Multimodality imaging of intraosseous ganglia of the wrist and their differential diagnosis

Paparo, Francesco; Fabbro, Emanuele; Piccazzo, Riccardo; Revelli, Matteo; Ferrero, Giulio; Muda, Alessandro; Cimmino, M. A.; Garlaschi, Giacomo

doi:10.1007/s11547-012-0875-x

Cited by 22 publications

(23 citation statements)

References 44 publications

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“…With SEM of a proximal pole, we were able to further characterise a late state of an SNU. As expected, the SEM clearly showed bone degradation with disorientation of collagen fibrils in the trabeculae, loss of trabecular structure, collapse of subchondral bone and formation of bone cysts, all of which are structural aspects that have been reported as characteristic for SNUs (Gabl et al 1999;Paparo et al 2012).…”

Section: Healing Parameterssupporting

confidence: 79%

Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions

et al. 2018

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The scaphoid is the most frequently fractured carpal bone and prone to non‐union due to mechanical and biological factors. Whereas the importance of stability is well documented, the evaluation of biological activity is mostly limited to the assessment of vascularity. The purpose of this study was to select histological and immunocytochemical parameters that could be used to assess healing potential after scaphoid fractures and to correlate these findings with time intervals after fracture for the three parts of the scaphoid (distal, gap and proximal). Samples were taken during operative intervention in 33 patients with delayed or non‐union of the scaphoid. Haematoxylin and Eosin (HE), Azan, Toluidine, von Kossa and Tartrate‐resistant acid phosphatase (TRAP) staining were used to characterise the samples histologically. We determined distribution of collagen 1 and 2 by immunocytochemistry, and scanning electron microscopy (SEM) was used to investigate the ultrastructure. To analyse the samples, parameters for biological healing status were defined and grouped according to healing capacity in parameters with high, partial and little biological activity. These findings allowed scoring of biological healing capacity, and the ensuing results were correlated with different time intervals after fracture. The results showed reduced healing capacity over time, but not all parts of the scaphoid were affected in the same way. For the distal fragment, regression analysis showed a statistically significant correlation between summarised healing activity scores and time from initial fracture (r = −0.427, P = 0.026) and decreasing healing activity for the gap region (r = −0.339, P = 0.090). In contrast, the analyses of the proximal parts for all patients did not show a correlation (r = 0.008, P = 0.969) or a decrease in healing capacity, with reduced healing capacity already at early stages. The histological and immunocytochemical characterisation of scaphoid non‐unions (SNUs) and the scoring of healing parameters make it possible to analyse the healing capacity of SNUs at certain time points. This information is important as it can assist the surgeon in the selection of the most appropriate SNU treatment.

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Section: Healing Parameterssupporting

confidence: 79%

Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions

et al. 2018

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“…They are benign lytic tumors, generally lobular, and frequently located on the subchondral part of the long bone's epiphysis. 1 They can sometimes be found on the carpal bones (lunate, scaphoid bones) either by accidental discovery or during a medical checkup for carpal pain. The origins of such cysts remain uncertain.…”

Section: Discussionmentioning

confidence: 99%

“…1 Classic cases include lytic bone tumors found through radiologic diagnosis, with a scapholunate ligament origin. Diagnoses of symptomatic cystic lesions of the lunate bone (Kienböck disease, trauma, scaphoid pseudarthrosis) must be eliminated before stating that the wrist pain is due to an intraosseous bone ganglion cyst.…”

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confidence: 99%

Arthroscopic Treatment of Intraosseous Ganglion Cyst of the Lunate Bone

Cerlier

Levadoux

2015

Arthroscopy Techniques

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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.W rist intraosseous ganglion cysts are rare tumors in adults, and they are asymptomatic and idiopathic most of the time; however, but they represent one of the few causes of wrist pain.1 Classic cases include lytic bone tumors found through radiologic diagnosis, with a scapholunate ligament origin. Diagnoses of symptomatic cystic lesions of the lunate bone (Kienböck disease, trauma, scaphoid pseudarthrosis) must be eliminated before stating that the wrist pain is due to an intraosseous bone ganglion cyst.Surgical treatment of this pathologic condition yields good results and a low recurrence rate. Wrist arthroscopy is a recent, up-and-coming surgical technique, usually performed with the patient under local or regional anesthesia and performed either with saline irrigation or as a dry procedure. The wrist arthroscopy setup includes a small fiberoptic camera with a diameter of 2.4 or 2.7 mm, a shaver without a suction pump and with or without an electrocautery, and basic arthroscopy instruments (palpation rod, basket forceps). There are more and more wrist arthroscopy indications, including scapholunate ligament repair, treatment of fractures of the distal radius, intercarpal arthrodesis, and intra-articular cyst resection, but the use of wrist arthroscopy in such cases needs to be qualified. The main advantage of this technique is that it reduces the intra-articular operative area and therefore minimizes postoperative joint stiffness. However, it is a difficult technique with a significant learning process.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 res...

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“…6 The procedure is performed with the patient in the supine position; the shoulder is abducted to 90 and the elbow flexed 90…”

Section: Techniquementioning

confidence: 99%

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

Bhatia

2015

Arthroscopy Techniques

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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.

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Multimodality imaging of intraosseous ganglia of the wrist and their differential diagnosis

Cited by 22 publications

References 44 publications

Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions

Time‐dependent changes in bone healing capacity of scaphoid fractures and non‐unions

Arthroscopic Treatment of Intraosseous Ganglion Cyst of the Lunate Bone

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

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