Flexor Tendon Sheath Ganglion Research Articles

Ganglion cysts developed from the flexor tendon sheaths in the fingers: Clinical and sonographic features.

The purpose of this study was to assess the clinical and sonographic features of flexor tendon sheath ganglion cysts in the fingers. We retrospectively reviewed the clinical and sonographic features of 35 cases of flexor tendon sheath ganglion cysts in the fingers in 34 patients that were pathologically confirmed between 2003 and 2018. The mean age of the patients was 44.2 years (range, 11-73 years). Lesions were located at the level of the metacarpophalangeal joint (n = 22 [63%]) and proximal phalanx (n = 11 [31%]), and involvement of the third finger was common (n = 19 [54%]). The mean lesion size was 6 mm and the mean volume was 90 mm3 . None of the lesions had a pedicle. Lesions were homogeneous (n = 24 [69%]) and anechoic (n = 23 [66%]). A septum was noted in 12 cases (34%). Flexor tendon sheath ganglion cysts are most commonly located in the third finger and at the level of the metacarpophalangeal joint and proximal phalanx. It usually presents as a simple cyst without a pedicle, but occasionally exhibits a mixed echogenicity and contains a septum.

Flexor tendon sheath ganglions — A new procedure to perform excision under ultrasound-guidance

Flexor tendon sheath ganglions are a common pathology, aspiration has been reported as a cost-effective procedure despite a high risk of recurrence. Surgical excision demonstrated less recurrence but is less accessible and more expensive. We developed a new ultrasound procedure for percutaneous excision. In this series, we report our results of the first 8 cases. Over a period of one year, 8 flexor tendon sheath ganglions were operated on, 4 middle fingers and 4 fourth fingers. Clinical examination was performed after one month and telephone interviews after 3 monthsThe WALANT technique was used for local anesthesia. All procedures were performed percutaneously under ultrasound guidance (In-plane control). Surgical blades were proscribed, only a 18 gauge needle was used for skin incision. A single 2-mm portal using a 2-mm shaver blade was used. Bandages were removed by the patient the day after surgery and patients return to activities as usual. Procedures were 5 minutes long (3–8). All ganglions were fully excised. After one month, a full finger motion was observed with tenderness at the point of excision. All patients were cured after 3 months with no recurrence. The ultrasound-guided excision of flexor tendon sheath ganglion, using a 2-mm portal, under local anaesthesia was reliable and efficient, without specific morbidity. Larger data should be collected to confirm these good outcomes and the excellent cost efficiency. The ultrasound-guided excision of flexor tendon sheath ganglion, using a 2-mm portal, under local anaesthesia was reliable and efficient, without specific morbidity. Larger data should be collected to confirm these good outcomes and the excellent cost efficiency.

Birth and growth of an ultrasound hand surgery center — A review of 900 procedures

With local anesthesia and new ultrasound-guided percutaneous procedures, it is now more often possible to perform hand surgery in minimal settings. Indeed, the authors argue that most hand surgery procedures could be performed in office surgeries. They have reported morbidities in a continuous series of 921 ultrasound-assisted hand procedures performed under local anesthesia in a clinic setting. Over a period of 3.5 years, 921 in-office procedures (635 patients) were performed using specific ultrasound-guided techniques (previously published) under local anesthesia. We included 265 trigger fingers, 418 carpal tunnel releases, 25 de Quervain releases and 202 Dupuytren contractures, 3 lateral epicondylitis, 8 flexor tendon sheath ganglions. Exclusion criteria for office surgery were: – ASA (American Society of Anesthesiologists) grade 3 or higher; – allergic history (latex, xylocaine…); – age over 85. Asepsis was achieved with a preoperative iodine shower and a 5-step antiseptic skin preparation. Fasting was forbidden and disease-modifying treatments, including anticoagulants, taken as usual. The WALANT technique was used for local anesthesia. All procedures were performed percutaneously under ultrasound guidance. Surgical blades were proscribed, only a 18 gauge needle was used for skin incision. All the instruments were thinner than 1.5 mm, non-disposable and cost less than 50 €. Bandages were removed by the patient the day after surgery. Morbidities were reported systematically: – before surgery, during local anesthesia (vagal faintness, panic attack); – during surgery (pain, excessive bleeding, faintness, mild heart attack); – after surgery (infection, Sudeck's disease, hematoma, scarring problem). Individual procedure efficacy was assessed in previous studies and not included in this series. Preoperative: – 18 vagal faintness, including 5 syncopes with spontaneous resolution; – no panick attack. Operative: – no pain felt; – no excessive bleeding, no specific hemostasis procedure needed; – no heart attack. Postoperative: – 1 infection in a trigger finger requiring re-operation; – 19 Sudeck's disease; – 10 mild hematoma after carpal tunnel release with spontaneous resolution. The combination of the WALANT technique and ultrasound-assisted procedures provides an original approach that can be used in a clinic setting. Three vagal faintness (without syncope) was observed in the last 400 patients. The morbidities reported were at least equivalent to those published in standard operating theatre procedures; only one patient was re-operated (case of infection). Hand surgery can be performed in good conditions as in-office surgery using local anesthesia and ultrasound guidance.

Flexor tendon sheath ganglions: A new procedure to perform excision under ultrasound-guidance

Flexor tendon sheath ganglions are a common pathology, aspiration has been reported as a cost-effective procedure despite a high risk of recurrence. Surgical excision demonstrated less recurrence but is less accessible and more expensive. We developed a new ultrasound procedure for percutaneous excision. In this series, we report our results of the first 8 cases. Over a period of one year, 8 flexor tendon sheath ganglions were operated on, 4 middle fingers and 4 fourth fingers. The WALANT technique was used for local anesthesia. All procedures were performed percutaneously under ultrasound guidance (In-plane control). Surgical blades were proscribed, only a 18-gauge needle was used for skin incision. A single 2-mm portal using a 2-mm shaver blade was used. Bandages were removed by the patient the day after surgery and patients return to activities as usual. Clinical examination was performed after one month and telephone interviews after 3 months. Procedures were 5 minutes long (3–8). All ganglions were fully excised. After one month, a full finger motion was observed with tenderness at the point of excision. All patients were cured after 3 months with no recurrence. The ultrasound-guided excision of flexor tendon sheath ganglion, using a 2-mm portal, under local anaesthesia was reliable and efficient, without specific morbidity. Larger data should be collected to confirm these good outcomes and the excellent cost efficiency.

Hand surgery in a clinic setting using ultrasound percutaneous procedure: A review of 900 procedures

Introduction With local anesthesia and new ultrasound-guided percutaneous procedures, it is now more often possible to perform hand surgery in minimal settings. Indeed, the authors argue that most hand surgery procedures could be performed in office surgeries. They have reported morbidities in a continuous series of 921 ultrasound-assisted hand procedures performed under local anesthesia in a clinic setting. Method Over a period of 3.5 years, 921 in-office procedures (635 patients) were performed using specific ultrasound-guided techniques (previously published) under local anesthesia. We included 265 trigger fingers, 418 carpal tunnel releases, 25 de Quervain releases and 202 Dupuytren contractures, 3 lateral epicondylitis, 8 flexor tendon sheath ganglions. Exclusion criteria for office surgery were: – ASA (American Society of Anesthesiologists) grade 3 or higher; – allergic history (latex, xylocaine?); – age over 85. Asepsis was achieved with a preoperative iodine shower and a 5-step antiseptic skin preparation. Fasting was forbidden and disease-modifying treatments, including anticoagulants, taken as usual. The WALANT technique was used for local anesthesia. All procedures were performed percutaneously under ultrasound guidance. Surgical blades were proscribed, only a 18 gauge needle was used for skin incision. All the instruments were thinner than 1.5 mm, non-disposable and cost less than 50? Bandages were removed by the patient the day after surgery. Morbidities were reported systematically: – before surgery, during local anesthesia (vagal faintness, panic attack); – during surgery (pain, excessive bleeding, faintness, mild heart attack); – after surgery (infection, Sudeck's disease, hematoma, scarring problem). Individual procedure efficacy was assessed in previous studies and not included in this series. Results Preoperative: – 18 vagal faintness, including 5 syncopes with spontaneous resolution; – no panick attack. Operative: – no pain felt; – no excessive bleeding, no specific hemostasis procedure needed; – no heart attack. Postoperative: – 1 infection in a trigger finger requiring re-operation; – 19 Sudeck's disease; – 10 mild hematoma after carpal tunnel release with spontaneous resolution. Conclusion The combination of the WALANT technique and ultrasound-assisted procedures provides an original approach that can be used in a clinic setting. Three vagal faintness (without syncope) was observed in the last 400 patients. The morbidities reported were at least equivalent to those published in standard operating theatre procedures; only one patient was re-operated (case of infection). Hand surgery can be performed in good conditions as in-office surgery using local anesthesia and ultrasound guidance.

Unusual Presentation of Flexor Tendon Sheath Massive Ganglion

We report a unusual case of a flexor tendon sheath ganglion in a 78 years old, right hand dominant female presented with right little finger large multiloculated swelling involving the whole volar aspect of the little finger leaving the patient with fears of malignancy.

A Case of Trigger Finger by Flexor Tendon Sheath Ganglion

A Case of Trigger Finger by Flexor Tendon Sheath Ganglion

Die Punktion des Beugesehnenscheidenganglions unter Ultraschallkontrolle. Eine Alternative zur blinden Aspiration oder Operation?

Surgery is generally thought to be the most successful treatment of flexor tendon sheath ganglions. Most previous investigators judge the blind percutaneous aspiration as unreliable. The purpose of this study was to investigate the feasibility and the success rate of percutaneous apiration guided by ultrasonography. We performed percutaneous aspiration under ultrasonographic control in 60 patients with flexor tendon sheath ganglions. Encouraged by our favourable results we can recommend this procedure instead of the blind percutaneous aspiration and even instead of surgery.

Flexor tendon sheath ganglions: results of surgical excision.

The purpose of our study was to review the clinical features and determine the results following surgical excision of a flexor tendon sheath ganglion. A retrospective analysis of 24 consecutive patients (25 ganglions) who underwent excision of a painful flexor tendon sheath ganglion by the same surgeon was performed. The patient's medical and operative records were reviewed. Each patient was invited to return for an evaluation, which consisted of a clinical interview, completion of a questionnaire, and physical examination. Those patients that were unable to return underwent a detailed telephone interview. Sixteen patients returned for a clinical evaluation, while eight patients underwent a telephone interview. There were 15 women and nine men, with an average age of 43 years (range, 21-68 years). The dominant hand was involved in 15 patients. The long finger was most commonly involved (11 cases). The ganglion arose from the A1 pulley in 13 cases, between the A1 and A2 pulleys in three cases, and from the A2 pulley in nine cases. At an average follow-up of 18.5 months (range, 5-38 months), all of the patients were satisfied with their final result. No patient developed a recurrence and all returned to their previous functional level. There were two minor complications that resolved uneventfully; one patient experienced mild incisional tenderness, while an additional patient experienced transient digital nerve paresthesias. We conclude that surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath.

Flexor tendon sheath ganglion: analysis of 128 cases.

A 30-year analysis of 128 patients with flexor tendon sheath ganglion was investigated. The majority of patients were females with sex ratio of 2.6 : 1. Most of the patients are in their third to fifth decade of life. Hand dominance, previous trauma as well as other illnesses involving the hand did not show any correlation to the formation of ganglion. The middle finger was most commonly affected and 69% of the ganglion were located on A1 and A2 pulley. Recurrence was high (89%) after multiple percutaneous puncture and treatment was successful with no cases of recurrence after surgical excision.

Treatment of flexor tendon sheath ganglions using ultrasound imaging

Forty-one patients with a symptomatic digital mass or swelling of suspected ganglionic origin were examined by ultrasound. Findings were classified into 4 groups: group 1, solitary cyst appearing as a well-defined solitary oval anechoic mass (27 digits); group 2, multiple cysts having multiple oval anechoic masses (3 digits); group 3, solid tumor indicating a heterogeneous hypoechoic mass (6 digits); and group 4, tenosynovitis with no abnormal echoic mass (5 digits). Treatment was determined by lesion classification. In group 1, 26 of the 27 solitary cysts were punctured, and a jellylike material was aspirated from 24 cysts. Postaspiration ultrasound examination revealed that a cyst was still present in 2 cases, and these were excised surgically. In group 2, all the cysts were surgically removed. A ganglion with multiple cysts was confirmed on pathological examination. In group 3, the lesions were removed surgically; among the diagnoses were tendon sheath ganglion, giant-cell tumor of tendon sheath, neurilemmoma, and hemangioma. In group 4, no abnormal masses had appeared at follow-up examination. The 24 patients whose ganglions were treated by aspiration, as well as the 8 patients whose ganglions were excised, were monitored for more than 12 months. None of these 32 patients experienced residual pain or lesion recurrence. These results indicate that ultrasound is useful, in cases in which flexor tendon sheath ganglion are suspected, for assisting in diagnosis and determining whether patients should undergo aspiration or surgical excision.