Palmar Ganglion Research Articles

Tubercular Tenosynovitis of the Wrist and Cardiac Correlation

Tubercular tenosynovitis has also been known as compound palmar ganglion which is a misnomer. Cardiovascular complications of tuberculosis (TB) are one of the most common extrapulmonary involvements of the disease. These cardiac complications arising due to tubercular inflammation are many and varies. These range from pericarditis (high prevalence) to acute myocardial infarction, aortitis, myocarditis, and mycotic aneurysms and many others. Cardiovascular complications of TB have a high rate of morbidity and mortality rate. There should be a high index of suspicion and interdisciplinary involvement of the various required specialties in the management of such a swelling with cardiac pathophysiology as well. This case report highlights one such example of tuberculosis with acute myocardial infarction (AMI) which got unmasked post TTS surgery.

Tubercular Flexor Tenosynovitis with Carpal Tunnel Syndrome Mimicking as Compound Palmar Ganglion

Introduction: Tubercular flexor tenosynovitis is an infrequent condition, which has a mixed clinical picture, but with careful examination and investigation, it should be diagnosed earlier before the involvement of underlying bones and nerves. Case Report: We present a case of a 69-year-old man who came with complaints of progressive swelling over the palm and forearm. He was presented as compound palmar ganglion but finally diagnosed as a case of chronic flexor tenosynovitis with association of carpal tunnel syndrome of tubercular origin without involvement of the underlying bones and was treated by complete excision and antitubercular therapy. Conclusion: Tuberculous flexor tenosynovitis is a condition that can be managed by excision and antitubercular therapy. However, it presents as a challenge to the surgeons when the presentation is very late. Hence, early identification and treatment are the main goals of this article.

Tuberculous Tenosynovitis of the Wrist

Tuberculous tenosynovitis, formerly known as compound palmar ganglion, is a rare condition that presents usually as chronic painless swelling, tenosynovitis, and sometimes with compressive neuropathy. Approximately 10% of all extrapulmonary manifestations of tuberculosis involve the musculoskeletal system and among them, involvement of the wrist and hand is a very rare condition. It is really important to manage this condition before it spreads to the underlying bones causing osteomyelitis and destruction. Here, we are going to report two cases both presenting with a painless swelling and restriction of movement of their wrists for more than 6 months. In physical examination, one of the patients had also numbness over median nerve territory. After imaging, biopsies, cultures, and histopathological examinations, wrist swelling was considered as tuberculous tenosynovitis and appropriate anti-tuberculosis treatment was started.

Patient with tuberculous flexor tenosynovitis of the hand

Chronic flexor tenosynovitis of the hand is a rare condition in the present time.[1][1] Tuberculous tenosynovitis of the wrist is generally called compound palmar ganglion though ganglion is a misnomer.[1][1]...

Compound palmar ganglion associated with tuberculous arthritis of wrist causing compression of the median and ulnar nerves: Management

Compound palmar ganglion associated with tuberculous arthritis of wrist causing compression of the median and ulnar nerves: Management

Tubercular compound palmar ganglion presenting as a severe carpal tunnel syndrome- A case report

Atypical presentation of tuberculosis is not uncommon in developing countries. Among extra-pulmonary sites, tendons are very rarely involved. Compound palmar ganglion associated with tuberculosis is an uncommon condition in which a swelling is present across the wrist joint on either side of the flexor retinaculum. Very rarely such lesion can compress over neural structures and may present as Carpal Tunnel Syndrome. A therapeutic challenge consists of treating disease and its associated presentation. Treatment of choice for such conditions include complete excision of the mass along with the radical synovectomy of the wrist joint and associated flexor tendon sheaths followed by anti-tubercular medications. With early diagnosis and treatment good recovery can be achieved. We present a Case of a large compound tubercular palmar ganglion who presented to us with symptoms of carpal tunnel syndrome which was treated surgically with excision and carpal tunnel release.

Tubercular compound palmar ganglion – A review

Tuberculous tenosynovitis is a chronic and rare infection of flexor tendon sheath of forearm, mainly around the wrist. Patients presents with swelling and pain, and sometime also with neurological symptoms when median nerve get involved. Patient evaluated clinically for the diagnosis, but the MRI is the gold standard tool for the diagnosis. Histopathological evaluation is also needed to confirm the diagnosis. Management is mainly surgical followed by full course of anti tubercular therapy. A delay in the management may leads to complications due to asymptomatic swelling. Keywords: Wrist swelling, Compound palmar ganglion, Tubercular tenosynovitis, Melon seeds, Median nerve.

Tuberculous tenosynovitis of the flexor tendons of the wrist: a case report

BackgroundTuberculous tenosynovitis poses a significant public health challenge, especially in developing countries. It usually affects the flexor tendons of the wrist.Case presentationWe present a case of a 65-year-old Ghanaian female. She presented a progressively enlarging mass over the volar aspect of the right wrist and palm. She did not have a previous history of tuberculosis. However, her erythrocyte sedimentation rate was high and Mantoux (purified protein derivative) test was strongly positive (more than 15 mm). Radiograph of ulna, radius, and wrist showed osteopenic changes around the distal radius. Excision biopsy of the mass was done and samples sent for histopathology comment. The findings were an inflamed, thickened synovia with rice bodies: suggestive of tuberculous tenosynovitis. Anti-tuberculous chemotherapy was commenced on the second postoperative day.ConclusionTuberculous tenosynovitis of the wrist is uncommon. However, in developing countries like Ghana where tuberculosis is prevalent, it should be part of the differential diagnosis of compound palmar ganglion in order to prevent delayed diagnosis and treatment.

Endoscopic Ganglionectomy of Palmar Ganglion via Flexor Carpi Radialis Tendoscopy

Palmar ganglion is rare. Deep palmar ganglion usually arises from the wrist joint and may cause compression neuropathy. Superficial palmar ganglion may arise from the flexor tendons of the wrist. The chance of compression neuropathy is expected to be less than deep palmar ganglion. However, there is a higher chance of perforation through the skin and the ganglion may affect hand grip. Open resection of the ganglion does not require extensive deep soft tissue dissection. However, the skin incision can still be extensile to trace the stalk to the tendon of origin. The purpose of this Technical Note is to report the details of endoscopic ganglionectomy for superficial palmar ganglion arising from the flexor carpi radialis tendon.

Tuberculous Compound Palmar Ganglion

ABSTRACT Introduction Compound palmar ganglion of tuberculous etiology is an infrequent condition, which has an obvious clinical picture, but still overlooked and should be diagnosed earlier before the involvement of underlying bones and nerves. Case Report We present the case of a 56-year-old male presenting with progressive swelling of the palm and forearm. He was diagnosed to have chronic flexor tenosynovitis without involvement of the underlying bones and was treated by complete excision and antitubercular therapy (ATT). Conclusion Tuberculous palmar ganglion is a condition that can be managed by excision and chemotherapy. However, it presents as a challenge to rural surgeons where the patients present late. Hence, early identification and treatment are the main goals of this article. How to cite this article Doraisamy N, Chandrasekhar M, Jebakumar J, Singh SDB. Tuberculous Compound Palmar Ganglion. J Postgrad Med Edu Res 2017;51(1):28-29.

Compound palmar ganglion causing compressive neuropathy of the median nerve

Tuberculosis (TB) of synovial sheath of tendon is uncommon, it is a severe form of extrapulmonary TB, diagnosis is obvious on clinical grounds in later stages, but is always confirmed by histopathology. Here, we are presenting a case of a 50-year-old female, who presented to us with gradual increasing swelling in her left hand and wrist and numbness over left thenar eminence. The patient was successfully treated with debulking operation and anti-tubercular drugs. Tubercular tenosynovitis of wrist and hand is a severe form of extrapulmonary TB. Intraoperatively, the presence of rice body or melon seed bodies is pathognomonic for confirming the diagnosis. Early diagnosis and intervention give good prognosis.

Tubercular compound palmar ganglion causing carpal tunnel syndrome

Compound palmar ganglion of tubercular origin with carpal tunnel syndrome is an uncommon condition. The aim of this study is to make awareness among practitioners so that the condition can be diagnosed and treated at an early stage before it spreads and destroy the surrounding structures. We present a 50-old-female with a painless swelling of the right wrist and palm of 1-year duration. Furthermore, the patient had a history of paresthesias and numbness of median nerve distribution. Local examination revealed a fluctuating, dumbbell-shaped swelling of the right wrist and palm with numbness of radial three and a half fingers. All the radiographic and laboratory tests were within the normal limits. Patient was treated with thorough debridement and decompression of carpal tunnel along with anti-tubercular therapy. Although rare, tubercular tenosynovitis with carpal tunnel syndrome must be kept in mind as a differential diagnosis of chronic tenosynovitis especially in the developing countries.

Imaging of compound palmar ganglion with pathologic correlation

Compound palmar ganglion, or chronic flexor tenosynovitis, most commonly of tuberculousorigin, is a rare extrapulmonary manifestation of tuberculosis (TB). The flexor synovialsheath is not a common site for TB but, once involved, causes rapid involvement of all flexortendons. We discuss the case of a 70-year-old farmer who presented to us with pain and progressive swelling of the palmar aspect of the wrist. On clinical examination, swelling both above and below the proximal wrist crease was found, with positive cross-fluctuation. Onultrasonography and magnetic resonance imaging, features suggestive of compound palmarganglion were present. The patient underwent surgical resection (extensive tenosynovectomy)and chemotherapy. Post-operative histopatholgical findings correlated with the radiological features.

Compound palmar ganglion: A tubercular manifestation of flexor tenosynovitis of the wrist

Compound palmar ganglion of tuberculous origin is uncommon. The clinical picture is very typical and is always confirmed by histopathology. The condition is best managed in its early stages before it spreads to the underlying bones causing destruction. Here, we report a 55-year-old male who presented with pain and progressive swelling over the left wrist and hand. Examination revealed positive cross fluctuation, restriction of movements and islands of numbness over median nerve territory. He was diagnosed to have chronic flexor tenosynovitis of left wrist and was treated with debulking tenosynovectomy along with anti tubercular therapy. He responded to treatment achieving full functional recovery. Compound palmar ganglion is considered a severe form of extra-pulmonary musculoskeletal tuberculosis. Intra-operative finding of melon seed bodies or rice bodies as seen in our case is pathognomonic of tuberculous tenosynovitis. According to literature, extensive debridement and full course chemotherapy brings about a better prognosis. Early diagnosis, complete debulking and appropriate anti-tubercular therapy is the recommended treatment. It can improve the patient functionally by preventing a subsequent arthrodesis which is a major concern for both the surgeon and the patient.

Compound Palmar Ganglion: A Case Report

-Compound palmar ganglion or tuberculous tenosynovitis of flexor tendons of wrist and hand is a rare disease. The incidence of extra-pulmonary tuberculosis including musculoskeletal system has also increased with re-emergence of tuberculosis due to increase in HIV / AIDS cases. We are presenting a case of 16 year old boy who present with a dumbbell shaped fluctuating swelling between flexor surface of right wrist and palm without any previous or present history of pulmonary tuberculosis /contact and trauma. Radiographic and laboratory finding were normal except raised ESR and strongly positive montouxe test. Patient was managed by open biopsy with excision of thickened synovium and removal of multiple rice bodies or melon seeds and sample send for histopathological examination. Histopathological report showed caseous necrosis and epithelial granuloma along with Langhans type giant cell, staining for AFB was negative. ATT was given to patient for 9 months with regular follow-up. Patient gained full range of motion in wrist in five month and there is no underlying disorder in last follow-up at one and half year. The tuberculous tenosynovitis is rare but must be kept in mind as differential diagnosis of chronic tenosynovitis.

Radial artery injury caused by a sclerosant injected into a palmar wrist ganglion

Radial artery injury caused by a sclerosant injected into a palmar wrist ganglion

Compound palmar ganglion with carpal tunnel syndrome.

Compound palmer ganglion is an uncommon condition characterized by a swelling in the distal part of volar aspect of wrist and communicating with another swelling over palm across the flexor retinaculum. It commonly results from tuberculous tenosynovitis. It may lead to carpal tunnel syndrome and need surgical excision with division of flexor retinaculum.

A palmar ganglion arising from the metacarpophalangeal joint

We present a case of a ganglion arising from the palmar aspect of the metacarpophalangeal joint.

Digital nerve compression by hyperplastic pacinian corpuscles: A case report and immunohistochemical study

A 68-year-old lady developed digital pain within days of the excision of a palmar ganglion. This was found to be due to a mass of hyperplastic Pacinian corpuscles compressing the digital nerve. Immunohistochemistry was carried out on the resected corpuscles using antisera to a range of neuropeptides. Possible mechanisms of hyperplasia are discussed.

Compression neuropathy of the motor branch of the median nerve caused by palmar ganglion

We describe a palmar ganglion producing paralysis of the motor branch of the median nerve; such a case has not been reported previously. Ultrasonography was useful for preoperative diagnosis.