Arthroscopic Treatment for Intraosseous Ganglion Cyst of Carpal Bone Combined With Occult Wrist Instability

Background: Intraosseous ganglion cysts (IOGs) of the carpal bone are uncommon tumors that may represent rare causes of chronic wrist pain. Arthroscopic resection has been described in isolated symptomatic cases as a feasible technique; however, there is no published study investigating this technique in an unstable wrist. We aimed to study the outcome of arthroscopic lesion resection combined with intercarpal ligament thermal shrinkage for the IGOs in the wrists with occult instability.Methods: Fourteen patients from our hospital database between 2013 and 2015 who had IOGs combined with occult carpal instability were retrospectively reviewed. Diagnosis was exclusively established based on persistent wrist pain and functional limitation before surgery. The IOGs were removed under arthroscope, and bone grafting was performed accordingly dependent on the sizes and locations of the lesion. The lax intercarpal ligaments were tightened by radiofrequency shrinkage. Results were analyzed for demographic data and functional outcomes.Results: At a mean follow-up of 27 months, all patients were satisfied with pain relief and the patients’ grip power improved. The pre- and postoperative range of motion of the affected wrist had no significant difference. Radiologically, cyst recurrence and joint instability development were not observed. The postoperative function of the wrists significantly improved based on the Mayo Wrist Score and Patient-rated Wrist Evaluation score.Conclusions: For IOGs of carpal bones in the wrist with occult instability, arthroscopic treatment, including cyst resection and ligament thermal shrinkage, was an effective way to improve pain and function of the effected wrist.

INTRAOSSEOUS GANGLION CYST OF SCAPHOID AND LUNATE: A CASE REPORT

INTRODUCTION:Intraosseous ganglion cyst of carpal bones is an uncommon cause of wrist pain. Although isolated cases of scaphoid and lunate have been reported in literature,intraosseous ganglion cyst in both scaphoid and lunate is rare. CASE REPORT:We report a case of 27 year old female who presented with a 6 month history of progressive left wrist pain. History of trauma was not reported. Conservative treatment with medications was unsuccessful. Examination revealed moderate swelling and tenderness over volar aspect of wrist with terminally painful wrist motions. Plain radiograph and MRI revealed well defined lesion in both scaphoid and lunate bone. Curettage and filling with radial bone graft provided a good functional recovery. CONCLUSION:we propose that early diagnosis of intraosseous ganglion is based on clinical presentation, proper radiologic investigation and index of suspicion can be helpful in the surgical management of intra osseous ganglion cyst in small bones of hand and intraosseous ganglion cyst may be considered as a differential diagnosis for wrist pain