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1.
World Neurosurg ; 135: 171-172, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31870821

RESUMO

Benign peripheral nerve sheath tumors are well known to neurosurgeons and a relatively commonly seen pathology. Intraneural ganglion cysts, once thought to be rare and poorly understood, are increasingly recognized in clinical practice and better understood based on the advent of high-resolution imaging. There are few reports of different nerve lesions in the same anatomic location appearing concurrently. Herein we present a patient with 2 distinct pathologies explaining 2 distinct symptom complexes-sensory changes in the superficial peroneal distribution (from a schwannoma of the superficial peroneal nerve) and mild motor weakness in the tibialis anterior (from an intraneural ganglion cyst arising from the superior tibiofibular joint affecting this motor branch). Recognition of the 2 pathologies allowed targeted surgical approaches, which led to resolution of the symptoms.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Idoso , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Imagem por Ressonância Magnética , Neurilemoma/complicações , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/cirurgia , Neuropatias Fibulares/complicações , Neuropatias Fibulares/cirurgia
2.
Medicine (Baltimore) ; 98(44): e17865, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689879

RESUMO

RATIONALE: Most cases of foot drop are known to result from lower motor neuron pathologies, particularly lumbar radiculopathy and peripheral neuropathy, including common peroneal neuropathy. To improve the prognosis of foot drop, it is important to quickly and accurately diagnose the etiology and provide appropriate treatment. PATIENT CONCERNS: A 65-year-old female patient with a history of L4-5 intervertebral disc herniation presented with right foot drop that had developed 1 month previously. DIAGNOSIS: Electrodiagnostic examination revealed common peroneal neuropathy combined with L5 radiculopathy, with the former being the main cause of the foot drop. MRI of the right knee was performed to identify the cause of the peroneal nerve lesion, which revealed an intraneural ganglion cyst in the common peroneal nerve. INTERVENTIONS: The patient was treated by ultrasound-guided percutaneous cyst aspiration and corticosteroid injection into the decompressed ganglion, followed by strengthening exercise, electrical stimulation therapy, and prescription of an ankle foot orthosis. OUTCOMES: We confirmed regeneration of the injured peroneal nerve at the follow-up electrodiagnostic examination 12 weeks after the intervention. In addition, the manual motor power test demonstrated an increase in the ankle dorsiflexor function score by one grade. LESSONS: Diagnosing the cause of foot drop can be difficult with multiple co-existing pathologies, and consideration of various possible etiologies is the key for appropriate diagnosis and treatment. In addition to imaging modalities such as MRI, electrodiagnostic examination can help to improve diagnostic accuracy. Intraneural ganglion cyst of the common peroneal nerve is rare, but should be considered as a possible cause of foot drop.


Assuntos
Cistos Glanglionares/complicações , Neuropatias Fibulares/etiologia , Radiculopatia/complicações , Corticosteroides/uso terapêutico , Idoso , Terapia Combinada , Terapia por Estimulação Elétrica , Eletrodiagnóstico , Terapia por Exercício , Feminino , Órtoses do Pé , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/terapia , Humanos , Vértebras Lombares , Imagem por Ressonância Magnética , Paracentese , Neuropatias Fibulares/terapia , Radiculopatia/diagnóstico , Radiculopatia/terapia
3.
Muscle Nerve ; 60(5): 544-548, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31361339

RESUMO

INTRODUCTION: Ultrasound (US) evaluation of peripheral nerves is a noninvasive, cost-effective approach to diagnosing focal mononeuropathies and guiding surgical management. We used the intranerve ratio to evaluate for possible cut-off values in diagnosis of fibular mononeuropathies (FNs). METHODS: A retrospective analysis of FN confirmed by electrodiagnosis (EDx) was performed to identify intranerve ratio values between affected and unaffected limbs at the fibular head and popliteal fossa. RESULTS: The optimal fibular head/popliteal fossa intranerve ratio to discriminate between limbs with and without disease was 1.25 (sensitivity, 51%; specificity, 71%). There was no statistically significant difference between affected vs unaffected limbs (ratio, 1.13; P = .15) nor in subgroup analyses. However, 25% of patients had structural lesions amenable to surgery. DISCUSSION: The utility of US in diagnosis of FN is limited using intranerve ratio data, but US has a distinct advantage over EDx for identifying treatable structural lesions.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Neoplasias da Bainha Neural/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Nervo Fibular/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Eletrodiagnóstico , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Joelho , Masculino , Pessoa de Meia-Idade , Neoplasias da Bainha Neural/complicações , Neoplasias da Bainha Neural/cirurgia , Condução Nervosa , Tamanho do Órgão , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/patologia , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/cirurgia , Estudos Retrospectivos
4.
Eur J Orthop Surg Traumatol ; 29(7): 1559-1563, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31222541

RESUMO

INTRODUCTION: Intraneural cysts usually involve the common peroneal nerve, and in many cases, they are causing symptoms due to neural compression. It is hypothesized that these cysts originate from the adjacent joints while articular pathology is a major contributing factor for the formation of these lesions. Although ulnar nerve is the second most commonly affected nerve, these lesions usually develop distally at the Guyon tunnel, so cubital tunnel syndrome due to epineural cysts is very rare. In such cases, elaborate preoperative work-up is mandatory and surgical treatment should follow certain well-defined principles. CASE DESCRIPTION: A 60-year-old female patient presented with complaints of pain along the medial side of her elbow, forearm and hand and a tingling sensation in the same distribution for the past 2 months. The patient had sustained an injury 15 years ago, and a distal humerus fracture was diagnosed at that time. Radiological signs of posttraumatic elbow arthritis were evident at the initial evaluation. The patient was diagnosed with cubital tunnel syndrome which was further confirmed by nerve conduction studies, and she underwent surgical decompression of the nerve. During surgery, intraneural cysts were identified and addressed by excision, while dissection of the articular branch of the nerve was also performed. Pain and numbness subsided shortly after surgery, while the patient remained free of symptoms until the last follow-up.


Assuntos
Síndrome do Túnel Ulnar/etiologia , Síndrome do Túnel Ulnar/cirurgia , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Nervo Ulnar
5.
Eur J Orthop Surg Traumatol ; 29(7): 1565-1574, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31177349

RESUMO

In this article, two cases of ulnar nerve neuropathy in Guyon's canal caused by a ganglion cyst are reported. A review of the literature found 73 cases reported in 35 articles of ulnar neuropathy at the wrist secondary to a ganglion cyst. We investigated the pathogenesis of ganglion cysts, which are separated as extraneural and intraneural. At this anatomical area, there are a variety of clinical factors that can also lead to ulnar nerve compression such us trauma, fracture of the hamate's hook, arterial thrombosis, tumors and other anatomical variations. The symptoms may include weakness, paresthesia, numbness and atrophy of hypothenar muscles. Except the careful clinical assessment, magnetic resonance imaging, ultrasound and electrophysiological control are useful tools regarding our differential diagnosis. The treatment of this clinical condition is surgical. We consider that instant surgical decompression is of the essence and enables postoperatively total recovery. LEVEL OF EVIDENCE: Level III.


Assuntos
Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Síndromes de Compressão do Nervo Ulnar/etiologia , Síndromes de Compressão do Nervo Ulnar/cirurgia , Feminino , Cistos Glanglionares/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Punho
6.
J Foot Ankle Surg ; 58(4): 795-801, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31053383

RESUMO

Intraneural ganglion cysts are benign mucinous lesions that form within joints and enter adjacent nerves via an articular branch. Despite being morphologically characterized as benign, they can demonstrate considerable intrafascicular destruction and expansion, resulting in worsening compressive neuropathies or nerve injury. There have been several suggested theories of pathogenesis, but the most widely accepted articular (synovial) theory describes a capsular defect in a neighboring joint that allows joint fluid to egress and track along the epineurium of the innervating articular branch. In this case report, we describe an intraneural ganglionic cyst located in the tarsal tunnel with extensive involvement of the tibial nerve. We describe the symptoms, diagnosis, and treatment as well as review the current literature on intraneural ganglionic cysts.


Assuntos
Cistos Glanglionares/complicações , Síndrome do Túnel do Tarso/etiologia , Tornozelo/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Cistos Glanglionares/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndrome do Túnel do Tarso/patologia , Síndrome do Túnel do Tarso/cirurgia , Nervo Tibial/cirurgia
7.
Z Orthop Unfall ; 157(5): 562-565, 2019 Oct.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-30537765

RESUMO

A ganglion cyst is rarely the cause of peripheral nerve compression. In the lower extremity, it is important to distinguish clinically the symptoms from a radiculopathy. In the literature, neural damage of the peroneal nerve due to a ganglion cyst has been described. An acute, isolated plegia of the foot/toe dorsiflexors with completely unaffected sensory function - as in our case - has not yet been described. After clinical examination and imaging, the ganglion cyst was surgically removed and the nerve decompressed, which was followed by complete recovery of the motoric function. Peripheral nerve compression due to a ganglion cyst is an important differential diagnosis in peripheral nerve deficit. The therapy of choice is the fastest possible surgical decompression. Recovery is expected within a few weeks.


Assuntos
Cistos Glanglionares/cirurgia , Nervo Fibular/cirurgia , Neuropatias Fibulares/cirurgia , Idoso , Descompressão Cirúrgica , Cistos Glanglionares/complicações , Cistos Glanglionares/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Nervo Fibular/lesões , Neuropatias Fibulares/diagnóstico por imagem , Neuropatias Fibulares/etiologia
8.
Skeletal Radiol ; 48(1): 163-165, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29876592

RESUMO

The transverse acetabular ligament is an unusual location for ganglion cysts. Only a few cases have been reported in the literature. They can be asymptomatic and represent an incidental finding or can cause an atypical pattern of hip joint/groin pain. We report a case of ganglion cyst arising from the TAL causing entrapment of the anterior branch of the obturator nerve with associated acute denervation of the abductor longus (AL), adductor brevis (AB), and gracilis muscles.


Assuntos
Cistos Glanglionares/complicações , Cistos Glanglionares/diagnóstico por imagem , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/etiologia , Nervo Obturador/lesões , Adulto , Cistos Glanglionares/cirurgia , Humanos , Ligamentos Articulares , Masculino , Síndromes de Compressão Nervosa/cirurgia , Radiografia Intervencionista , Sucção , Tomografia Computadorizada por Raios X
9.
BMC Neurol ; 18(1): 217, 2018 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-30579340

RESUMO

BACKGROUND: Cubital tunnel syndrome is common nerve compression syndrome among peripheral nerve compression diseases. However, the syndrome caused by intraneural ganglion cysts has been rarely reported. Medical approaches, like ultrasound-guided aspiration and open surgical treatment remain to be discussed. CASE PRESENTATION: A 57-year-old woman presented with occasional pain, numbness and paralysis in her left hand and a palpable, painless mass in the ulnar side of her left elbow. Ultrasound-guided aspiration of the mass was performed to decompress the ulnar nerve. The patient experienced an evident release of pain in her hand, but symptoms of numbness and paralysis recurred 3 months later which greatly bothered the patient's daily life. After evaluation, we had to perform an open surgery to excise the cyst. External neurolysis and anterior subcutaneous transposition were done. The patient was followed up for 2 years, and she made a complete recovery with no functional limitation. CONCLUSIONS: The symptoms caused by intraneural ganglion cyst can be alleviated by accurate puncture. But puncture may be not complete and symptoms could recur. Complete external neurolysis can be counted as a complete and reliable treatment. Therefore, early diagnosis, careful preoperative imaging assessment and full decompression can be expected to receive a good rehabilitation.


Assuntos
Síndrome do Túnel Ulnar/etiologia , Cistos Glanglionares/complicações , Nervo Ulnar/patologia , Descompressão Cirúrgica/métodos , Cotovelo , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Dor/fisiopatologia , Paralisia/etiologia , Ultrassonografia
10.
J Hand Surg Asian Pac Vol ; 23(4): 596-600, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30428806

RESUMO

Ganglion of the anterolateral elbow is rare and may be associated with compression neuropathy of the radial nerve or its branches. Open ganglionectomy implies extensive soft tissue dissection. We present a case of anterolateral elbow ganglion without any compression neuropathy. This was successfully treated with endoscopic ganglionectomy.


Assuntos
Articulação do Cotovelo/inervação , Endoscopia/métodos , Cistos Glanglionares/cirurgia , Síndromes de Compressão Nervosa/etiologia , Nervo Radial/diagnóstico por imagem , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/diagnóstico , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/cirurgia
11.
Medicine (Baltimore) ; 97(41): e12794, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313106

RESUMO

RATIONALE: Radiating leg pain usually originates from the lumbar spine and occasionally from peripheral lesions. Here we report a case involving a patient with radiating pain in the right leg who exhibited 2 suspicious lesions, including 1 spinal lesion and 1 extraspinal cystic mass lesion, on magnetic resonance imaging. Polydeoxyribonucleotide sodium (PDRN) was recently noted as such a substitute. PDRN has anti-inflammatory effects, as it lowers the expression of inflammatory cytokines including interleukin-6 and tumor necrosis factor-alpha. PATIENT CONCERNS: A 51-year-old man (weight, 93 kg; height, 168 cm) working as a bus driver presented at the pain clinic with continuous right buttock pain, radiating leg pain and a tingling sensation involving the calf and dorsum of the foot, since 1 week. DIAGNOSES: He was definitively diagnosed using differential blocks, which revealed the cyst to be the actual cause of the pain. INTERVENTIONS: Surgical resection was not feasible because of the position of the cyst; therefore, corticosteroid injection under ultrasonographic guidance was attempted. However, this provided short-term relief. Subsequently, a solution containing PDRN was injected around the piriformis muscle and repeated 3 more times at intervals of 2 weeks. OUTCOMES: After PDRN injection, we conducted two follow-up monitoring every two months for 2 months. Last follow-up, the patient no longer complained of pain. this resulted in relatively long-term relief from pain. LESSONS: The findings from this case suggest that PDRN is an effective alternative for steroids in patients with radiating leg pain, although its efficacy and safety needs to be evaluated in further large-scale studies.


Assuntos
Anti-Inflamatórios/uso terapêutico , Cistos Glanglionares/tratamento farmacológico , Dor/tratamento farmacológico , Polidesoxirribonucleotídeos/uso terapêutico , Nervo Isquiático/patologia , Anti-Inflamatórios/administração & dosagem , Cistos Glanglionares/complicações , Humanos , Perna (Membro) , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Dor/etiologia , Polidesoxirribonucleotídeos/administração & dosagem
12.
Medicine (Baltimore) ; 97(36): e12161, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200116

RESUMO

RATIONALE: Tumors of the scaphoid are rare, and some can cause pathological fractures. No cases of pathological fractures of the scaphoid have been reported in children. The most common treatment for pathologic fractures of the scaphoid bone associated with a benign lesion in adults is surgical, with intralesional curettage associated with autologous bone grafting and internal fixation. PATIENT CONCERNS: A 10-year-old boy presented with wrist pain after falling from his height. DIAGNOSES: X-ray, CT-scan and MRI showed a pathological undisplaced fracture of the scaphoid on a benign lytic lesion. INTERVENTIONS: The arm was immobilized in a below-elbow cast. OUTCOMES: The fracture healed within 4 months of immobilization. 3 years after the fracture, the functional status was normal, and the lytic lesion could not be seen on radiographs. LESSONS: Retrospectively, the most probable etiology was a ganglion cyst. Our case suggests that some pathological fractures of the scaphoid may not need surgery, especially not in children.


Assuntos
Tratamento Conservador , Fraturas Ósseas/terapia , Osso Escafoide/lesões , Acidentes por Quedas , Cistos Ósseos/complicações , Cistos Ósseos/diagnóstico por imagem , Cistos Ósseos/terapia , Criança , Diagnóstico Diferencial , Fixadores Externos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Cistos Glanglionares/complicações , Cistos Glanglionares/diagnóstico por imagem , Cistos Glanglionares/terapia , Humanos , Masculino , Osso Escafoide/diagnóstico por imagem
14.
Rev. Hosp. Ital. B. Aires (2004) ; 38(2): 56-61, jun. 2018. ilus.
Artigo em Espanhol | LILACS | ID: biblio-1023034

RESUMO

El síndrome de atrapamiento del nervio supraescapular es una causa infrecuente de dolor en el hombro y de difícil diagnóstico clínico. Puede ser consecuencia de traumatismo, infección, compresión extrínseca o estiramiento secundario a movimientos repetitivos. Los quistes supraglenoideos deben considerarse en el diagnóstico diferencial pues son una causa frecuente de compresión del nervio supraescapular que ocurre casi exclusivamente en hombres. Se evaluaron con resonancia magnética (RM) y en forma retrospectiva siete pacientes con diagnóstico de atrapamiento del nervio supraescapular por quiste supraglenoideo. La RM mostró la causa y localización de la compresión nerviosa así como la distribución del edema muscular en todos los casos. Puede evaluar el grado de severidad de la enfermedad y realizar el diagnóstico diferencial con otras causas que provocarían atrapamiento del nervio supraescapular. (AU)


Suprascapular nerve entrapment has been regarded as a relatively uncommon condition that is easily overlooked in the differential diagnosis of shoulder discomfort. The common feature is nerve damage, caused either by trauma, extrinsic compression or by stretching secondary to repeated movements. Ganglion cysts account for the majority of the masses causing entrapment and seem to occur exclusively in men. Seven cases of suprascapular nerve entrapment caused by supraglenoid cyst compression were reviewed with MRI. MRI showed the cause and location of nerve compression as well as the distribution of muscular edema in all cases. MR imaging also allows an evaluation of the severity of the disease. It is also very efficient in excluding several differential diagnoses. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Espectroscopia de Ressonância Magnética/uso terapêutico , Neuropatia Mediana/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Fatores de Tempo , Dor de Ombro/etiologia , Neuropatia Mediana/diagnóstico , Neuropatia Mediana/etiologia , Neuropatia Mediana/fisiopatologia , Cistos Glanglionares/complicações , Edema/diagnóstico por imagem
15.
J Hand Surg Asian Pac Vol ; 23(2): 210-216, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29734908

RESUMO

BACKGROUND: Cubital tunnel syndrome (CuTS) is generally treated successfully by surgery and recurrent cases are rare. This study retrospectively investigated the clinical characteristics of recurrent CuTS caused by ganglion. METHODS: We evaluated nine patients who were surgically treated for recurrent CuTS caused by ganglion. Age distribution at recurrence ranged from 43 to 79 years. The initial surgery for CuTS had been performed using various methods. The asymptomatic period from initial surgery to recurrence ranged from 22 to 252 months. Clinical, diagnostic imaging, and operative findings during the second surgery were analyzed. All patients were treated by anterior subcutaneous ulnar nerve transposition with ganglion resection and later examined directly within a mean of 71 months after the second surgery. RESULTS: The interval from recurrence to consultation was shorter than two months for eight cases. Chief complaints included numbness with or without pain in the ring and little fingers in all patients and resting pain in the medial elbow in five patients. Elbow osteoarthritis was present in all cases. Although four of 10 ganglia were palpable, ultrasonography and magnetic resonance imaging could identify all ganglia preoperatively. The ulnar nerve typically had become entrapped by the ganglion posteriorly and by fascia, scar tissue, and/or muscle anteriorly. Chief complaints and ulnar nerve function were improved in all patients following revision surgery. CONCLUSIONS: The acute onset of numbness with or without intolerable pain in the ring and little fingers after a long-term remission period following initial surgery for CuTS in patients with elbow osteoarthritis appears to be the characteristic clinical profile of recurrent CuTS caused by ganglion. As ganglia are often not palpable, ultrasonography and magnetic resonance imaging are recommended for accurate diagnosis.


Assuntos
Síndrome do Túnel Ulnar/etiologia , Síndrome do Túnel Ulnar/cirurgia , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Adulto , Idoso , Síndrome do Túnel Ulnar/diagnóstico , Feminino , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
16.
Arthroscopy ; 34(7): 2247-2253, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29501216

RESUMO

PURPOSE: To determine if cyst management is necessary in the setting of SLAP lesions with concomitant paralabral ganglion cysts. METHODS: We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, including all studies that met inclusion criteria from January 1975 to July 2015. We included patients with a SLAP II-VII lesion and a concomitant paralabral ganglion cyst who underwent arthroscopic labral repair with or without cyst decompression. Patients with follow-up of less than 3 months, a SLAP I lesion, or who underwent concomitant cuff repair were excluded. The Methodological Index for Non-randomized Studies (MINORS) scoring system was used to quantify the potential bias in each study. Outcome measures reported were provided in a table format and a subjective analysis was performed. RESULTS: Nineteen studies were included yielding a total of 160 patients: 66 patients treated with repair alone [R] and 94 patients with additional cyst decompression or excision [R+D]. The VAS, Rowe, and Constant scores were excellent and similar in both groups. The mean VAS was 0.6 in [R] and ranged between 0 and 2 in [R+D] (0.5, 0, 2, 0.2). The mean Rowe scores were 94 and 98 in [R] and 95 in [R+D]. The mean Constant scores were 97 in [R] and ranged between 87 and 98 in [R+D] (98, 87, 92, 94). In total, 5 of 90 patients were unable to return to work and 2 of 45 were unable to return to sport. All 15 patients who had follow-up electromyographies displayed resolution, and in the 115 patients with follow-up MRIs, 12 did not have complete resolution of the cyst. CONCLUSIONS: Despite the lack of high-quality evidence, the studies subjectively analyzed in this review suggest that both groups have excellent results. The results do not show any advantages from performing decompression. LEVEL OF EVIDENCE: Level IV, systematic review of Level II and Level IV studies.


Assuntos
Cistos Glanglionares/cirurgia , Lesões do Ombro/cirurgia , Artroscopia/métodos , Cistos Glanglionares/complicações , Cistos Glanglionares/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Metanálise como Assunto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Lesões do Ombro/complicações , Lesões do Ombro/diagnóstico por imagem , Resultado do Tratamento
17.
Clin Orthop Surg ; 10(1): 94-98, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29564053

RESUMO

Background: To describe the clinical and magnetic resonance imaging findings of ganglion cysts with effusion in the flexor hallucis longus tendon sheath around the hallux to evaluate their origin. Methods: Patients with recurrent or painful ganglion cysts around the hallux with effusion in the flexor hallucis longus tendon sheath who underwent surgical treatment at St. Vincent's Hospital from February 2007 to August 2016 were investigated. Surgical indication was a painful or recurrent mass caused by the cystic lesions. Those without effusion of the flexor hallucis longus tendon sheath were excluded. We assessed the clinical and magnetic resonance imaging findings. Results: Magnetic resonance imaging findings in all patients showed several ganglion cysts around the hallux and large fluid accumulations within the flexor hallucis longus tendon sheath. Regarding the location, six ganglion cysts were on the dorsomedial aspect, one on the plantar medial aspect, seven on the plantar lateral aspect, and one in the toe pulp. Ten patients showed joint effusions in both the metatarsophalangeal and interphalangeal joints, two in the metatarsophalangeal joints, and three in the interphalangeal joints. There were communication stalks with a tail shape or abutment between ganglion cysts with surrounding joint effusions. Intraoperatively, connections between ganglion cysts, the synovial cyst of the flexor hallucis longus tendon sheath, and surrounding joints were seen. Conclusions: Synovial fluid accumulation in the metatarsophalangeal or interphalangeal joint supplies the synovial cyst of the flexor hallucis longus tendon sheath and subsequently ganglion cysts in the hallux. In clinical practice, the surgeon should carefully check surrounding joints with tendon sheaths to prevent recurrence of the ganglion cysts around the hallux.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Hallux , Cisto Sinovial/diagnóstico por imagem , Líquido Sinovial/diagnóstico por imagem , Tendões/diagnóstico por imagem , Adulto , Idoso , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Articulação Metatarsofalângica/diagnóstico por imagem , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/cirurgia , Recidiva , Cisto Sinovial/complicações , Articulação do Dedo do Pé/diagnóstico por imagem , Adulto Jovem
18.
World Neurosurg ; 111: 307-310, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29309980

RESUMO

BACKGROUND: Peroneal intraneural ganglion cysts (IGCs) are nonneoplastic lesions. They are responsible for a small number of footdrop cases, which occur after additional nerve damage. The earliest patient symptom related to IGCs is knee pain. CASE DESCRIPTION: A 17-year-old boy developed pain in the left knee, which progressively worsened over 14 months. He did not seek any medical assistance during this time. The patient subsequently was involved in a bicycle accident, and 3 months later he was unable to raise his left foot and was referred to our clinic for footdrop. Surgery was performed, but the weakness persisted. We could not detect any functional reinnervation on electromyography 12 months after surgery. CONCLUSIONS: The most important factors in determining the prognosis of IGCs are the extent of the nerve trauma and the early diagnosis and treatment of the IGC. Detection of almost complete functional denervation on electromyography may indicate that it is too late for surgery.


Assuntos
Artralgia/etiologia , Transtornos Neurológicos da Marcha/etiologia , Cistos Glanglionares/complicações , Neuropatias Fibulares/complicações , Adolescente , Artralgia/diagnóstico por imagem , Artralgia/fisiopatologia , Artralgia/cirurgia , Diagnóstico Tardio , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/cirurgia , Cistos Glanglionares/diagnóstico por imagem , Cistos Glanglionares/fisiopatologia , Cistos Glanglionares/cirurgia , Humanos , Joelho/diagnóstico por imagem , Joelho/patologia , Traumatismos do Joelho/complicações , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/fisiopatologia , Traumatismos do Joelho/cirurgia , Masculino , Neuropatias Fibulares/diagnóstico por imagem , Neuropatias Fibulares/fisiopatologia , Neuropatias Fibulares/cirurgia , Recidiva
20.
Med Ultrason ; 19(4): 447-450, 2017 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-29197923

RESUMO

The soleus arcade syndrome is a rare compression neuropathy of the tibial nerve that often remains undiagnosed due to low clinical awareness and difficult diagnosis. We present the case of a female patient admitted with acute worsening of a pre-existing sensory tibial neuropathy and acute tibial nerve palsy after knee joint injection. After a knee magnetic resonance imaging remained non-diagnostic, dynamic ultrasonography was performed. Constriction by the soleus arcade and proximal swelling of the tibial nerve could be demonstrated during plantarflexion of the ankle by means of a dynamic examination in the standing patient. The patient underwent surgery and recovered fully. This proposed diagnostic approach can be used to identify soleus arcade syndrome by ultrasound.


Assuntos
Cistos Glanglionares/complicações , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/diagnóstico por imagem , Neuropatia Tibial/complicações , Neuropatia Tibial/diagnóstico por imagem , Ultrassonografia/métodos , Doença Aguda , Diagnóstico Diferencial , Feminino , Cistos Glanglionares/cirurgia , Humanos , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/cirurgia , Síndrome , Nervo Tibial/diagnóstico por imagem , Nervo Tibial/cirurgia , Neuropatia Tibial/cirurgia
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