Occult Ganglion Research Articles

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

Unilateral carpal tunnel syndrome caused by an occult ganglion in the carpal tunnel: a report of two cases.

Carpal tunnel syndrome (CTS) usually presents bilaterally and a secondary nature should be suspected in patients with unilateral symptoms, especially those with a long-standing history, and when the symptomatic hand shows severe neurophysiologic impairment, while the contralateral hand is neurophysiologically intact. Space-occupying lesions are known to cause CTS and the incidence of space-occupying lesions in unilateral CTS is higher than that of bilateral CTS. It is easy to detect a mass when it is palpable; however, occult lesions are usually overlooked. Whenever a patient presents with unilateral symptoms and unilateral neurophysiologic impairment, the possibility of a space-occupying lesion compressing the median nerve should be kept in mind in the differential diagnosis. This study presents two cases with an occult ganglion in the carpal tunnel compressing the median nerve and causing unilateral symptoms of CTS. We stress on the importance of imaging studies in patients with unilateral symptoms that are usually not used in CTS. The reported patients were evaluated and magnetic resonance images revealed an intratunnel space-occupying lesion.

Clinical Examination of Scaphoid Fractures

Undetected scaphoid fractures may lead to complications, including nonunion, malunion, avascular necrosis, and wrist arthritis. A competent physical examination is essential for the diagnosis of scaphoid fractures in the setting of occult fractures presenting with normal radiographs. The differential diagnosis of occult scaphoid fractures includes acute tears of the scaphoid-lunate ligament, Kienbock's disease, occult ganglion, nondisplaced radial styloid fractures, and injury to the radial aspect of the radio-scapho-capitate ligament. All of these may have normal plain radiographs but often can be distinguished based on physical examination findings. The 2 key points of such an examination include the exact location of point tenderness and provocative special tests. Although Watson's scaphoid shift test is classically described for scaphoid instability, we highlight its significance in the setting of scaphoid fractures.

Compression of the Posterior Interosseous Nerve Due to an Occult Ganglion Cyst in the Elbow of an Amateur Pianist

The continued growth of recreational and professional instrument playing is accompanied by the need for health care providers who can recognize and treat conditions in musicians that have traditionally been associated with other occupational injuries. This is particularly important when early diagnosis and prompt intervention may alter the outcome. We present an interesting case of paralysis of the posterior interosseous nerve caused by a ganglion at the arcade of Frohse (supinator arch) in close proximity to the extensor carpi radialis brevis. The patient was an amateur pianist who developed the ganglion after intensive piano practice for 3 months. The patient experienced complete pain relief with full preservation of function after treatment. We review the evaluation, diagnosis, biomechanical pathogenesis, and current treatment algorithms for this cyst.

Magnetic Resonance Imaging in the Diagnosis of Occult Dorsal Wrist Ganglions

Small occult dorsal wrist ganglia, which are not visible or palpable, may be painful. Clinically, there is tenderness over the scapholunate ligament and pain with hyperextension of the wrist with normal radiographs and an otherwise normal examination. We reviewed 20 patients with suspected occult ganglia who underwent an MRI scan and subsequently underwent surgical excision of the cyst. We compared the MRI diagnosis with the intra-operative findings and the histological evaluation of the surgical specimen to determine the accuracy of MRI in identifying an occult ganglion. When intra-operative determination of disease was used as a standard, the sensitivity of MRI scanning was 83%, the specificity was 50%, the positive predictive value was 94% and the accuracy 80%. Using histology as the standard, the sensitivity was 80%, the specificity 20%, and the positive predictive value 75%.

MRI for Differentiating Ganglion and Synovitis in the Chronic Painful Wrist

The purpose of our study was to determine if preoperative MRI can differentiate between occult ganglion and synovitis in the chronic painful wrist. MRI is accurate in preoperatively distinguishing between ganglion and synovitis in the setting of chronic dorsal wrist pain. Four main criteria were useful: margin, shape, internal structure, and enhancement after administration of contrast material, with shape and internal structure being most helpful.

MRI diagnosis of occult ganglion compression of the posterior interosseous nerve and associated supinator muscle pathology

Occult interosseous ganglions in the proximal forearm can result in pain and decreased supination. We will describe the magnetic resonance imaging (MRI) diagnosis of an interesting case of supinator atrophy secondary to compression of the posterior interosseous branch of the radial nerve. A brief review of this entity follows.

Occult ganglions of the dorsal scapho-lunate ligament. Histological and long term review of 65 operated cases

Occult ganglions of the dorsal scapho-lunate ligament. Histological and long term review of 65 operated cases

Ultrasonography in the Diagnosis of Ulnar Tunnel Syndrome Caused by an Occult Ganglion

We report a case of ulnar tunnel syndrome caused by an occult ganglion which was diagnosed preoperatively by ultrasonography.

Ultrasonography in the diagnosis of ulnar tunnel syndrome caused by an occult ganglion

We report a case of ulnar tunnel syndrome caused by an occult ganglion which was diagnosed preoperatively by ultrasonography.

Ganglions of the hand and wrist.

Ganglions of the hand and wrist are common benign lesions. They most frequently arise adjacent to joints and tendons, but may also be intratendinous or intraosseous. Treatment options include observation, aspiration, and surgical excision. Observation is acceptable in most instances. Indications for more aggressive treatment include pain, interference with activity, nerve compression, and imminent ulceration (in the case of some mucous cysts). The recurrence rate after puncture and aspiration is greater than 50% for cysts in most locations, but is less than 30% for cysts in the flexor tendon sheath. Surgical excision is effective, with a recurrence rate of only 5% if care is taken to completely excise the stalk of the cyst along with a small portion of joint capsule. Surgical treatment of occult ganglions is successful with accurate assessment of the source of the pain. Arthroscopic treatment of dorsal wrist ganglions is still experimental, but early results are encouraging. Ganglion surgery requires a formal operative environment and careful technique in order to minimize injury to adjacent structures and minimize the likelihood of recurrence.

Compression of the radial nerve caused by an occult ganglion: Three case reports

We report on three patients with radial nerve compression in the region of the supinator muscle caused by an occult ganglion. After excision of the ganglion and decompression of the posterior interosseous nerve, the nerve palsy resolved completely in all cases.

Diagnostic validity of ultrasound in patients with persistent wirst pain and suspected occult ganglion

Until recently, the presence of occult ganglions could be determined only by surgical exploration. This prospective study investigated the reliability of ultrasound in the diagnosis of occult ganglions in a patient series over 4 years. The sensitivity, specificity, and accuracy of ultrasound, as well as its positive and negative predictive values, were determined in 83 patients suspected of having an occult wrist ganglion and who had persistent pain and consented to an operation. Examinations were carried out with a 7.5-MHz linear probe and spacer. Outcome of surgery and histologic examination served as the gold standard in 168 patients who had undergone ultrasound; 89 underwent surgery. In 83 patients for whom enough information was available to allow statistical assessment, sensitivity, specificity, and accuracy rates of 88%, 85%, and 87% were respectively obtained. In dorsal wrist ganglions (75%), better results were obtained: a sensitivity rate of 93%, a specificity rate of 86%, and an accuracy rate of 91%. It was concluded that ultrasound of the wrist can be used as a first-line imaging procedure in clinically inconclusive situations and that ultrasound evidence of an occult dorsal ganglion is a reliable indicator for surgery.

Unilateral carpal tunnel syndrome and space-occupying lesions

To assess the association between unilateral carpal tunnel syndrome and space-occupying lesions, 128 patients have been reviewed. They were divided into bilateral, subclinical (unilateral signs and symptoms, and bilateral slowing in the median nerve conduction) and unilateral carpal tunnel syndrome. Space-occupying lesions were investigated on the basis of physical examination and wrist imaging using plain radiographs and ultrasonograms. Of 20 patients with unilateral carpal tunnel syndrome, space-occupying lesions were found in seven (occult ganglion in five and occult calcified mass in two). In contrast, none of 89 patients with bilateral carpal tunnel syndrome and 19 with subclinical carpal tunnel syndrome had space-occupying lesions. We conclude that careful examination and wrist imaging on suspicion of local pathology, especially a space-occupying lesion, are needed when the condition is unilateral and the aetiology is not clear from the history and on physical examination.

Ultrasonography in the diagnosis of carpal tunnel syndrome caused by an occult ganglion

A case is reported of carpal tunnel syndrome caused by an occult ganglion which was diagnosed preoperatively by ultrasonography.

Histologic and magnetic resonance imaging correlations in Kienböck's disease

Nine patients had magnetic resonance imaging studies to aid in the diagnosis of wrist pain in the midcarpal region. Six had positive magnetic resonance imaging studies with a decrease in signal intensity from the area of the lunate, one had an occult ganglion, and two had negative studies. Among the six patients with a diagnosis of Kienböck's disease by magnetic resonance imaging, four patients had collapse of the lunate on plain radiographs, and the other two patients had normal wrist radiographs. Magnetic resonance imaging studies showed a substantial decrease in the signal intensity on T 1- and T 2-weighted images of the entire lunate in three patients, and three patients had focal areas of decreased signal intensity. All of the patients had a biopsy of the lunate at the time of surgery. The histology of the biopsies of the lunate appeared to correspond to the magnetic resonance imaging studies. Undecalcified bone specimens from the patients with Kienböck's disease showed marked osteonecrosis in three patients, focal areas of osteonecrosis in two patients, and alternating areas of osteonecrosis with dramatic areas of new bone formation in one patient. Although in four patients the diagnosis was obvious by plain radiographs, magnetic resonance imaging studies were essential in confirming the diagnosis in two patients and were helpful in ruling out the diagnosis in three patients.

The dorsal occult ganglion of the wrist and ultrasonography

In five cases of suspected occult ganglion on the back of the wrist, an ultrasonographic examination was performed. This revealed a small hypoechogenic area on the dorsal aspect between the scaphoid and the Innate or just dorsal to the Innate. Exploration of this area in three cases confirmed the presence of an occult ganglion. In the other two cases, further aspiration revealed traces of mucinous jelly at the tip of the needle.

Athletic Injuries of the Wrist

The wrist is at risk for injury in many athletic endeavors, often in acute falls or dorsiflexion injuries and at other times from repetitive stress involved with fitness routines or specific motions called for in the sport. Dorsiflexion accounts for most wrist problems giving rise to compression injuries dorsally such as scaphoid impaction, triquetrohamate impaction, and occult ganglions. These are seen most often in weight lifters, gymnasts, and push-up enthusiasts. Tension injuries occur on the palmar aspect of the wrist with disruption or attenuation of the supporting ligaments or interosseous membranes. This provides scapholunate tears, scapholunate dissociation, lunatotriquetral, midcarpal instability problems, and so forth, which are generally the result of single energetic injuries commonly associated with contact sports. Distal radioulnar injuries include chondromalacia of the ulnar head, ulnar head subluxation, and ulnocarpal impingements with tears of the triangular fibrocartilage. Forceful rotational injuries are generally associated with the former and stressful ulnar deviation with the latter, where tennis players and baseball batters are at risk. Fracture of the hook of the hamate and pisotriquetral chondromalacia are common in sports requiring holding a club, handle, or bat. Precise, early diagnosis affords the best chance for successful treatment.