Intraosseous Ganglion Research Articles

Treatment of Intraosseous Ganglion Cyst of the Lunate: A Systematic Review.

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. 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. 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. 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.

Intraosseous ganglion cyst of the distal tibia in a young male patient

The case of a 25-year-old man with a ganglion cyst of the medial aspect of the ankle has been presented. Biopsy was taken during the surgery and sent for histopathology, which showed cystic area lacking epithelial lining filled with mucoid material. The patient was treated with curettage of the medial malleolus.

Pathological analysis of cystic lesions of the bones: a retrospective single-center 10-year overview

Objective: Many different neoplastic and non-neoplastic lesions involve the skeletal system. Clinical and radiological tools primarily assess the nature of these lesions.The aim of this study was to analyze the cystic bone lesions in a pathologic point of view. Methods: All bone cysts between 2002 and 2013 retrospectively evaluated under the guidance of clinical information and radiological images. Descriptive data such as age, gender, tumor site, symptoms, and clinical and radiological findings obtained from the hospital’s database system. Results: There were 96 cystic bone lesions; 47 were aneurysmal bone cysts (ABCs), 37 were simple bone cysts (SBCs), one was a lesion with features of both ABC and SBC, four were intraosseous ganglia, four were epidermoid cysts, and three were hydatid cysts. The mean ages of the patients with ABCs and SBCs were 18.7 ± 12.8 years (range, 3-75 years) and 23.8 ± 13.3 years (range, 3-62 years), respectively. Most of the lesions located in the long bones. Conclusions: Cystic lesions of the bone rarely encountered in daily pathology routine. As with all conditions affecting the skeletal system, one of the most important steps towards an accurate pathological diagnosis is to perform with clinical and radiological information while evaluating the patients.

Dual-energy contrast-enhanced CT to evaluate scaphoid osteonecrosis with surgical correlation.

To evaluate the validity of contrast enhanced dual energy CT using a lung perfusion algorithm in assessing for post-traumatic scaphoid proximal pole avascular necrosis. From Aug 2013 to Aug 2016, 18 patients (19 wrists, 16 males, 2 females, mean age 28years) were assessed as high-risk for proximal pole scaphoid avascular necrosis by a single surgeon following a scaphoid fracture and were referred for contrast-enhanced dual energy CT. 8 wrists had specimens sent for correlative histological analysis and 11 were correlated with operative notes. Eight surgical specimens were sent to histology and showed a 100% correlation (8/8) with the DECT findings. The remaining 11 wrists that did not have a specimen sent had in-surgery findings that also correlated with DECT. A single case was discrepant (1/11) due to presence of an intra-osseous ganglion, which was reported as osteonecrosis on CT, but considered viable at surgery. No case was called viable on CT that proved to be necrotic at either surgery or histologically. Contrast-enhanced dual energy CT using a perfusion algorithm is an innovative and promising method in evaluating viability of the post-trauma proximal pole of scaphoid.

Unicameral bone cysts: Current concepts.

Unicameral bone cysts (UBC) or simple/solitary bone cysts are benign fluid filled cavities that enlarge over time, resulting in thinning of the bone. Usually these cysts are reported in the metaphyseal areas of long bones with open physes. 85% of UBCs occur almost exclusively in children and adolescents. UBCs are more aggressive in the first decade of life and correspondingly the recurrence rate for these patients is four times that for adolescents. The proximal humerus and femur account for almost 90% of these cases. UBCs are classified as active when they are within 1 cm of the physis and latent as they progress to a diaphyseal location. Differential diagnoses for UBC include aneurysmal bone cyst, fibrous dysplasia, enchondroma, and intraosseous ganglia. By the time of skeletal maturity most UBCs tend to resolve. Nonoperative treatment may be a viable option for many patients with small or symptomatic lesions. Interventions include steroid injection, open curettage and bone grafting, decompression and percutaneous injection of marrow or graft substitutes.

Nonarticular osseous cyst-like lesions of the intermedioradial carpal bone may be incidental magnetic resonance imaging findings in dogs.

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.

Scaphoid Cysts: Literature Review of Etiology, Treatment, and Prognosis.

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.

A case of intraosseous ganglion of greater tubercle with cuff tear

A case of intraosseous ganglion of greater tubercle with cuff tear

Tibial periosteal ganglion cyst: The ganglion in disguise.

Soft tissue ganglions are commonly encountered cystic lesions around the wrist presumed to arise from myxomatous degeneration of periarticular connective tissue. Lesions with similar pathology in subchondral location close to joints, and often simulating a geode, is the less common entity called intraosseous ganglion. Rarer still is a lesion produced by mucoid degeneration and cyst formation of the periostium of long bones, rightly called the periosteal ganglion. They are mostly found in the lower extremities at the region of pes anserinus, typically limited to the periosteum and outer cortex without any intramedullary component. We report the case of a 62 year-old male who presented with a tender swelling on the mid shaft of the left tibia, which radiologically suggested a juxtacortical lesion extending to the soft tissue or a soft tissue neoplasm eroding the bony cortex of tibia. It was later diagnosed definitively as a periosteal ganglion in an atypical location, on further radiologic work-up and histopathological correlation.

A rare cause of ulnar-side wrist pain: Ganglion cyst of the triquetrum

Diagnosing chronic wrist pain may sometimes be challenging and the differential diagnoses include many conditions (traumatic, rheumatoid, neoplasms, etc.). This report describes a case of chronic wrist pain due to intraosseous ganglion cyst of triquetrum. The wrist pain had lasted for 6 months and was not relieved by conservative treatment. Magnetic resonance imaging revealed an intraosseous ganglion cyst. The triquetrum was tender on palpation. After curettage and grafting of the cyst, and 6 months of follow-up, the patient was free of complaints with full range of motion of the wrist. Although mostly asymptomatic, intraosseous ganglion cysts should be kept in mind when assessing wrist pain.

Symptomatické intraoseální ganglion os trapezium - kazuistika a přehled literatury

Symptomatické intraoseální ganglion os trapezium - kazuistika a přehled literatury

Therapeutic effect of bone cement injection in the treatment of intraosseous ganglion of the carpal bones.

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.

A pathological fracture of the scaphoid revealing an intraosseous ganglion cyst

Intraosseous ganglion cyst is a benign bone lesion with histological similarities to the soft tissue ganglion cyst. Its location on the short bones, including the carpal bones has rarely been reported. The radiolucent carpal lesions are usually symptom-free found incidentally on radiographs of the wrist performed for other reasons. Detecting a pathological fracture of the scaphoid revealing an intraosseous ganglion cyst is exceptional. We report the case of a 21-year-old, right-handed male, presented with a one year history of progressive right-wrist pain, worsened since a month without a history of previous trauma. Plain radiographs and CT-scan revealed a cystic lesion of the scaphoid with a pathological fracture. He was successfully treated with curettage and packing with a Zaidemberg's vascularized radial graft without recurrence at two years postoperatively. Pan African Medical Journal 2016; 23

Arthroscopic Treatment of Intraosseous Ganglion Cyst of the Lunate Bone

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.

Ulnar Abutment Syndrome

With regard to the published article “arthroscopic curettage of intraosseous ganglions of lunate bone” in the last journal edition, it is time to review ulnar abutment syndrome with similar clinical and radiologic findings (1). The main cause of this syndrome is the overload of carpal bones, especially lunate bone related to positive ulnar variance. In normal wrist, 20% of the load is transmitted to ulna whereas 2 mm positive ulnar variance increases this load up to 40%. This problem may even happen in normal wrists because of ulnar variance changes during forearm rotation (2). Other predisposing factors are radial shortening after healed distal radius fractures, scapholunate dissociation, lunatotriquetral dissociation and triangular fibrocartilage complex (TFCC) tears. Most of these patients have pain in ulnar side of wrist associated with dorsoulnar wrist tenderness and positive Nakamura's ulnar stress test (ulnar side wrist pain during flexion and extension of ulnar deviated and pronated and axially loaded wrist). Differential diagnoses are lunate ganglion cysts, vascular grooves and Kienbock’s disease. Routine X-ray and MRI are useful for diagnosis. Radiologic findings are positive ulnar variance associated with lunate sclerosis and sometimes lunate cysts. Pronated grip view may better define ulnar impactions. Diagnostic MRI findings are TFCC degenerative tears and lunate chondromalacia. First line of treatment is nonoperative, including decreasing wrist load and using pain killers. In the absence of good response, operative treatment may be indicated. The most prevalent surgical treatment is ulnar shortening osteotomy to unload lunate bone (3). Alternative option is wafer distal ulna resection (removal of 2 4 mm of distal ulna below TFCC). In Palmers types 2a through 2D, (4) salvage procedures are distal ulna resection in low demand patients (Darrach procedure), Sauve-Kapandji procedure in manual laborers, distal ulnar hemi-resection arthroplasty, and finally ulnar head replacement.

Direct “Cystoscopic” Approach for Arthroscopic Decompression of an Intraosseous Ganglion of the Lunate

Intraosseous ganglion cysts (IOGs) are uncommon lesions of the carpal bones and can present with persistent pain and stiffness of the wrist. Surgical decompression is recommended, and a variety of approaches to decompress symptomatic IOGs of the wrist have been described. We describe an arthroscopic approach that can be performed with only 2 portals and offers excellent access for visualization and instrumentation. The procedure involves creating a 3.2-mm tunnel into the lunate cyst; this is performed through the dorsal non-articular surface of the lunate, under direct vision, and the position is confirmed with fluoroscopy. A 2.4-mm arthroscope is passed through the drill hole, and a direct “cystoscopic” view of the IOG is obtained. Biopsy of the cyst contents is performed under direct vision, and small-joint shavers and burrs are used for effective debridement. Advantages of this technique are actual visualization of the pathology, complete intracystic debridement, and simultaneous treatment of any coexistent intra-articular pathology. In addition, the minimal 3.2-mm lunate tunnel access maintains the structural integrity of the lunate and reduces the need for additional bone graft supplementation.

Intraosseous ganglion cysts of the carpus: current practice.

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.

Intraosseous ganglion cyst of scaphoid: A case report

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 of the distal tibia: clinical, radiological, and operative management.

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.

Arthroscopic intralesional curettage for large benign talar dome cysts.

Introduction: Surgical management of large talar dome cysts is challenging due to increased morbidity by associated cartilage damage and malleolar osteotomy. The purpose of this study is to evaluate the clinical and radiological outcome of endoscopic curettage and bone graft for large talar dome cysts. Methods: This is a retrospective analysis of data for eight patients (eight feet) who were treated by arthroscopic curettage and grafting for large talar dome cysts. Seven cases were treated by posterior ankle arthroscopy as the lesion was located posteriorly while one case was treated by anterior ankle arthroscopy as the lesion was breached anteriorly. Results: The final diagnosis, was; large osteochondral lesion of talus (two cases), aneurysmal bone cyst (ABC) (two case), intra-osseous ganglion (two cases), Chronic infection in talus (one case) and angiomatous lesion of the talus (one case). The mean follow up period was 18.3 (±3.06 SD) months (range 16–25 months). The median preoperative AOFAS score was 74.5 (±5.34 SD) points. The mean postoperative AOFAS score at one year follow up was 94.6 (±2.97 SD) points. None of the patient had recurrence of the lesion during follow up. Return to normal daily activity was achieved at 11.25 (±2.37 SD) weeks. Discussion: In this short case series study, large talar dome bony cysts of different pathologies including aneurysmal bone cysts could be treated effectively by endoscopic curettage and bone grafting with no recurrence no complications during the follow-up period.