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Radiologia 2022Palpable tumors in children are a common reason for consulting a radiologist. The differential diagnosis is extensive and considerably different from that used in...
Palpable tumors in children are a common reason for consulting a radiologist. The differential diagnosis is extensive and considerably different from that used in adults. Some of the etiologies of palpable tumors are little known outside of pediatrics. The most commonly used imaging test is ultrasonography, because in addition to being harmless and cost-effective, it is conclusive in most cases. Most palpable lesions in children are benign; it is estimated that only 1% are malignant. Knowing these lesions enables the correct diagnosis without the need to resort to unnecessary, sometimes invasive tests, thus avoiding delays in treatment when more severe disease is present. This article aims to review the clinical and radiological characteristics of the palpable lesions that are most common in pediatric patients, explaining the key features that enable accurate diagnosis.
Topics: Humans; Child; Adult; Neoplasms; Ultrasonography; Diagnosis, Differential; Radiology; Pediatrics
PubMed: 36402541
DOI: 10.1016/j.rxeng.2022.08.001 -
JBJS Essential Surgical Techniques 2023Ganglion cysts are benign soft-tissue tumors that are most commonly found in the wrist. Within the wrist, 60% to 70% of ganglion cysts occur on the dorsal side and 20%...
BACKGROUND
Ganglion cysts are benign soft-tissue tumors that are most commonly found in the wrist. Within the wrist, 60% to 70% of ganglion cysts occur on the dorsal side and 20% to 30% occur on the volar side. Although ganglia arise from multiple sites over the dorsal wrist, dorsal ganglia most commonly originate at the scapholunate joint. Open excision is the standard surgical treatment for dorsal wrist ganglia. This procedure is considered when symptoms such as pain and range-of-motion deficits begin to impact activities of daily living.
DESCRIPTION
Open excision of a dorsal wrist ganglion is commonly performed with the patient under general anesthesia or a regional block. The patient is placed in the supine position, and a tourniquet is applied on the affected upper limb. After outlining the periphery of the palpable ganglion, the surgeon makes a transverse or longitudinal incision over the ganglion. The surgeon then begins a deep dissection, dissecting through the subcutaneous tissue and isolating the ganglion while avoiding any rupture, if possible. Once the cyst has been identified, extensor tendons surrounding the cyst are retracted and the cyst and stalk are mobilized. The cyst and stalk are subsequently excised, and the wound is closed.
ALTERNATIVES
Alternative treatments for dorsal wrist ganglia include nonoperative interventions such as observation, aspiration, controlled rupture, and injection. Operative treatments include arthroscopic and open dorsal wrist ganglion resections.
RATIONALE
Although nonoperative treatment can produce successful outcomes, the various modalities have been associated with recurrence rates ranging from 15% to 90%. As a result, surgical excision remains the gold standard of treatment and is typically indicated when weakness, pain, and limited range of motion interfere with activities of daily living. Among surgical interventions, arthroscopic excision is a minimally invasive procedure that has become more common because of the reduced scarring and faster recovery. However, open excision, which does not involve complex equipment, is regarded as the standard among surgical treatments. Although the rates of recurrence for arthroscopic versus open dorsal ganglion excision are similar, arthroscopic excision is less effective with regard to pain relief. This difference in pain relief could potentially be the result of the neurectomy of the posterior interosseous nerve in an open excision. In contrast, an arthroscopic procedure may provide less relief of pain from the posterior interosseous nerve stump attaching to the scarred capsule.
EXPECTED OUTCOMES
Open excision of a dorsal wrist ganglion is a safe, reliable procedure. The recurrence rate after open excision is similar to that after arthroscopic excision and significantly lower recurrence than that after ganglion cyst aspiration. Additionally, not all ganglion cysts can be aspirated. In a retrospective study assessing the risk of recurrence after open excision of ganglion cysts in 628 patients, researchers reported a recurrence rate of 4.1% among the 341 who underwent open dorsal ganglion excision. Furthermore, the authors reported male sex and less surgeon experience as significant risk factors for cyst recurrence. In a study assessing outcomes of open dorsal ganglion excision in 125 active-duty military personnel, researchers reported a recurrence rate of 9%. More notably, the researchers found persistent pain at 4 weeks postoperatively in 14% of the participants. The authors recommended that patients whose daily activities require forceful wrist extension, such as athletes and military personnel, should be counseled on the potential functional limitations and residual pain from open dorsal wrist ganglion excision.
IMPORTANT TIPS
When conducting an open excision, it is beneficial to identify the stalk of the cyst, allowing the surgeon to excise the complete ganglion complex and prevent recurrence.For large cysts that adhere to the surrounding soft tissue, it is helpful to rupture the ganglion in order to facilitate an easier deep dissection.Excising the scapholunate interosseous ligament could possibly lead to scapholunate dissociation and instability.The posterior interosseous nerve courses past the 4th dorsal compartment and may be resected during the deep dissection.
PubMed: 38274143
DOI: 10.2106/JBJS.ST.21.00043 -
The Archives of Bone and Joint Surgery Jul 2021The recurrence of ganglion cysts after surgical excision has a reported rate of 4% to 40%. Recurrence rate after revision surgical excision is unknown. The purpose of...
BACKGROUND
The recurrence of ganglion cysts after surgical excision has a reported rate of 4% to 40%. Recurrence rate after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a secondary excision procedure.
METHODS
With Institutional Review Board approval, we retrospectively identified by CPT code and reviewed charts of patients who had recurrent ganglion cyst excision performed over a five-year period (2010 - 2014). Recurrence was defined as reappearance of a cyst in the same area as it was previously. Demographic information including recurrences and revision surgeries was collected in addition to outcome variables such as patient satisfaction, pain levels, and functional limitations.
RESULTS
Out of the 42 revision cases identified 20 patients were reached. Mean time to recurrence of the cyst after the first ganglion cyst excision was 2.5 years (range: 1 month - 12 years). After the second ganglion cyst excision, three patients (15%) had a recurrence, each occurring within one year (mean: 11 months; range: 9-12). One of the three patients underwent a third successful ganglion cyst excision. The other two patients declined surgical intervention to date. Patients without a second recurrence (n=17) reported an average pain score of 0.1 (range: 0-2) on a scale of 1-10. Three (18%) reported some difficulty with day-to-day activities due to their scar. Seven (41%) patients reported at least transient numbness or tingling. Mean satisfaction was 9.8 on a scale of 1-10, and 100% reported that they would undergo another ganglion cyst excision should they ever have another recurrence.
CONCLUSION
Patients should be advised about the risk of recurrence after re-excision of ganglion cysts, which was noted to be 15% in our cohort. This rate of recurrence is similar to that of primarily excised cysts.
PubMed: 34423085
DOI: 10.22038/abjs.2020.34661.1958 -
Eplasty 2022Tumors of the hand are encountered frequently and represent a variety of pathologic diagnoses, both benign and malignant. Even within a single pathologic type,...
BACKGROUND
Tumors of the hand are encountered frequently and represent a variety of pathologic diagnoses, both benign and malignant. Even within a single pathologic type, presentation can vary. This study reviews hand tumors encountered by an individual surgeon and described presenting features to better aid in clinical decision making.
METHODS
A retrospective chart review of patients presenting with a hand tumor between January 2005 and December 2017 from an individual surgeon's perspective was performed. Pertinent data were extracted by researchers and statistical analysis was completed with GraphPad Prism (GraphPad Software, Inc).
RESULTS
A total of 101 patients aged 14 months to 87 years (mean age, 40.52 years) were included. Within this patient group, soft tissue tumors accounted for 97%, malignant neoplasm 2%, and bone tumors 1%. Ganglion cysts were most common (54.5%) followed by hemangiomas (9.9%), giant cell tumors (6.9%), granulomas (5.9%), and fibromas (5%). A total of 54.5% of patients reported pain and 43.5% reported decreased range of motion (ROM).
CONCLUSIONS
In this patient cohort, ganglion cyst was the most common tumor type and presented with pain and deficits in ROM. This is contrary to the asymptomatic presentation of such cases in the literature. Other common tumors were hemangiomas, giant cell tumors, granulomas, and fibromas. Malignant tumors were rare, as expected, and both cases presented without pain or tenderness.
PubMed: 35602523
DOI: No ID Found -
Journal of Surgical Case Reports Jun 2022Ganglion cysts arising from tendons are uncommon lesions with an unknown cause. We present a case report of a 38-year-old female was diagnosed with an intra-tendinous...
Ganglion cysts arising from tendons are uncommon lesions with an unknown cause. We present a case report of a 38-year-old female was diagnosed with an intra-tendinous ganglion cyst of the peroneus longus. She complained of right ankle swelling for 1 year and associated with pain. MRI revealed a peroneus longus intra-tendinous ganglion below the lateral malleolus with a thin wall. The ganglion cyst was surgically excised while the structure of the peroneus longus tendon was preserved. The clinical and functional outcomes were satisfactory after 1 year without recurrence.
PubMed: 35702261
DOI: 10.1093/jscr/rjac279 -
Arthroscopy Techniques Dec 2018Paralabral cysts are an increasingly recognized cause of suprascapular nerve (SSN) impingement, often causing insidious weakness in the rotator cuff. Compression at the...
Paralabral cysts are an increasingly recognized cause of suprascapular nerve (SSN) impingement, often causing insidious weakness in the rotator cuff. Compression at the suprascapular notch is often due to the presence of a SLAP tear and leads to pain, weakness, and atrophy of both the supraspinatus and infraspinatus muscles. Compression of the SSN at the spinoglenoid notch leads to weakness and atrophy of the infraspinatus only. Arthroscopic decompression of cysts with repair of labral pathology is typically performed in a sublabral fashion, which may make visualization of the extent of the cyst difficult and places the SSN at increased risk. With any approach, an intimate knowledge of the anatomy of the SSN is vital to safe decompression. We present a surgical technique for decompression of paralabral cysts using an intra-articular transcapsular approach. This approach maximizes visualization and efficiency and reduces possible damage to the SSN.
PubMed: 30591872
DOI: 10.1016/j.eats.2018.08.011 -
Hand (New York, N.Y.) Nov 2022Ganglion cysts are the most common soft tissue tumor of the hand and wrist, affecting pediatric and adult populations. Despite their frequency, there is no consensus... (Review)
Review
Ganglion cysts are the most common soft tissue tumor of the hand and wrist, affecting pediatric and adult populations. Despite their frequency, there is no consensus within the literature regarding the best management of pediatric wrist ganglia, and there are few recent publications examining this topic. We provide an up-to-date literature review examining the current issues and controversies in the management of pediatric wrist ganglia.
Topics: Adult; Humans; Child; Ganglion Cysts; Wrist; Hand; Wrist Joint; Soft Tissue Neoplasms
PubMed: 33174451
DOI: 10.1177/1558944720966716 -
Cureus May 2023Suprascapular nerve dysfunction caused by ganglion cysts is a rare condition that can cause significant pain and weakness in the shoulder. The suprascapular nerve is a...
Suprascapular nerve dysfunction caused by ganglion cysts is a rare condition that can cause significant pain and weakness in the shoulder. The suprascapular nerve is a branch of the brachial plexus that innervates the supraspinatus and infraspinatus muscles. It is most commonly compressed at the suprascapular notch or the spinoglenoid notch. A 40-year-old male presented with a two-year history of left shoulder pain that was aggravated by overhead activities. Physical examination revealed mild tenderness along the infraspinatus with noticeable atrophy, full range of motion, and mild external rotation weakness. MRI was obtained and confirmed the suspected diagnosis of suprascapular nerve dysfunction caused by a ganglion cyst at the spinoglenoid notch. The patient was initially treated conservatively with physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs), but after completing nine months of conservative management, he showed no improvement. The patient elected to undergo open ganglion cyst excision and decompression of the spinoglenoid notch. Postoperatively, the patient's pain resolved gradually and he regained the full power of external rotation. The patient was followed for one year postoperatively and was satisfied with the outcome with a full range of motion, full power, and a complete return to his baseline level of activity. In conclusion, this case report demonstrates the successful treatment of suprascapular nerve dysfunction caused by a ganglion cyst at the spinoglenoid notch with open ganglion cyst excision and decompression. This procedure is a safe and effective treatment option for patients with this condition who have failed to respond to conservative treatment and emphasizes and signifies the role of eliciting a detailed patient history, conducting a thorough radiographic examination including MRI scans, and planning optimum surgical interventions.
PubMed: 37346219
DOI: 10.7759/cureus.39279 -
Hand (New York, N.Y.) Mar 2022The recurrence rate after open excision of ganglion cysts is approximately 20%. However, this literature is based on a small series of subjects. This study aims to...
The recurrence rate after open excision of ganglion cysts is approximately 20%. However, this literature is based on a small series of subjects. This study aims to determine the rate and risk of recurrence after open excision of ganglion cysts in a large patient series. This study included 628 patients who had ganglion cyst excision from 2010 to 2018. A retrospective chart review recorded the following: age, sex, laterality, volar/dorsal location, and recurrence. An overall recurrence rate was calculated. In addition, a 1-way analysis of variance test was used to compare recurrence rates among the individual surgeons, and unpaired tests were used to compare age of recurrence, dorsal cyst recurrence, laterality of cyst, and recurrence based on sex. Finally, a comparison of recurrence rate over time was conducted for surgeon 3. The overall recurrence rate was 3.8% (24 of 628). The recurrence rates for each surgeon were 3% (9 of 353), 2% (3 of 167), and 11% (12 of 107), = .02. The age of those with and without a recurrence did not differ (32 years vs 38 years), = .06. The recurrence rate of dorsal ganglion cysts was 4.1% (14 of 341) compared with 3.5% (10 of 286) for volar ganglion cysts, = .69. Male patients had a recurrence in 6.4% (13 of 204) of cases compared with 2.6% (11 of 424) of female patients, = 0.01. There was a decrease in the rate of recurrence from 42.9% to 5.3% over 5 years for surgeon 3. : In our sample, male sex and surgeon experience were significant risk factors in ganglion cyst recurrence.
Topics: Adult; Female; Functional Laterality; Ganglion Cysts; Humans; Male; Retrospective Studies; Risk Factors; Wrist
PubMed: 32452245
DOI: 10.1177/1558944720921477 -
BMC Musculoskeletal Disorders Aug 2012A case series for ganglion cyst of the cruciate ligament with MRI findings, clinical presentation, and management options along with review of literature is presented. (Review)
Review
BACKGROUND
A case series for ganglion cyst of the cruciate ligament with MRI findings, clinical presentation, and management options along with review of literature is presented.
METHODS
Of 8663 consecutive patients referred for knee MR imaging, 31 were diagnosed with ganglion cysts of the cruciate ligaments, including 21 men and 10 women of ages 12 to 73 years (mean: 37). A review of charts revealed that knee pain was the chief complaint in all cases. Arthroscopic debridement of ganglion cyst was performed in 11 patients.
RESULTS
MRI proved to be a valuable tool in diagnosing and deciding management of these cases. All 11 patients who underwent arthroscopic treatment were symptom-free on a minimum follow-of one year.
CONCLUSION
Cyst formation associated with cruciate ligament of the knee is an infrequent cause of knee pain. MR imaging was important in confirming the cyst lesions and provided useful information prior to arthroscopy. Arthroscopic debridement of ganglion cyst produced excellent outcome without recurrence. This study describes the pertinent MRI and intraoperative findings of ganglion cyst.
Topics: Adolescent; Adult; Aged; Anterior Cruciate Ligament; Arthralgia; Arthroscopy; Child; Debridement; Female; Ganglion Cysts; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Posterior Cruciate Ligament; Time Factors; Treatment Outcome; Young Adult
PubMed: 22862803
DOI: 10.1186/1471-2474-13-137