scaphoid, while the lateral radiograph revealed volar flexion of the lunate. Bone curettage was performed using sharp curettes, and due to the physical findings of carpal instability, temporary scapho-trapezoidal joint fixation was done using two Kirchner wires. Two years post-surgery, wrist pain had significantly improved and carpal instability findings disappeared. Computed tomography revealed no obvious collapse of carpal bones and expansion of bone defects in the lunate and scaphoid. Bone formation was observed in the bone curettage area of the scaphoid.
... Their incidence is difficult to estimate. 1 They are most frequently painless and asymptomatic, and they are usually discovered by chance on plain radiographies, magnetic resonance imaging (MRI), or computerized tomography (CT) examination. Patients with ILBG can develop symptoms, however: mostly pain, if the cyst is responsible for a lunate fracture or an opening into the scapholunate joint space. 2 Intraosseous ganglia can occur in all carpal bones but are mainly located in the lunate, sometimes bilaterally, 3 and can be associated with soft tissue wrist ganglia. ...
... 1,3 Bilateral presentation has been noted in some cases. 1 The typical population is rather young (25 to 40 years), with female predominance (80% in some series). 1,5,15 Open procedures of curettage and bone grafting have been the standard treatment for many years, enabling good results with low recurrence rates. ...
... 1,3 Bilateral presentation has been noted in some cases. 1 The typical population is rather young (25 to 40 years), with female predominance (80% in some series). 1,5,15 Open procedures of curettage and bone grafting have been the standard treatment for many years, enabling good results with low recurrence rates. The open dorsal approach, however, leads to frequent stiffness and persistent pain. ...
Intraosseous lunate bone ganglia (ILBG) are known to be a cause of chronic wrist pain and disability. Standard treatment consists of curettage and autologous bone grafting. Open procedures have shown good results with few recurrences, but with frequent stiffness or persistent pain. Arthroscopic techniques are more recent and seem very reliable. Several arthroscopic techniques have been reported for ILBG approach and treatment. The present study describes an approach that preserves all the lunate cartilage of both radiocarpal and midcarpal surfaces. The surgical technique allows easy and direct access to the bone ganglia, passing through the intermediate portion of the scapholunate ligament, with the scope in the 1-to-2 portal and instrumentation through the 3-to-4 portal. The rest of the procedure is straightforward: curettage and bone grafting are performed through this specific approach, similarly to other techniques. This an easy and accurate approach that avoids any damage to the major cartilage surfaces of the lunate, with easy and reliable access to the intraosseous lunate bone ganglion, allowing cyst curettage and autologous bone graft in a proper and noninvasive way.
... If any tissue was left, pyogenic granuloma tended to recur. We must keep in mind amelanotic melanoma and squamous cell carcinoma for differential diagnosis [27]. ...
... According to other studies in the literature, the most common benign tumor of the hand was ganglion cysts, although pyogenic granuloma was the most common tumor in our study [27]. In our study, ganglion cyst was second common benign tumors of the hand. ...
... Although its underlying causes are unknown, mucinoid degeneration of colloid tissue is the best theory. Ganglion cysts mostly arise from the dorsal wrist, volar wrist, dorsal distal interphalangeal joint and volar metacarpophalangeal joint [27]. ...
Objective: Tumors of the hand are common and mostly benign. Benign soft tissue tumors of the hand can arise from the skin, tendons, vessels, nerve and subcutaneous tissue. Tumors can be removed by surgical excision for cosmetic reasons and a possibility of malignancy. The objective of this retrospective study was to evaluate the types of benign soft tissue tumors of the hand in comparison to the literature.
Materials and Methods: We conducted a retrospective review of all surgically excised benign soft tissue tumors of the hand at the University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital between March 2000 and October 2017. A total of 426 patients (208 males and 218 females) were included in this study. The mean age was 39.4 years (range, 4-61 years). 426 patients were evaluated according to their ages, genders, anatomic location and histopathology of tumors and their treatment modalities.
Results: The most common benign tumor of the hand was pyogenic granuloma (25%). The other diagnosed benign tumors of the hand with the decreasing percentage were ganglion cysts (15%), giant cell tumors of the tendon sheaths (GCTTS) (15%), other hand tumors (13%), hemangiomas (8%), neurinomas and schwannomas (6%), fibromas and fibrolipomas (5%), epidermal cysts (3%), glomus tumors (2%) and arteriovenous malformations (2%).
Conclusion: A comprehensive history and detailed physical examination performed by specialists are essential in the diagnosis of the tumor. The vast majority of hand tumors are benign, and if a tumor of the hand is suspected, a biopsy should be performed before definitive treatment. [Hand Microsurg 2018; 7(2.000): 88-92]
... a následné vyplnění vzniklé dutiny spongiózou (1,6,7,12,13). Existují kazuistické popisy možných komplikací IOG charakteru zlomeniny, ruptury flexoru prstů či syndromu karpálního tunelu (5). ...
... penetrační teorie dochází tlakem extraoseálního měkkotkáňového ganglia k jeho penetrací do kosti. Spojení extra-a intraoseálního ganglia bylo v dostupných studiích prokázáno v 31-47 % případů (11,12). Důvody prorůstání do kosti místo do vazu, který lze spíše vnímat jako locus minoris rezistentiae by bylo možno vysvětlit větší tvárností kostní tkáně v rámci její přestavby, umožňující vytvoření kostních cyst a na druhou stranu rigiditou kolagenních vláken vaziva. ...
... Traum. čech., 83, 2016, No. 4 KAZUISTIKA CASE REPORT nekrózou (7,8,12,13). Vznik idiopatických ganglii lze jinak také popsat jako následek kontinuálního intraartikulárního tlaku spolu s repetitivními mikrotraumaty vedoucími k ischemii a nekróze kosti s následnou resorpcí vedoucí ke vzniku cysty (8). ...
An intraosseous ganglion cyst has been reported in nearly all of the carpal bones; it is a rare cause of chronic wrist pain. The case presented here is a rare finding of symptomatic intraosseous ganglion of the trapezium bone. The relevant literature is reviewed. Key words: ganglion cyst, trapezium bone, wrist.
... Differential diagnoses of painful cystic radiolucent carpal lesion are osteoid osteoma, osteoblastoma and intraosseous ganglion. [1][2][3][4][5][6][7] Rarely ganglion cyst is found in small bones of hand and feet. [1][2][3][5][6][7][8][9][10][11][12] Intraosseous ganglion is a rare cause of wrist pain and having histological similarity to that of soft tissue ganglion. ...
... [1][2][3][4][5][6][7] Rarely ganglion cyst is found in small bones of hand and feet. [1][2][3][5][6][7][8][9][10][11][12] Intraosseous ganglion is a rare cause of wrist pain and having histological similarity to that of soft tissue ganglion. The cyst contains mucoid viscous material without epithelial or synovial lining. ...
... 6,7) The intraosseous ganglion is rarely seen in Lunate and scaphoid as carpal bones are unusual site of involvement. 1,[4][5][6][7][8] Intraosseous ganglion peak incidence in second to fourth decade of life and is having female preponderance. The postulated etiopathogenesis of this lesion due to myxomatous degeneration of connective tissue leading to cyst formation. ...
Intraosseous ganglion cyst is a rare bone tumor and the lesion could often be missed. The diagnosis could be delayed so proper
radiologic investigation and index of suspicion is necessary .Differential diagnoses of painful cystic radiolucent carpal lesion are
osteoid osteoma, osteoblastoma and intraosseous ganglion. Curettage of the scaphoid lesion and filling of void with bone graft
provides good functional outcomes. The cyst contains mucoid viscous material without epithelial or synovial lining. We present a
case of 30 years old male with intraosseous ganglion cyst of scaphoid which was treated with curettage and bone grafting. Rarely
ganglion cyst is found in small bones of hand and should be considered as differential diagnosis of chronic radial wrist pain.
Keywords: Intraosseous Ganglion, Scaphoid, Curettage, Bone grafting
... It is generally believed that there are two types, the idiopathic or primary type (lesion perhaps due to a degenerative bone process) and the secondary type (lesion caused by the cortical penetration of a previously existing soft tissue ganglion). Most investigators believe that the primary type is more frequent [7]. ...
... The most common soft tissue ganglion, accounting for 60-70% of all ganglia of the hand and wrist, is dorsal ganglion, which usually originates in the scapholunate interosseous ligament [7]. ...
... Surgery is indicated, even in asymptomatic cysts, when periodical X-rays show that the cyst is progressively growing and replacing the cancellous substance of a carpal bone or eroding cortex [7]. ...
An intra-osseous ganglion of the lunate treated operatively, is reported. The patient suffered 2 years of pain in the left wrist and a cystic lesion in the lunate. Curettage and bone grafting resulted in complete relief of pain.
... Treatment options depend on clinical and imaging findings. Surgery is required if the IGC is symptomatic or if imaging data suggest an increase in size (5). The growing IGC can lead to traumatic and collapsed fractures with serious complications (6). ...
... Carpal IGC mainly manifests as wrist soreness and discomfort or pain, together with decreased wrist mobility, decreased hand grip, and in severe cases, abnormal sensation or wrist dysfunction (19). Therefore, surgical intervention is recommended for those patients who have symptoms or in whom the imaging data suggest growing cysts (5). The aim of surgery is to reduce local pain, improve wrist function, and prevent complications. ...
Objective
To investigate the application and the clinical efficacy of wrist arthroscopy in the treatment of carpal intraosseous ganglion cysts (IGCs).
Methods
A retrospective case study method was adopted to analyze the clinical data of 28 patients with carpal IGCs admitted to the Sixth Hospital of Ningbo from April 2012 to January 2019. A hypodensity in the bone was shown by X-ray before the operation, with hypodensity and cystic change in the bone being confirmed by computed tomography and magnetic resonance imaging. Arthroscopic open window of the wrist, cystectomy, and autologous iliac bone graft implantation were conducted. Regular postoperative X-ray combined with CT follow-ups were conducted to observe the healing after bone implantation. Patients were followed up regularly and assessed by the Modified Mayo Wrist Score in four aspects of the postoperative pain, wrist mobility, grip, and function to provide an objective overall assessment of the therapeutic outcome.
Results
All 28 patients were followed up for 8–16 months, with an average follow-up duration of 10 months. After the operation, pain disappeared completely for 25 patients, and 3 cases showed significant improvement. All cases were pathologically confirmed as ganglion cysts and had first-stage bony healing after bone grafting with an average healing time of 10.8 weeks. The grip returned to normal for all patients, and wrist flexion and extension were the same as the healthy wrist for 25 patients, with a Modified Mayo Wrist Score of excellent in 19 cases and good in 9 cases. No recurrence was observed.
Conclusion
In patients with symptomatic carpal IGCs, the application of arthroscopic open window, cystectomy, and autologous bone graft implantation could achieve satisfactory clinical therapeutic effects.
... Surgery is recommended when symptoms, such as pain, are present, and in growing intraosseous cysts, which can cause complications, including fractures. 9 Bone cavity curettage is frequently performed after resection of an intraosseous ganglion cyst, and the cavity should be filled by an autologous or an artificial bone graft, like bone cement, to avoid bone fractures or pain. 9 We can conclude from this report that, though rare, ganglion cysts can develop at the sternoclavicular joint. ...
... 9 Bone cavity curettage is frequently performed after resection of an intraosseous ganglion cyst, and the cavity should be filled by an autologous or an artificial bone graft, like bone cement, to avoid bone fractures or pain. 9 We can conclude from this report that, though rare, ganglion cysts can develop at the sternoclavicular joint. ...
We report the case of a 63-year-old man who presented with a mass on the right clavicle near the sternoclavicular joint. He had received prior puncturing treatment, but relapsed each time. Magnetic resonance imaging revealed that the mass was a ganglion cyst, which appeared to be connected to the right clavicle. Excisional biopsy revealed that the cyst was an intraosseous ganglion cyst, and the cavity was connected to the sternoclavicular joint. The cavity was filled with an artificial bone graft after curettage to prevent fracture. Histological examination showed that the cyst wall had no lining cells and consisted of fibrous connective tissue. To the best our knowledge, this case is the first report of an intraosseous ganglion cyst of the sternoclavicular joint.
... There are two opposing theories: the idiopathic or primary intraosseous lesion is due to an intramedullary metaplasia of mesenchymal cells into synovial-like cells or ischemic bone necrosis resulting from mechanical stress or repeated microtraumatisms . Resorption of necrotic material will give the place to an intraosseous cyst [6] [13]. ...
... These pains could result from intraosseous hyperpressure secondary to pathologic process development within an inextensible limited cavity. Other clinical manifestations might be observed and correlated with IOG cyst complications [1] [2] [6]: ...
Intraosseous ganglion (IOG) cyst of the scaphoid is an infrequent cause of hand and wrist pain. Intraosseous ganglia located in the scaphoid have rarely been described in the literature. We report the case of a 30-year-old right-handed woman who presented with a more than 24-month history of progressive right-wrist pain. No history of trauma was reported. Conservative treatment with anti-inflammatory medications before referral was unsuccessful. Examination revealed a small palpable mass in the carpal navicular region with no limitation of normal wrist motion. An IOG cyst of the scaphoid was found on standard radiograph and CT-scan of the wrist. Treatment consisted in curettage of the cyst followed by packing of the defect with autologous cancellous bone graft harvested in the distal end of the radial metaphysis. Satisfactory functional recovery was achieved. The clinical, radiographic and therapeutic aspects of this rare condition are discussed by the authors.
... Bin dokuz yüz doksan dokuz yılında Uriburu ve ark.'nın yaptıkları çalışmalar incelendiğinde dokuz hastaya açık yöntemle küretaj ve greftleme uygulamış, bu hastaların sekizinde hareket açıklığı ve kavrama gücünün tam iyileştiğini belirtmişlerdir. [9] Waizenegger ve ark., açık yöntemle küretaj ve greftleme uyguladıkları 12 hastayı değerlendirmişlerdir. [4] Açık yöntemle yapılan küretaj ve Artroskopik yöntemle tedavi sonrası yapılan çalışmaları incelediğimizde; Cerlier ve ark., 2015 yılında yaptıkları çalışmalarında dört hastada ameliyat sonrası ağrının ikinci ayda tamamen geçtiğini ve kavrama gücünün karşı tarafla karşılaştırıldığında %100 oranında olduğunu bildirmişlerdir. [10] Ashwood ve Bain tarafından artroskopi yardımlı küretaj ve greftleme uygulanan ve ortalama 3,8 yıl takipli sekiz hastanın sonuçlarının bildirildiği çalışmada, hastalarda ortalama olarak 14 ayda uygulanan greftlerde radyolojik olarak osteointegrasyonun geliştiği saptanmıştır. ...
... On the other hand, symptomatic IGCs, might not respond to painkillers and then surgery would be indicated [12].Surgery will involve curettage of the cyst followed by an autologous bone grafting with the intention to avoid any recurrence or collapse. A vascularized bone graft is advisable when treating bone cysts associated with fracture [13].In our case, the patient responded well to conservative measures did not require surgery, however, still under follow-up.Osagie et al. [14] reported a 17-year-old male with a 12-month history of progressive right wrist pain due to an intraosseous ganglion of the trapezoid and capitate. The lesions were found to be continuous with the wrist synovium. ...
Introduction
Intraosseous carpus ganglion cysts are very rare causes of hand and wrist pain. Isolated cases of lunate, scaphoid, pisiform, hamate, triquetrum, capitate, metacarpal, and phalanx cysts have no report of more than two carpal cysts, according to our knowledge.
Case Report
A case of simultaneous triquetrum, lunate, and capitate intraosseous ganglion cysts is presented. A 56-year-old right-handed woman presented with a 6-month history of persistent left-wrist pain. An old minor trauma was reported; however, the plain radiographs did not show any fractures. Subsequently, magnetic resonance imaging was performed, and it showed small cysticstructures in the lunate, triquetrum, and capitate which is keeping with small intraosseous ganglia. The patient did not want to go down the surgical route as the pain was to some extent manageable.
Conclusion
Intraosseous carpal ganglion cysts, although rare, can cause chronic wrist pain and should be included in the differential diagnosis.
... Following resection, the ganglion cyst cavity within the lunate bone should be filled to avoid bone fractures caused by the axial pressure (28). Bone cement is a type of biological bone substitute materials that has been applied in clinical treatment for years, and is particularly suitable for the repair of bone defects subsequent to resection of bone tumor (29,30). ...
The aim of the present study was to treat intraosseous ganglia of the carpal bones with injectable bone cement grafting. Between January 2012 and December 2013, 4 patients (3 men and 1 woman) presenting with wrist pain and activity limitation were diagnosed with intraosseous ganglion of the carpal bones by radiography. The patients were treated with minimal invasive curettage and bone cement injection surgery. All patients were followed up for a mean time of 17 months (range, 12-22 months). The wrist pain was significantly reduced in all patients following surgery. In addition, the activity range and grip strength were also improved compared with the preoperative parameters. Subsequent to treatment, the Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score presented mean values of 78.8 (range, 75-80) and 11 (range, 7.7-15.0), respectively. These results suggested that the patients showed a good recovery. All patients were satisfied with the postoperative results and returned to work within 4 weeks. In conclusion, bone cement injection is an effective and safe therapeutic strategy for the treatment of intraosseous ganglia of the carpal bone.
... Intraosseous ganglion may develop either within the bone near but not directly communicating with a joint or from adjacent joint tissues with secondary penetration into bone [2]. The first type is more commonly reported [3][4][5]. Intraosseous ganglion was described by Fisk in 1949 as a periosteal ganglion-like lesion developing a cystic bony defect through intraosseous penetration [6]. In 1966, Crabbe named it the intraosseous ganglion cyst [7]. ...
Background: Intraosseous ganglion cysts are rare causes of hand and wrist pain. Differential diagnosis of painful cystic radiolucent carpal lesions includes osteoid osteoma and osteoblastoma. Isolated cases of ganglion cysts occurring in the lunate, scaphoid, pisiform, hamate, triquetrum, capitate, metacarpal, and phalanx have been reported.
Case Presentation: A case of intra-articular intraosseous ganglion cyst of the scaphoid is presented. A 32-year-old right-handed man presented with a 2 year history of progressive left-wrist pain. No history of trauma was reported. Conservative treatment with anti-inflammatory medications before referral was unsuccessful. This case was treated with curettage and bone grafting having excellent results with visual and analog pain scores reduced from 68 to 11 and range of motion was 90° extension to 80°flexion and full grip strength.
Conclusion: Cases of intraosseous ganglions are reported in literature mostly in lower limbs and lunate among carpals, with scaphoid being a rare site of the involvement. In this report, we described a symptomatic case which was successfully treated by intralesional curettage, and autogenous bone grafting.
... Intraosseous ganglion cyst is an infrequent cause of chronic wrist pain. It is most commonly reported in the lunate and scaphoid bones (3)(4)(5)(6). Its differential diagnosis includes osteoid osteoma, giant cell tumor, enchondroma, osteoblastoma and the Kienbock's disease (7). ...
Background: Intraosseous ganglions (IOGs) of the lunate bone are a rare cause of chronic wrist pain. Traditional treatment by open curettage and bone grafting can lead to ongoing pain and stiffness of the wrist.
... The differential diagnosis of intraosseous ganglion includes unicameral bone cyst, chondromyxoid fibroma, Brodie's abscess, giant cell tumour, fibrous dysplasia, and pigmented villonodular synovitis [10,15]. In this case the patient underwent surgery with percutaneous drilling for a possible Brodie abscess and had a recurrence of the lesion possibly due to the fact that the cavity was only decompressed and not excised. ...
Intraosseous ganglia are benign cystic lesions located in the subchondral bone. Intraosseous ganglion cysts of the ankle are relatively uncommon. We present a case of recurrent intraosseous ganglion in the ankle of a 41-year-old female who had recurrence after initial surgery. She was treated effectively by curettage and autogenous cancellous bone grafting. At the final follow-up, satisfactory results were obtained with no recurrence or complications.
... Intraosseous ganglia are relatively common in the wrist, with an estimated prevalence of 9.6% (8), and are probably the result of mucoid degeneration of adjacent ligaments. Occasionally these ganglia can cause pain, and may require curettage and bone grafting (9)(10)(11). ...
... The course of disease varies from case to case; pathologic fractures can occur. X-ray, CT and MRI examinations play a role in the diagnosis of intraosseous ganglions 5 ; however, the final diagnosis depends on intraoperative findings and postoperative pathological findings 6 . ...
... The prevalence of intraosseous ganglia has been reported to have a small male preponderance [7], but no significant difference based on sex was seen in the current series. The most common bone affected in this study was the tibia, a result consistent with that of previous studies showing a tendency for the long bones of the lower limb; however, the carpal bones are another well-recognized site [5,[8][9][10][11]. ...
Background:
Intraosseous ganglion is a cystic lesion that contains gelatinous material, most often occurs in middle-aged patients, and is regarded as similar to soft-tissue ganglion. The etiology is unknown, but association with degenerative joint disease has been considered.
Materials and methods:
At a single institute, 17 patients (8 men, 9 women) with a mean age of 48.9 years (22-72 years) were surgically treated for an intraosseous ganglion. The lesions were located in 9 long bones (5 tibiae, 2 humeri, 1 ulna, and 1 femur); 4 flat bones (2 scapulae, 2 ilia); and 4 small bones (2 scaphoid, 1 metacarpal bone, and 1 talus). The diagnosis was confirmed based both on the gross intraoperative finding of intralesional gelatinous material and on histopathology.
Results:
All lesions occurred at the epiphysis or near the joint. The plain radiographs showed a lesion with marginal osteosclerosis. The average lesion size was 22.4 mm (range 6-40 mm). Among the 17 patients, 2 (12%) had osteoarthritis, 3 (18%) had pathological fracture, and 4 (24%) had extraskeletal extension.
Discussion and conclusion:
The periosteum and cortex of bone represent physical barriers. Therefore, it seems much more likely that primary bone lesions will spread to the soft tissues. Intraosseous ganglion does not appear to be associated with either soft-tissue ganglion or with osteoarthritis. This clinical information and the appearance on plain radiographs, particularly the marginal osteosclerosis, are of differential diagnostic importance.
We present a case of a 29-year-old woman with diffuse, unilateral wrist pain and carpal tunnel syndrome secondary to an interosseous ganglion of the lunate and aim to highlight uncommon aetiologies when assessing patients with atypical carpal tunnel symptoms.
Background
Intraosseous ganglia of the carpal bones are uncommon with sparse publications to guide treatment. The purpose of this study was to review a single-institution experience to determine the outcomes of patients with surgically treated intraosseous carpal ganglia.
Methods
Skeletally mature patients with intraosseous carpal ganglia between 1995 and 2016 treated operatively were identified. Demographic information, clinical data, and radiographic studies were evaluated.
Results
Thirty-three ganglia in 31 patients were identified. Intraosseous ganglia were located in the lunate (23), scaphoid (9), and trapezoid (1). Patients who presented with pathologic fracture or collapse had larger intraosseus ganglia than those presenting with pain alone. Surgery significantly improved pain. Patients treated with debridement with autograft bone graft had a higher consolidation rate compared with allograft bone but no difference in pain.
Conclusions
Patients with large or symptomatic lesions can be treated successfully with curettage and debridement, which leads to relief of pain. The use of bone grafting remains controversial.
As magnetic resonance imaging (MRI) becomes more readily available and more frequently utilized in the assessment of canine carpal lameness, both normal variations and early pathologic conditions must be recognized to optimize patient care and provide accurate diagnosis. On cross sectional studies of the canine carpus, cyst‐like lesions have been detected at the dorsolateral aspect of the intermedioradial carpal bone. The cross‐sectional imaging and histologic properties of these lesions have not been described. The purpose of this observational study is to evaluate the MRI and histologic features of these cyst‐like lesions in a cohort of clinically sound dogs. It was hypothesized that the lesions would show features similar to intraosseous ganglion cysts of the human wrist. Twenty‐five cadaveric canine carpi were obtained and a total of 13 lesions were detected on MRI. Based on MRI, six carpi with lesions of varying size and one normal carpus were submitted for histological evaluation. Five of the abnormal carpi had nonarticular cyst‐like lesions; one specimen with a positive magnetic resonance image for a cyst‐like lesion had no cyst‐like lesion on histology. Conspicuity of a medium‐size lesion as evaluated on radiographs was poor. Given the presence of these nonarticular cyst‐like lesions in a population of clinically sound patients, their clinical importance is uncertain. The development of these lesions may relate to altered mechanics or genetic predispositions, requiring additional study.
Rationale:
Tumors of the scaphoid are rare, and some can cause pathological fractures. No cases of pathological fractures of the scaphoid have been reported in children. The most common treatment for pathologic fractures of the scaphoid bone associated with a benign lesion in adults is surgical, with intralesional curettage associated with autologous bone grafting and internal fixation.
Patient concerns:
A 10-year-old boy presented with wrist pain after falling from his height.
Diagnoses:
X-ray, CT-scan and MRI showed a pathological undisplaced fracture of the scaphoid on a benign lytic lesion.
Interventions:
The arm was immobilized in a below-elbow cast.
Outcomes:
The fracture healed within 4 months of immobilization. 3 years after the fracture, the functional status was normal, and the lytic lesion could not be seen on radiographs.
Lessons:
Retrospectively, the most probable etiology was a ganglion cyst. Our case suggests that some pathological fractures of the scaphoid may not need surgery, especially not in children.
Purpose:
Intraosseous ganglion cyst (IGC) is a rare disease, particularly in lunate. The objective of this study was to summarize current knowledge on the treatment of IGC of the lunate, through a literature review, to provide a therapeutic strategy for this rare disease.
Methods:
The PubMed, ISI Web of Science, Cochrane Library, EMBASE, Science Direct database were searched with a set of predefined inclusion and exclusion criteria. Manual searches for references were performed to find potential relevant studies. The authors extracted data from the articles selected.
Results:
Different treatment modalities of IGC of the lunate were described, all of which were divided into 3 categories: conservative treatment, classical surgical procedures, and novel surgical procedures. An overview on the main treatment modalities for IGC of the lunate was provided.
Conclusions:
Conservative treatments can be the doctors' first choice for patients with IGC. Surgical procedure is advised when conservative treatment fails. Traditional surgical curettage with autologous bone grafting is the mainstay of treatment with satisfactory outcomes; however, novel surgical techniques like arthroscopically assisted minimally invasive technique or filling with bone cement are considered as more promising attempts with less trauma and shorter recovery period. Nonetheless, studies with high levels of evidence are guaranteed for developing widely accepted clinical treatment guidelines.
Background:
Cystic lesions of the carpal bones are rare entities that are infrequently reported in the literature. Scaphoid intraosseous cystic lesions represent a rare subset of carpal bone cysts. This review aims to summarize the available evidence on the evaluation and treatment of scaphoid cystic lesions to help guide clinical management.
Methods:
Systematic electronic searches were performed using PubMed, Ovid, and Embase databases. Studies included were graded for their risk of bias. Pooled descriptive statistics were performed on incidence, etiology, physical exam findings, treatment, and follow-up.
Results:
A total of 38 patients representing 41 scaphoid cystic lesions were pooled from 27 articles. Patients presented with wrist pain without fracture (n = 27), pathological fracture (n = 9), swelling only (n = 1), or were asymptomatic (n = 4). Cystic lesions of the scaphoid were initially revealed on imaging with radiographs alone (n = 22), radiographs in combination with computed tomography (CT) (n = 10) or magnetic resonance imaging (n = 6), CT alone (n = 1), or using all 3 modalities (n = 2). Intraosseous ganglia were identified most frequently (n = 31), followed by "bone cyst-like pathological change" (n = 3), unicameral bone cysts (n = 2), aneurysmal bone cysts (n = 2), primary hydatid cysts (n = 2), and cystic like changes post fall (n = 1). Treatment modalities included curettage and bone graft (n = 39) or below-elbow cast (n = 2). On follow-up (average of 21.3 months; n = 40), all patients improved clinically after treatment and were found to have full wrist range of motion without pain (n = 31), slightly reduced grip strength (n = 3), limited range of motion (n = 2), or persistent mild discomfort (n = 2).
Conclusions:
Scaphoid cystic lesions are most commonly intraosseous ganglia, but can include other etiologies as well. The main presenting symptom is radial wrist pain that usually resolves after treatment. The presence of intracarpal cystic lesions should be considered in the differential diagnosis of wrist pain.
Intraosseous ganglion cysts are rare entities, even rarer in the subchondral region of the distal tibia. A 20-year-old male presented to us with complaints of pain and limp in the right ankle joint, which was diagnosed as an intraosseous ganglion cyst of the right distal tibia and was successfully treated with curettage and bone cement with no recurrence seen even after a year.
A technique for using an x-ray detectable radiopaque element from a surgical sponge to assess the adequacy of debridement of carpal bone cysts, Kienböck disease (lunate avascular necrosis), enchondroma of the digits, and scaphoid nonunions is described. The technique is simple to perform, inexpensive, and presents minimal additional risk to the patient. The technique has been used over the past 16 years and has enabled adequate debridement of these hand and wrist maladies by radiographically demonstrating the adequacy of the debridement to be bone grafted. It avoids the problems associated with liquid contrast dye and has proven to be very safe, effective, and inexpensive.
Imaging serves an important role in the diagnosis and classification of Kienböck’s disease. The four-stage system proposed by Lichtman et al. in 1977 is an imaging-based classification system, which has significant implications for treatment planning. Whereas the initially proposed Lichtman classification was based primarily on radiographical osseous findings, advancements in the understanding of computed tomography (CT) and magnetic resonance imaging (MRI) features of Kienböck’s disease have allowed incorporation of these two modalities into the classification system. The appearance of imaging features of Kienböck’s disease mirrors the natural course of the disease—progressing from marrow edema of the lunate (stage I) to trabecular sclerosis (stage II), to lunate collapse (stage III), and ultimately to secondary degenerative changes of the wrist. MRI has proven to be useful for the detection of early Kienböck’s disease, which is frequently not demonstrated on radiography and CT. It is also useful for assessing and staging the articular cartilage involvement and monitoring the revascularization and response to treatment.
This chapter discusses the diagnostic criteria and imaging features of Kienböck’s disease. It utilizes the Lichtman classification as a framework in this description. A comparison of the utility of the various imaging modalities and a discussion of the differential diagnoses for Kienböck’s disease are also included.
Intraosseous ganglion cyst of the carpal bones represents a rare cause of wrist pain. We report a case of a 42 year-old, right-handed female, who presented with pain of the right wrist following a fall on the palm of the hand. Clinical study revealed a moderate swelling over the mid-section of the palmar face and pain through extreme ranges of motion of the wrist. Plain radiographs and CT-scan of the wrist have revealed an intraosseous ganglion cyst of the lunate bone. Curetting-filling by Kuhlman’s vascularized radial bone graft allowed a good functional recovery. The clinical, radiological and therapeutic aspects are discussed.
The ganglion is a pseudocyst 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 or 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 structures; 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.
A ganglion is a peculiar disorder, which presents principally with a swelling of the wrist or finger. It is so common that many are treated with good advice and reassurance and in the United Kingdom around half the patients who present in orthopaedic or hand clinics with this condition no longer undergo surgery.
Professor Kenji Takagi was the first to report on the use of large joint arthroscopy in 1920 [1]. Whilst early attempts were hampered by cumbersome instrumentation, developments over the following 50 years would allow small joint instrumentation. In 1979, Chen reported on the development of a technique for wrist arthroscopy [2]. In 1986 Roth et al. [3] presented an “Instructional Course Lecture” on wrist arthroscopy at the American Academy of Orthopaedic Surgeons meeting, which brought it into the mainstream of orthopaedic surgery. Since then, wrist arthroscopy has continued to evolve as an important diagnostic and therapeutic tool. Wrist arthroscopy now has many indications and these continue to be extended as the principles of open surgical procedures are applied to the arthroscope (Table 13.1).
Intraosseous ganglion cysts are rare causes of wrist pain. Surgical treatment of this pathologic condition yields good results and a low recurrence rate. The main complications are joint stiffness and vascular disturbances of the lunate bone. Wrist arthroscopy is a surgical technique that reduces the intra-articular operative area and therefore minimizes postoperative stiffness. This article describes an arthroscopic technique used for lunate intraosseous cyst resection associated with an autologous bone graft in a series of cases to prevent joint stiffness while respecting the scapholunate ligament. This study was based on a series of 4 patients, all of whom had wrist pain because of intraosseous ganglion cysts. Arthrosynovial cyst resection, ganglion curettage, and bone grafting were performed arthroscopically. Pain had totally disappeared within 2 months after the operation in 100% of patients. The average hand grip strength was estimated at 100% compared with the opposite side, and articular ranges of motion were the same on both sides in 100% of cases. No complications were reported after surgery. On the basis of these results, arthroscopic treatment of intraosseous synovial ganglion cysts seems to be more efficient and helpful in overcoming the limitations of classic open surgery in terms of complications.
Intraosseous ganglion cysts of the carpal bones located in the lunate are one of the rarely seen pathologic conditions. Here we present a case of the penetrating type of intraosseous ganglion cyst located in the lunate as an uncommon cause of wrist pain. The patient was successfully treated by surgical intervention. Intraosseous ganglion cyst should be considered in the differential diagnosis of chronic dull wrist pain.
Intraosseous cysts of the carpal bones are an infrequent cause of chronic wrist pain. The main body of work has investigated their occurrence in the proximal carpus, with limited incidence in the distal row. We review the current literature on the treatment of symptomatic carpal cysts following the report of a 17-year-old male with a 12-month history of progressive right wrist pain due to an intraosseous ganglion of the trapezoid. This review explores the pathology of carpal cysts, their varying presentation and current treatments.
A total of 27 carpal bone cysts were analyzed for their sites, relations of other wrist soft tissue ganglions and their results of treatment were evaluated.
Background:
Intraosseous ganglion (IOG) cysts rarely have been reported in the carpal bones and lunate is the most common area of involvement. They can present as chronic wrist pain accompanied by a radiolucent lytic lesion in the lunate bone. We provided a retrospective review of six cases of intraosseous ganglion cysts within the lunate bones that all of the patients presented with chronic wrist pain.
Methods:
We retrospectively reviewed the medical records, pathologic reports and imaging files of the six patients who were referred and treated due to chronic wrist pain with final diagnosis of the lunate intraosseous ganglion. All cases were treated by curettage and autologous cancellous bone grafting.
Results:
There were six patients with final diagnosis of the lunate IOG who received surgical treatment. Four out of six patients were female and the remaining was male. Mean age of the patients was 33 years (22 - 56). Right wrist was involved in four patients. Pain was the chief complain in all patients. Mean time of suffering from the wrist pain till referring to hand clinic for definite treatment was nine months (3 - 24). Mean duration of follow up was 30.6 months (6 - 48). The wrists became pain free after surgical treatment and no graft absorption or recurrences were seen in the control radiographs obtained throughout the follow-up period.
Conclusion:
Diagnosis of intraosseous ganglion was based on the imaging features and clinical presentation. Although most cases of the lunate bone IOGs are symptom free and found incidentally after wrist imaging performed for other reasons, these lytic lesions should be included in differential diagnosis list of chronic wrist pain especially in the presence of increased uptake in bone scan located on the lunate area.
Intraosseous ganglia can affect the carpal bones of the hand and must be considered in the differential diagnosis of wrist pain. A 38-year-old female presented with a 14-month history of left wrist pain and a radiolucent cystic lesion was seen computed tomography (CT) scanning. Characteristic radiographic findings of a cyst in association with a fine sclerotic rim was apparent. We report an unusual presentation of a ganglion cyst in the lunate bone with excellent treatment outcome.
The intraosseous ganglion cyst (IOGC) is a benign and lytic bone tumor affecting mostly the metaphyseal and epiphyseal regions of long bones. Its location on the short bones, including the carpal bones has been little reported in the literature. Our review of the literature shows consensus about the surgical techniques to use, but there is currently no real consensus about its pathophysiology, and its diagnostic work-up. Complications related to this lesion (mainly the risk of pathologic fracture) are potentially serious, and can cause irreversible damage. They therefore require accurate assessment to guide the choice of medical or surgical treatment, including a CT scan, which - we believe - is essential.
Copyright © 2012. Published by Elsevier SAS.
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.
Intraosseous ganglia is one of the most frequent lytic defect at the wrist. Its location in the lunate may be discovered by chance on an X-ray performed for another reason, or because of wrist pain and very rarely for a lunate fracture. A.P., lateral and oblique X-rays are mandatory. Bone scan, CT scan and MRI may be of help. Differential diagnosis may exist with an ulnar abutment syndrome with a lunate defect and with all the lytic bone tumours, a systemic disease or multiple defects as in overuse syndromes. In some cases, there is a condensation around the defect and a Kienböck’s disease may be suspected. Thirty-seven patients have been operated on between 1978 and 2001, of which 70% were females. Average age was 34 years (16–58). Clinical presentation was always wrist pain. In seven cases, another carpal localization was present. Surgical treatment consisted in bone curettage and cancellous bone grafting. In four cases, a ganglia emerging from the scapholunate space in soft tissues was combined. Pain disappeared after the procedure. A few patients had a 20–30° wrist flexion decrease but without functional impairment. Several theories have tried to explain the onset of these intraosseous ganglia. In conclusion, these lesions are another cause of wrist pain. One has to be sure that this is this lesion which is the real cause of wrist pain. A systematic X-ray has to be performed for painful soft tissue wrist ganglia.
Le kyste synovial intra-osseux du scaphoïde constitue une étiologie très rare des douleurs du poignet et de la main. La localisation au niveau du scaphoïde est exceptionnellement décrite dans la littérature. Nous rapportons une observation d’une femme de 30 ans, droitière qui s’est présenté pour des douleurs du poignet droit évoluant depuis 24 mois, sans notion de traumatisme. Cette douleur était rebelle aux anti-inflammatoires. L’examen a objectivé la présence d’une légère tuméfaction en regard du scaphoïde sans limitation de la mobilité du poignet. La radiographie standard et la tomodensitométrie du poignet ont révèle un kyste intra-osseux du scaphoïde. Le curetage–comblement par greffon spongieux prélevé sur la métaphyse inférieure du radius ipsilatéral a permis la guérison avec une bonne récupération fonctionnelle. Les aspects cliniques, radiologiques et thérapeutiques seront discutés par les auteurs.
The intraosseous ganglion cyst (IOGC) is a benign and lytic bone tumor affecting mostly the metaphyseal and epiphyseal regions of long bones. Its location on the short bones, including the carpal bones has been little reported in the literature. Our review of the literature shows consensus about the surgical techniques to use, but there is currently no real consensus about its pathophysiology, and its diagnostic work-up. Complications related to this lesion (mainly the risk of pathologic fracture) are potentially serious, and can cause irreversible damage. They therefore require accurate assessment to guide the choice of medical or surgical treatment, including a CT scan, which - we believe - is essential.
A radiologically proven post-traumatic intraosseous ganglion of the fifth metacarpal bone is described. Intraosseous ganglia have been described in the literature with reference to benign cyst-like bone lesions. They appear radiographically, as well circumscribed, juxta-articular, cystic lesions, which contain myxoid fibrous tissue histologically. They occur most frequently in the long bones of the lower limb. Most reported cases of intraosseous ganglia in the hand involve the carpal bones, particularly the lunate and the scaphoid. Most intraosseous ganglia are merely an incidental radiographic finding. Those of the carpal bones have been reported to be a source of pain. The literature concerning post-traumatic intraosseous ganglia is scarce.Un kyste intraosseux du cinquime mtacarpien est dcrit partir dune fracture radiologiquement documente. Les kystes intraosseux ont t dcrits dans la littrature en rfrence aux tumeurs bnignes dallure kystiques. Radiologiquement ils se prsentent comme des lsions kystiques bien circonscrites, para articulaires, contenu myxode lexamen histologique. Ils sont souvent localiss sur les os longs des membres infrieurs. La plupart des cas observs la main ont t dcrits au niveau du carpe, touchant le plus souvent le semi lunaire et le scaphode. La plus-part du temps la dcouverte est radiologique. Certaines des localisations au carpe ont t dcrites comme douloureuses. Il y a peu de description de kyste dorigine post traumatique dans la littrature .
Ganglien entstehen durch Proliferation eines Bindegewebes (bei Texturstörung) mit Hohlraumbildung ohne epitheliale Auskleidung
bei gleichzeitiger Hyaluronanbildung. Die Gangliogenese ist an das Vorhandensein von Bindegewebe gebunden und Folge einer
Überlastung.
Ganglion cysts are the result of connective tissue proliferation (in the case of a texture disorder) involving the formation
of a cavity with no epithelial lining at the same time as hyaluronan formation. Ganglion genesis is associated with the presence
of connective tissue and the results of overuse.
SchlüsselwörterGanglien–Bindegewebe –Gangliogenese –Hyaluronan–Überlastung
KeywordsGanglion cysts–Connective tissue–Ganglion genesis–Hyaluronan–Overuse
The clinical, radiographic and pathological features of eighty-eight cases of histologically verified intra-osseous ganglia in eighty-three patients are described. All were located in the subchondral bone adjacent to a joint and most frequently involved the hip, the ankle (medial malleolus), the knee and the carpal bones. Forty-seven of the eighty-three patients were male and all the patients were between fourteen and seventy-three years of age, with an average age of forty-one years. There are two fundamental types of intra-osseous ganglia, one apparently arising by penetration of juxta-osseous ganglion into the underlying bone, a mechanism proved in fourteen of our eighty-eight cases (16 per cent); in the remaining seventy-four cases, the ganglion cyst was primarily intra-osseous ("idiopathic"). The initial cause of the intramedullary mucoid degeneration is discussed. We believe that mechanical stress and repeated minor trauma near the surface of the bone may lead to intramedullary vascular disturbance with consequent foci of aseptic bone necrosis. The revitalisation of these areas causes fibroblastic proliferation, followed by mucoid degeneration of the connective tissue, possibly due to some unknown local factor. Curettage or excision is usually effective, and recurrence (only four cases) is exceptional.
We wish to report an intraarticular carpal ganglion with two separate intraosseous components as well as an extraarticular component. In addition, we report the first bone scan of such a lesion. The unique nature of this lesion coupled with the scan study may shed some light on the pathogenesis of these lesions.
A rare case of bilateral intraosseous ganglia of the lunate is reported. The patient had had 7 months of pain in both wrists and a cystic lesion in both lunates. Curettage and bone grafting resulted in complete relief of pain.
We describe an adolescent girl with symptoms secondary to bilateral, symmetrical ganglion cysts of the scaphoid bones. From the roentgenographic and operative findings, it was believed that the cysts were the penetrating type. The patient is among the youngest reported with carpal bone ganglion cysts and the first with bilateral scaphoid cysts completely described in the English-language medical literature.
The case of a thirty-year-old woman with a cystic lesion in the right lunate is reported. The cyst was an intraosseous ganglion which is a relatively rare entity in that location.
A case of an intraosseous ganglion arising in a phalanx is described. This condition has not been reported previously.
Intraosseous ganglion of the lunate is a relatively rare entity. Two cases are reported, in one of which a communication with the scapholunate joint was demonstrated by polytomography. Curettage and bone grafting resulted in complete relief of pain.
The term intraosseous ganglion has been used to describe cystic subchondral defects of bone derived independently of joint pathology. Case reports have most often dealt with the lower extremity, with a much less frequent occurrence reported within the carpal bones. This is a case of an intraosseous ganglion occurring within the trapezoid. Case Report A 44-year-old left-handed male loading dock laborer presented with a 3-month history of intermittent left hand pain exacerbated by power grip. He had no history of trauma or inflammatory disease. On physical examination moderate diffuse swelling and tenderness over the dorsal radial aspect of the left wrist was found. The first carpometacarpal joint grind test was strongly positive. Motion at the left wrist or thumb was not limited. Pinch and grip strengths were diminished. Laboratory studies were within normal limits. Plain x-ray films of the left wrist showed marked cortical sclerosis of the trapezoid. A central lucency was present but difficult to assess against the dense surrounding bone (Fig. I). Arthritic changes were not present. The bone scan had a normal radionuelide angiogram and increased uptake in the region of the left trapezoid in the early (Sminute) and late (4-hour) phases (Fig. 2). Computed tomography demonstrated cortical thickening and a central lu
A rare case of simultaneous bilateral intraosseous ganglia of the scaphoid and lunate bones is presented. The cysts were removed and the carpal bones were grafted with cancellous bone, resulting in a satisfactory outcome.