Ultrasound-Guided Aspiration Does Not Reduce the Recurrence Rate of Ganglion Cysts of the Wrist

Background Ganglion cysts are the most frequent soft tissue tumor encountered in the upper extremity and are commonly treated by aspiration or by surgical excision. Ultrasound is a promising addition to traditional aspiration, as it allows for visualization of the needle within the ganglion before aspiration. Questions Are ganglion cysts of the wrist less likely to reoccur if they are aspirated under ultrasound guidance versus “blind” aspiration without the use of ultrasound guidance? Does patient functionality change based on whether or not the cyst recurred? Patients and Methods In total, 52 patients were successfully contacted and recurrence rates were compared between those whose cyst was treated with ultrasound-guided (13 patients) with those whose cyst was treated with blind aspiration (39 patients). Mean follow-up time was 2.9 years. Results Recurrence rates were 69% (9 patients) and 74% (29 patients) for the ultrasound-guided and blind aspiration groups, respectively (p-value: 0.73), showing no significant difference in recurrences of wrist ganglion between the two groups. A metric of functionality (Quick–DASH [Disabilities of the Arm, Shoulder, and Hand]) revealed worse outcomes in patients who experienced return of ganglion cyst after aspiration versus those who did not. Conclusion Additional studies with improved sample sizes are needed to demonstrate the superiority of ultrasound-guided aspiration versus blind aspiration. Due to a high recurrence rate following aspiration (both ultrasound-guided and blinded), a lower threshold for surgical intervention is likely reasonable. Level of Evidence This is a Level IIIb study.

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Factors Impacting Recurrence Rate After Open Ganglion Cyst Excision

Hand ◽

10.1177/1558944720921477 ◽

2020 ◽

pp. 155894472092147

Author(s):

Landon M. Cluts ◽

John R. Fowler

Keyword(s):

Recurrence Rate ◽

Ganglion Cyst ◽

Significant Risk ◽

Recurrence Rates ◽

Cyst Excision ◽

Small Series ◽

Ganglion Cysts ◽

Surgeon Experience ◽

Cyst Recurrence ◽

Open Excision

Background: 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. Methods: 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 t 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. Results: 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), P = .02. The age of those with and without a recurrence did not differ (32 years vs 38 years), P = .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, P = .69. Male patients had a recurrence in 6.4% (13 of 204) of cases compared with 2.6% (11 of 424) of female patients, P = 0.01. There was a decrease in the rate of recurrence from 42.9% to 5.3% over 5 years for surgeon 3. Conclusion: In our sample, male sex and surgeon experience were significant risk factors in ganglion cyst recurrence.

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The Treatment of Wrist Ganglion Cyst by the Chinese Acupotomy and Crisscross Thread

10.21203/rs.3.rs-94895/v1 ◽

2020 ◽

Author(s):

Shuliang Zhang ◽

Bin Xu ◽

Yangjun Lao ◽

Di Lu

Keyword(s):

Recurrence Rate ◽

Ganglion Cyst ◽

Combined Treatment ◽

Vas Score ◽

Ganglion Cysts ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Cost ◽

Open Excision

Abstract Background: The current treatments of wrist ganglion have considerable recurrence rate, we developed a new treatment for ganglion cysts in our clinical practice, which combined acupotomy with crisscross thread method, so we now to compare the clinical effectiveness of Chinese acupotomy and crisscross thread with aspiration followed by injection of steroid and open excision for ganglion cysts treatment. Methods: Recruited patients with wrist ganglion were divided into three groups according to the treatments. Among them, 27 patients who were treated by a new combined treatment of Chinese acupotomy and crisscross thread method in group A, 30 patients who were treated by aspiration followed by steroid injection in group B, and 28 patients who were treated by open excision in group C. The data of age, gender, weight, size of ganglion cysts, visual analogue scale (VAS) , cost were recorded and compared by One-way analysis of variance, followed by an LSD (Least Significant Difference)test. The recurrence rates were recorded were analysed by chi-square test.Results: At the first day and one week after treatment, VAS score of group A was similar to group B with no statistic difference. VAS score of group C was higher than group A and B with statistic difference. Six months later, there was no statistic difference among the three groups about VAS. The recurrence rate was 3.7% in group A and 36.7% in group B and 10.7% in group C. No patient infected in three groups. The cost of group A was more than group B with no statistic difference. The cost of group A was much less than group C with statistic difference.Conclusions: The combination of Chinese acupotomy and crisscross thread method was a simple, economical and effective procedure for wrist ganglion cysts.

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Case Report: Ultrasound Guided Mucosal Fold Lateralization for Laryngeal Webs

Frontiers in Surgery ◽

10.3389/fsurg.2021.781422 ◽

2021 ◽

Vol 8 ◽

Author(s):

Sohit Paul Kanotra

Keyword(s):

Case Report ◽

Recurrence Rate ◽

Ultrasound Guidance ◽

Anterior Commissure ◽

High Recurrence Rate ◽

Ultrasound Guided ◽

Vocal Cords ◽

Mucosal Flap ◽

Mucosal Surfaces ◽

Mucosal Fold

The surgical management of Laryngeal webs is challenging and is associated with a high recurrence rate due the presence of opposing raw mucosal surfaces of the vocal cords, especially near the anterior commissure which causes re-scarring. We describe an endoscopic technique of mucosal flap lateralization (MFL) with ultrasound guidance, which prevents the apposition of the anterior raw surfaces of the vocal cords after web incision, thus avoiding recurrence.

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Double intra venous cannula versus single needle technique of aspiration and methylprednisolone injection in the treatment of wrist ganglion: a comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191456 ◽

2019 ◽

Vol 5 (3) ◽

pp. 432

Author(s):

Siddharth Gupta ◽

Rajesh K. Chopra ◽

Mozammil Pheroz ◽

Manish R. Gupta ◽

Arvind Kumar ◽

...

Keyword(s):

Recurrence Rate ◽

Ganglion Cyst ◽

Treatment Options ◽

Current Treatment ◽

P Value ◽

Intravenous Cannula ◽

Needle Technique ◽

Significant Difference ◽

Group 2 ◽

Group 1

Background: Ganglion is the one of the common soft tissue swellings in the hand and wrist. Treatment options available include reassurance, nonsurgical means like aspiration with or without steroid or hyaluronidase injection and surgical or arthroscopic excision. All current treatment options produce suboptimal results. This study endeavours to compare the outcome and recurrence rate and other complications after treatment of wrist ganglion by aspiration and methylprednisolone injection by double Intravenous cannula versus single needle technique.Methods: A prospective comparative clinical study was done with a total of 72 patients. 36 patients in group 1 were treated with double intravenous cannula technique and 36 patients in group 2 were treated with single needle technique. All the patients were followed up for 6 months to look for recurrence and any complication. The patient’s age, sex and various characteristics of the ganglion cyst like side, site, size, etc. were recorded.Results: In group 1, recurrence was seen in 6 patients (15.7%) while in group 2, recurrence were seen in 14 (38.8%) patients. There was statistical significant difference between the two groups with p value of 0.04. No complication was seen in both groups due to methylprednisolone injection.Conclusions: Inspired by the results we advise to use aspiration and methylprednisolone injection by double intravenous cannula technique in the treatment of wrist ganglion before any surgical intervention. It is safe, simple, cost effective method and is less invasive and less time consuming with recurrence rate comparable to surgical and arthroscopic interventions.

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Müller-Weiss Disease: The Descriptive Factors of Failure Conservative Treatment

Foot & Ankle International ◽

10.1177/10711007211002826 ◽

2021 ◽

pp. 107110072110028

Author(s):

Thos Harnroongroj ◽

Theerawoot Tharmviboonsri ◽

Bavornrit Chuckpaiwong

Keyword(s):

Regression Analysis ◽

Conservative Treatment ◽

Demographic Characteristics ◽

Classification Systems ◽

Clinical Severity ◽

P Value ◽

Level Of Evidence ◽

Factors Associated ◽

Radiographic Parameters ◽

Significant Difference

Background: Conservative treatment is the first-line approach for Müller-Weiss disease (MWD). However, factors associated with the failure of conservative treatment have never been reported. Our objectives were to compare the differences in demographic and radiographic parameters between “successful” and “failure” conservative treatment in patients with MWD and identify descriptive factors associated with failure conservative treatment. Methods: We retrospectively reviewed 68 patients with MWD divided into 29 “failure” and 39 “successful” conservative treatment groups. Demographic characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores for pain and walking disability, and radiographic parameters such as calcaneal pitch, lateral Meary, anteroposterior (AP) Meary angle, and talonavicular-naviculocuneiform arthritis were compared. Logistic regression analysis was performed to identify descriptive factors of failure conservative treatment. A P value <.05 was considered a statistically significant difference. Results: We found more severe VAS pain and walking disability scores and FAOS for the pain, activities of daily living, and quality of life subscales in the failure group ( P < .05). Regression analysis demonstrated 2 significant descriptive factors associated with failure conservative treatment: abducted AP Meary angle >13.0 degrees and radiographic talonavicular arthritis. No demographic characteristics were found to be associated with failure conservative treatment. Conclusion: Midfoot abduction (AP Meary angle, >13 degrees) and radiographic talonavicular arthritis were factors associated with failure conservative treatment in MWD and should be determined concurrently with the clinical severity. Classification systems for MWD should include these factors. Level of evidence: Level III, retrospective comparative study.

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The Effect of “High-ankle Sprain” Taping on Ankle Syndesmosis Congruity: A Cadaveric Study

The Open Sports Sciences Journal ◽

10.2174/1875399x02013010123 ◽

2020 ◽

Vol 13 (1) ◽

pp. 123-128

Author(s):

Stéphanie Lamer ◽

Jonah Hébert-Davies ◽

Vincent Dubé ◽

Stéphane Leduc ◽

Émilie Sandman ◽

...

Keyword(s):

Ankle Sprain ◽

Weight Bearing ◽

Axial Loading ◽

Cadaveric Study ◽

P Value ◽

Level Of Evidence ◽

Parametric Data ◽

Custom Made ◽

Significant Difference ◽

High Ankle Sprain

Background: Different treatment options exist for dynamically unstable purely ligamentous syndesmotic injury, including surgery, walking boot, brace and taping. Objective: The main purpose of this study was to evaluate the effect of high-ankle sprain taping (ring taping) on syndesmotic stability in various ligament conditions when axial loading is applied. Methods: This controlled cadaveric laboratory study included ten cadaveric specimens installed in a custom-made device applying 750N of axial loading in order to simulate weight-bearing. Sectioning of syndesmotic ligaments, AiTFL and IOL, was done sequentially and CT scan images were taken with and without high-ankle sprain taping. A validated measurement system consisting of 3 lengths and 1 angle was used. Results were compared with Wilcoxon tests for paired samples and non-parametric data. Results: In every ligament condition (intact vs. cut), no statistically significant difference was observed between specimens, with or without high-ankle sprain taping and with or without axial loading. When the data from ankles with AiTFL and IOL ruptures were compared, the mean for length “b” without axial loading was 7.19 (±2.17), compared to 7.20 (±1.98) with axial loading (p-value = 0.905). With taping and the leg still in axial loading, the value was 7.17 (±2.09) (p-value = 0.721), which is not statistically significant. Conclusion: It is impossible to conclude regarding high-ankle sprain taping’s capacity to maintain syndesmosis congruity because no significant difference was observed, regardless of condition. The most important finding is that high-ankle sprain taping did not cause malreduction of the injured syndesmosis. Level of Evidence: Level V cadaveric study

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Dorsal Wrist Pain in the Extended Wrist-Loading Position: An MRI Study

Journal of Wrist Surgery ◽

10.1055/s-0037-1599829 ◽

2017 ◽

Vol 06 (04) ◽

pp. 276-279 ◽

Cited By ~ 1

Author(s):

Erin Nance ◽

David Byun ◽

Yoshimi Endo ◽

Scott Wolfe ◽

Steve Lee

Keyword(s):

Ganglion Cyst ◽

Weight Bearing ◽

Retrospective Chart Review ◽

Wrist Pain ◽

Control Group ◽

Level Of Evidence ◽

Ganglion Cysts ◽

Magnetic Resonance Imaging Mri ◽

Mri Study ◽

Dorsal Ganglion

Background The etiology of dorsal wrist pain associated with loading of the wrist in extension has not been clearly identified in the literature. Purpose Many exercise disciplines incorporate upper extremity weight-bearing exercises in an extended wrist posture, for example push-ups, plank position, and various yoga and Pilates poses. This study evaluates patients with dorsal wrist pain in the extended wrist-loading position and identifies anatomic abnormalities in the wrist using magnetic resonance imaging (MRI). Methods A retrospective chart review was performed comparing MRI of patients who complained of dorsal wrist pain while performing weight bearing in a wrist extension position with a control group of patients who complained of ulnar-sided wrist pain. The primary MRI outcome was dorsal wrist pathology, including occult dorsal ganglion cyst, scapholunate ligament tear or degeneration, and dorsal capsulitis. Results Dorsal wrist pathology was significantly more prevalent in patients with dorsal wrist pain (84%) than in the patient cohort with ulnar-sided wrist pain (12%). Occult dorsal ganglion cysts were the most common sources of pathology (76%). Conclusion MRI demonstrated an identifiable dorsal abnormality in 84% of patients with dorsal wrist pain associated with weight bearing on the extended wrist. Occult dorsal ganglion cysts are the most common cause of dorsal wrist pain, followed by partial scapholunate tears. When patients complain of dorsal wrist pain during specific extended loading wrist positions such as push-ups, yoga, or Pilates poses, an MRI may be warranted to help identify anatomic abnormalities that may help guide treatment choices. Level of Evidence Diagnostic, Level III.

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Recurrence After Arthroscopic Labral Repair for Traumatic Anterior Instability in Adolescent Rugby and Contact Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546518794673 ◽

2018 ◽

Vol 46 (12) ◽

pp. 2969-2974 ◽

Cited By ~ 20

Author(s):

Emma Torrance ◽

Ciaran J. Clarke ◽

Puneet Monga ◽

Lennard Funk ◽

Michael J. Walton

Keyword(s):

Recurrence Rate ◽

Shoulder Instability ◽

Case Series ◽

Labral Repair ◽

Shoulder Injuries ◽

Adolescent Athletes ◽

Recurrence Rates ◽

Level Of Evidence ◽

Bony Bankart ◽

The Mean

Background: Traumatic glenohumeral dislocation of the shoulder is one of the most common shoulder injuries, especially among adolescent athletes. The treatment of instability for young athletes continues to be controversial owing to high recurrence rates. Purpose: To investigate the recurrence rate of shoulder instability after arthroscopic capsulolabral repair for adolescent contact and collision athletes. Study Design: Case series; Level of evidence, 4. Methods: Sixty-seven patients aged <18 years underwent an arthroscopic labral repair over a 5-year period. The mean ± SD age of the cohort was 16.3 ± 0.9 years (range, 14-17 years) and consisted of 1 female and 66 males. All patients were contact athletes, with 62 of 67 playing rugby. Demographic, clinical, and intraoperative data for all patients with shoulder instability were recorded in our database. Recurrence rates were recorded and relative risks calculated. Results: At a follow-up of 33 ± 20 months, 34 of 67 patients had recurrent instability for an overall recurrence rate of 51% among adolescent contact athletes after arthroscopic labral repair surgery. The mean time to recurrence was 68.1 ± 45.3 weeks. All recurrences occurred as a result of a further sporting injury. Relative risk analysis demonstrated that athletes aged <16 years had 2.2 (95% CI, 1.2-2.1) times the risk of developing a further instability episode as compared with athletes aged ≥16 years at the time of index surgery ( P = .0002). The recurrence rate among adolescent athletes after bony Bankart repairs was 57.9% versus 47.9% for soft tissue labral repairs ( P = .4698). The incidence of Hill-Sachs lesions ( P = .0002) and bony Bankart lesions ( P = .009) among adolescent athletes was significantly higher than among adult controls ( P = .002). The presence of bone loss did not lead to a significant increase in recurrence rate over and above the effect of age. Conclusion: Adolescent contact athletes undergoing arthroscopic labral repair have an overall recurrence rate of 51%. Rugby players who undergo primary arthroscopic shoulder stabilization aged <16 years have 2.2 times the risk of developing a further instability episode when compared with athletes aged ≥16 years at the time of index surgery, with a recurrence rate of 93%.

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Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Endocrine Connections ◽

10.1530/ec-17-0312 ◽

2018 ◽

Vol 7 (1) ◽

pp. R26-R37 ◽

Cited By ~ 4

Author(s):

Nidan Qiao

Keyword(s):

Recurrence Rate ◽

Cushing’S Disease ◽

Meta Analysis ◽

Cushing's Disease ◽

Recurrence Rates ◽

Microscopic Surgery ◽

Significant Difference ◽

Comprehensive Search ◽

Definition Of

Introduction It is unclear whether the proportions of remission and the recurrence rates differ between endoscopic transsphenoidal surgery (TS) and microscopic TS in Cushing’s disease (CD); thus, we conducted a systematic review and meta-analysis to evaluate studies of endoscopic TS and microscopic TS. Methods We conducted a comprehensive search of PubMed to identify relevant studies. Remission and recurrence were used as outcome measures following surgical treatment of CD. Results A total of 24 cohort studies involving 1670 adult patients were included in the comparison. Among these studies, 702 patients across 9 studies underwent endoscopic TS, and 968 patients across 15 studies underwent microscopic TS. Similar baseline characteristics were observed in both groups. There was no significant difference in remission between the two groups: 79.7% (95% CI: 73.1–85.0%) in the endoscopic group and 76.9% (95% CI: 71.3–81.6%) in the microscopic group (P = 0.485). It appears that patients who underwent endoscopic surgery experience recurrence less often than patients who underwent microscopic surgery, with recurrence proportions of 11.0% and 15.9%, respectively (P = 0.134). However, if follow-up time is taken into account, both groups had a recurrence rate of approximately 4% per person per year (95% CI: 3.1–5.4% and 3.6–5.1%, P = 0.651). Conclusions We found that remission proportion and recurrence rate were the same in patients who underwent endoscopic TS as in patients who underwent microscopic TS. The definition of diagnosis, remission and recurrence should always be considered in the studies assessing therapeutic efficacy in CD.

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To Compare the Recurrence Rate of Strictures after Internal Optical Urethrotomy with Intralesional Injection of Mitomycin C versus without Mitomycin C Injection in Patients Presenting with Anterior Urethral Stricture

10.53350/pjmhs2115102856 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2856-2858

Author(s):

Ismat Ullah ◽

Muhammad Waqar Shahid ◽

Muhammad Azeem Mughal ◽

Rahat Usman

Keyword(s):

Mitomycin C ◽

Recurrence Rate ◽

Urethral Stricture ◽

Controlled Trial ◽

P Value ◽

Intralesional Injection ◽

Corpus Spongiosum ◽

Indwelling Catheter ◽

Significant Difference ◽

The Mean

Background: The urethral strictures occurred due to narrowing of urethra. These may occur after an injury or ureteral or excretory system diseases, due to the injury to urothelium or corpus spongiosum that lead to the development of scar tissues. Mitomycin C can be used as chemotherapeutic agent because of its quality of being anti-tumour actions. Aim: To compare the recurrence rate of strictures after internal optical urethrotomy with intralesional injection of Mitomycin C versus without Mitomycin C injection in patients presenting with anterior urethral stricture. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Urology, Lahore General Hospital, Lahore from 5th September 2016 to 5th March 2017. Methodology: Sixty male patients age 18-70 years, diagnosed with anterior (penile and bulbar) urethral stricture up to 2.0cm were included. Patients were randomly divided into two groups; Group A patients were treated with internal optical urethrotomy alone and Group B patients treated with internal optical urethrotomy with intralesional injection of Mitomycin C. After the procedure, an 18F or 20F indwelling catheter left for 7 days. After 6 months, surgical site evaluated and if stricture again developed, then recurrence labeled. Results: The mean age was 39.32±11.38 years, mean duration of stricture was 6.85±3.32 months and the mean stricture size was 1.21±0.45 cm. The recurrence occurred in 18 (30%) patients. Significant difference was noted for recurrence in both groups (p-value<0.05). Conclusion: The recurrence rate with anterior urethral stricture is significantly lower in with Mitomycin C as compared to without Mitomycin C. Keywords: Recurrence, Urethral stricture, Mitomycin C

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