woolrich outlet online A case report and review of the literature
Intraosseous ganglion (IOG) cyst of the scaphoid is an infrequent cause of hand and wrist pain. Intraosseous ganglia located in the scaphoid have rarely been described in the literature. We report the case of a 30 year old right handed woman who presented with a more than 24 month history of progressive right wrist pain. No history of trauma was reported. Conservative treatment with anti inflammatory medications before referral was unsuccessful. Examination revealed a small palpable mass in the carpal navicular region with no limitation of normal wrist motion. An IOG cyst of the scaphoid was found on standard radiograph and CT scan of the wrist. Treatment consisted in curettage of the cyst followed by packing of the defect with autologous cancellous bone graft harvested in the distal end of the radial metaphysis. Satisfactory functional recovery was achieved. These lesions, when located in the scaphoid, are infrequent causes of hand and wrist pain [1ChantelotC., LaffargueP., MasmejeanM., PeltierB., BaroukP., FontaineC. Intraosseous ganglion of scaphoid and lunate bones Harefuah1998 ; 134(4) : 270 272. Pathological fracture of the carpal scaphoid (intraosseous synovial cyst). Clinical and therapeutic aspect. Painful intraosseous ganglion of the scaphoid overshadowed by thoracic outlet syndrome. Intraosseous ganglion of the scaphoid bone of the wrist. Isolated cases of ganglion cysts, mostly occuring in the lunate and scaphoid,
have been reported. We report a case of IOG cyst of the scaphoid carpal bone. During that period, the patient had received multiple symptomatic treatments associating antalgic, non steroidal anti inflammatory drugs combined with periodical wrist immobilization but no improvement was observed. Symptomatology became permanent the last 2months. Clinical examination revealed a moderate swelling over the mid section of the palmar face and pain through extreme ranges of motion of the wrist. Wrist motion was not limited. Blood examination was unremarkable. Radiographic studies of the right wrist revealed a round shaped defect of the proximal part of the scaphoid (Figure 1). This lesion was solitary, well defined, with a thin sclerotic margin and no cortical defect. The adjacent joints were normal. Computed tomography revealed a lucent area within the scaphoid with communication between the cystic lesion and the adjacent joints. Other carpal bones were normal in shape and of homogeneous density (Figure 2). The patient underwent surgery through an anterior approach of the scaphoid bone combined with arthrotomy and lesion localization was performed using a wire under image intensifier. The cyst was visible through bone trephination and was of gelatinous and typical yellowish appearance. Thorough intralesional curettage of the scaphoid cavity followed by packing of the defect with cancellous bone graft harvested from the distal aspect of the radial metaphysis were performed. The bacteriological analysis for specific and common germs was negative. The content of the cyst was described anatomopathologically as a cystic formation with walls constituted by flattened, synovial like, fibroconnective tissue cells with no true epithelial lining. Neither mucoid nor myxoid degeneration was observed. A removable splint was applied for 3weeks for wrist immobilization. At 4 year follow up, pain had disappeared and the wrist demonstrated stable normal mobility (Figure 3). In most series, intraosseous ganglia have been reported to be located in the lower limb, and mainly occur in the epiphysometaphyseal part of the femur and tibia.
Pathogenesis of IOG cysts still remains controversial. There are two opposing theories: the idiopathic or primary intraosseous lesion is due to an intramedullary metaplasia of mesenchymal cells into synovial like cells or ischemic bone necrosis resulting from mechanical stress or repeated microtraumatisms. Intraosseous ganglia of the scaphoid and lunate bones: report of 15cases in 13patients J Hand Surg Am1999 ;
24 A : 508 515[cross ref]