RESUMO
Synovial or ganglion cysts are the most common soft tissue tumors of the wrist and hand and can arise from joints or tendons. Intratendinous synovial cysts, in contrast, are rare and their pathogenesis is still a matter of debate. The treatment of synovial cysts of articular origin using arthroscopy is commonly used with good results. For cysts of tendon origin, that is, extra-articular, when located at the ankle, shoulder, knee, and wrist, endoscopic treatment has also been described in a procedure called tenoscopy. We describe the technique and the good results using tenoscopy for a patient treated for an intratendinous synovial cyst located at the extensor communis tendon of the third digit. It is a reproducible, safe technique with low morbidity, and the patient has had no complications or recurrence.
Assuntos
Cistos Glanglionares , Tendões , Humanos , Cistos Glanglionares/cirurgia , Tendões/cirurgia , Endoscopia/métodos , Masculino , Feminino , Adulto , Mãos/cirurgia , Cisto Sinovial/cirurgiaRESUMO
BACKGROUND: There is controversy regarding the treatment of symptomatic synovial cysts, specifically, the need for a concomitant fusion when surgical resection of the synovial cysts is required. We present a retrospective review of a series of patients treated for symptomatic synovial cysts of the lumbar region during the last 20 years by a single surgeon, analyzing the current available literature. METHODS: Retrospective review. The same surgical technique was applied to all patients. Demographic, clinical, surgical data and synovial cyst recurrence rate were recorded. Postoperative results reported by patients were documented according to the McNab score. RESULTS: Sixty nine subjects, with mean follow-up of 7.4 years. 62% (43) were female, with a mean 57.8 years at the time of surgery. In 91.3% (63), the primary management was conservative for a minimum period of 3 months. All subjects underwent surgery due to the failure of conservative treatment. The segment most operated on was L4-L5 (63.77%). 91.3% (63) of the sample reported excellent and good and 6 subjects (8.6%) fair or poor results. There was no evidence of synovial cysts recurrence at the operated level. CONCLUSION: In symptomatic synovial cysts, it seems that conservative treatment is only effective in a limited number of patients and in the short term. Thus, the recommendation of a surgical indication should proceed as soon as the conservative management fails to result in significant symptom relief. Based on our results, we recommend, together with the resection of the cyst, the instrumentation of the segment to avoid its recurrence and the management of axial pain.
Assuntos
Doenças da Coluna Vertebral , Cisto Sinovial , Descompressão Cirúrgica , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Masculino , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Cisto Sinovial/diagnóstico , Cisto Sinovial/cirurgia , Resultado do TratamentoRESUMO
Background: Extradural synovial cysts (ESC) originate from an extrusion of the synovium in unstable or degeneratedjoints. In the spine, this condition can cause neurological signs such as hyperesthesia, proprioceptive ataxia and paresis.Since extradural presentations of synovial cysts are unusual in dogs, the aim of this manuscript is to report a case ofextradural synovial cyst of the cervical spine, as well as the clinical findings, diagnosis, surgical treatment and clinicalevolution after therapy.Case: A 3-year-old spayed Saint Bernard weighing 60 kg was presented to a Veterinary Medical Teaching Hospital with ahistory of acute paraparesis that evolved to non-ambulatory tetraparesis five days after the appearance of the first clinicalsigns. Neurological examination revealed non-ambulatory tetraparesis, normal muscle tone and segmental spinal reflexesin the thoracic and pelvic limbs, as well as cervical pain associated with limited neck movement. According to the neurological examination, the likely lesion location was the C1-C5 spinal cord segment. The differential diagnosis list includedintervertebral disc disease, caudal cervical spondylomyelopathy, neoplasm, infectious or noninfectious inflammatorydisease, and cystic diseases. Complete blood (cell) count and serum biochemistry tests were within reference limits. Thecerebrospinal fluid analysis revealed 35 mg/dL of protein (< 30 mg/dL) and 27 cells (up to 5 cells/mm3) with a predominance of lymphocytes. In plain radiography, bone proliferations of the C4 (caudal) C5 (cranial) articular processes wereobserved and, in myelography, extradural spinal cord compression was evident between C4-C5 on the right side. The animal underwent dorsal laminectomy for spinal cord decompression. An extradural synovial cyst and proliferated articularprocesses were removed. At 1,281 days after surgery, the dog was clinically normal and presented no neurological deficits...(AU)
Assuntos
Animais , Feminino , Cães , Cisto Sinovial/cirurgia , Cisto Sinovial/veterinária , Paraparesia/veterinária , Síndromes de Compressão Nervosa/veterinária , Radiculopatia/veterinária , Doenças da Coluna Vertebral/veterinária , Vértebras Cervicais , Cães , Laminectomia/veterináriaRESUMO
Background: Extradural synovial cysts (ESC) originate from an extrusion of the synovium in unstable or degeneratedjoints. In the spine, this condition can cause neurological signs such as hyperesthesia, proprioceptive ataxia and paresis.Since extradural presentations of synovial cysts are unusual in dogs, the aim of this manuscript is to report a case ofextradural synovial cyst of the cervical spine, as well as the clinical findings, diagnosis, surgical treatment and clinicalevolution after therapy.Case: A 3-year-old spayed Saint Bernard weighing 60 kg was presented to a Veterinary Medical Teaching Hospital with ahistory of acute paraparesis that evolved to non-ambulatory tetraparesis five days after the appearance of the first clinicalsigns. Neurological examination revealed non-ambulatory tetraparesis, normal muscle tone and segmental spinal reflexesin the thoracic and pelvic limbs, as well as cervical pain associated with limited neck movement. According to the neurological examination, the likely lesion location was the C1-C5 spinal cord segment. The differential diagnosis list includedintervertebral disc disease, caudal cervical spondylomyelopathy, neoplasm, infectious or noninfectious inflammatorydisease, and cystic diseases. Complete blood (cell) count and serum biochemistry tests were within reference limits. Thecerebrospinal fluid analysis revealed 35 mg/dL of protein (< 30 mg/dL) and 27 cells (up to 5 cells/mm3) with a predominance of lymphocytes. In plain radiography, bone proliferations of the C4 (caudal) C5 (cranial) articular processes wereobserved and, in myelography, extradural spinal cord compression was evident between C4-C5 on the right side. The animal underwent dorsal laminectomy for spinal cord decompression. An extradural synovial cyst and proliferated articularprocesses were removed. At 1,281 days after surgery, the dog was clinically normal and presented no neurological deficits...
Assuntos
Feminino , Animais , Cães , Cisto Sinovial/cirurgia , Cisto Sinovial/veterinária , Doenças da Coluna Vertebral/veterinária , Paraparesia/veterinária , Radiculopatia/veterinária , Síndromes de Compressão Nervosa/veterinária , Cães , Laminectomia/veterinária , Vértebras CervicaisRESUMO
Pain located in the lateral aspect of the elbow is a common cause of consultation in the trauma consultation. The most common cause is "lateral epicondylitis," however there are several differential diagnoses that may require different management. There is a case of radial tunnel syndrome secondary to extrinsic compression, with an emphasis on its diagnosis and surgical technique.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Túnel Carpal/diagnóstico , Neuropatia Radial/cirurgia , Neuropatia Radial/diagnóstico , Síndromes de Compressão Nervosa , Nervo Radial , Cisto Sinovial/cirurgia , Imageamento por Ressonância Magnética , Terapia Combinada , Cotovelo , Articulação do Cotovelo , Manejo da Dor , Injeções Intra-Articulares , Exame Neurológico/métodosRESUMO
Introducción: La aparición de quiste sinovial pretibial posterior a cirugía de reconstrucción de LCA es una complicaciónpoco frecuente, de origen multifactorial que puede suceder incluso años luego de la cirugía. El objetivo del presentetrabajo fue analizar una serie de pacientes tratados por esta complicación. Material y métodos: Se evaluaron retrospectivamente 14 pacientes operados de resección de quiste pretibial posterior auna cirugia de LCA entre el año 2008 y 2016. Se analizó el tipo de injerto, técnica quirúrgica e implante utilizado, la clínicadel paciente y el tiempo de aparición de los síntomas. Se realizó una evaluación radiológica pre y post operatoria. Sedescribió la cirugía de resección del quiste y la anatomía patológica. Evaluamos el índice de recidiva. Resultados: Nueve hombres y 5 mujeres con edad promedio de 38 años. El seguimiento promedio fue de 35 meses.Todos operados con isquiotibiales cuádruple y técnica trans-tibial. El tiempo promedio entre la cirugía de LCA y aparicióndel quiste fue de 29 meses. Clínicamente presentaban una tumoración entre 1.1 y 3 cm sin signos de inestabilidad. Através de Rx y RM se evidenció ensanchamiento del túnel tibial en todos los casos. Se rellenó el túnel tibial con injertoóseo en 7 casos. La anatomía patológica informó: 12 quistes sinoviales (5 asociados a remanentes de sutura) y 2 casosúnicamente fibrosis. Un paciente evolucionó con recidiva...
Introduction: Among complications following ACL reconstruction, the formation of a pre-tibial cyst in the site of the tibialtunnel is very rare and might happen even years after surgery. The purpose of this study was to analyze 14 patients with tibialsynovial cyst after ACL reconstruction.Material and method: We retrospectively evaluated patients operated between 2008 and 2016. We analyzed the graftselection and surgical technique for ACL reconstruction, the time between primary surgery and the onset of symptoms andthe clinical presentation. A pre and postoperative radiological evaluation was performed for every patient. Surgical techniquefor cyst excision, histological analysis and culture results were also analyzed. The recurrence rate was evaluated at finalfollow-upResults: Nine patients were male, with an average age of 38 years. The average follow-up was of 35 months. All ACLreconstructions were performed using hamstring graft and a trans-tibial technique. The average time between primary ACLsurgery and onset of the cyst was 29 months. All patients presented a palpable tumor at proximal tibia and a stable knee.The cyst size varied between 1.1 and 3 cm. In all cases, Rx and MRI could appreciate a widening of the tibial tunnel. Thetibial tunnels were filled with cancellous bone in 7 cases. Pathological anatomy reported 12 synovial cysts (5 associated withremaining suture) and 2 fibrosis. One recurrence was reported...
Assuntos
Adulto , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Cisto Sinovial/cirurgia , Tíbia/cirurgia , Seguimentos , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Introducción: El objetivo de nuestro trabajo es presentar una serie de 35 pacientes con diagnóstico de quiste articular de rodilla sintomático tratados de forma quirúrgica. Se describe el algoritmo diagnóstico, los resultados y el índice de recidiva. Material y método: Se evaluaron en forma retrospectiva 35 pacientes con diagnóstico de quiste articular de rodilla los cuales fueron tratados en forma quirúrgica. Excluimos aquellos pacientes con diagnóstico de ligamento mucoide y quiste para-meniscal. Veinte hombres, 15 mujeres, con una edad promedio de 39 años. En todos ellos se realizó una biopsia escisión: 31 a través de una artroscopía y 4 resección a cielo abierto. La clínica variaba entre hidrartrosis, bloqueo articular y dolor inespecífico. En todos los casos se realizó el mismo algoritmo diagnostico mediante resonancia magnética (RM). Se realizó un seguimiento clínico para evaluar recidiva. Resultados: El diagnostico se confirmó a través de anatomía patológica en todos los casos, obteniendo 16 sinovitis vellonodular pigmentada focalizada, 5 quiste mucoide, 4 quiste sinovial, 1 quiste de tejido fibroso, 6 gangliones del LCA y 1 del LCP, 2 fibrosis postoperatorios de LCA y 2 quiste de Baker. Treinta y cuatro pacientes evolucionaron en forma favorable. Un paciente con quiste de Baker complicado evolucionó con una recidiva luego de 6 meses de la cirugía. Conclusión: La RM preoperatoria es de gran importancia, ya que los quistes se pueden localizar en zonas de difícil acceso o no exploradas en forma habitual. Es importante la sospecha de este tipo de patología ya que con un diagnóstico temprano y tratamiento quirúrgico se obtienen resultados satisfactorios. Nivel de Evidencia: IV. Tipo de Estudio: Serie de Casos. Retrospectivo.
Introduction: The objective of this study was to investigate a series of 35 patients diagnosed with symptomatic intraarticular knee cysts and describe the diagnostic techniques and surgical treatment. Materials and Methods: This is a retrospective study involving 35 patients diagnosed with intra-articular knee cysts who underwent surgical treatment. We excluded patients diagnosed with a mucoid ligament and para-meniscal cysts. Twenty of the patients were men, 15 women with an average age of 39 years old. All patients underwent an escitional biopsy: 31 using arthroscopy and 4 with an open resection. Among the clinical variations were hydarthrosis, joint lock and complaints of unspecific pain. All of the mentioned cases were diagnosed using MRI imaging and clinical follow up care in order to evaluate suspicion of relapse. Results: The diagnosis was confirmed through anatomic pathology in all cases, with 16 focalized pigmented villonodular synovitis, 5 mucoid cycts, 4 synovial cysts, 1 fibrosis cyst, 6 ACL ganglions, 1 PCL ganglion, 2 ACL post-operative fibrosis and 2 Bakers cycts. 34 patients showed favorable outcome and one patient with a Bakers Cyst presented complication with a relapse 6 months after the inicial surgery. Conclusion: The pre-operative MRI is of great importance, cycts can be found in areas that are difficult to access or located in areas that are rarely explored. It is important to suspect these types of pathologies due to the fact that an early diagnosis and surgical treatment lead to favorable results. Level of Evidence: IV. Study Design: Retrospective. Case series.
Assuntos
Adulto , Pessoa de Meia-Idade , Adulto Jovem , Articulação do Joelho/cirurgia , Cisto Sinovial/cirurgia , Cisto Sinovial/diagnóstico , Cistos Ósseos/cirurgia , Cistos Ósseos/diagnóstico , Sinovite Pigmentada Vilonodular , Estudos Retrospectivos , Imageamento por Ressonância Magnética , Resultado do TratamentoRESUMO
Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.
Cistos sinoviais da coluna lombar são uma causa incomum de dor na coluna e radiculopatia, geralmente com evolução gradual dos sintomas, que são secundários ao comprometimento do canal vertebral. Raramente, há hemorragia intracística, que pode se manifestar de forma aguda com síndrome compressiva radicular ou mesmo medular. Habitualmente, os cistos sinoviais associam-se a doença degenerativa facetária, embora a patogênese não esteja completamente estabelecida. Relatamos aqui um caso em que uma complicação hemorrágica em um cisto sinovial no nível L2-L3, adjacente à interfacetária direita, causou dor lombar e radiculopatia em um paciente em terapia anticoagulante, sendo necessária a ressecção cirúrgica.
Assuntos
Idoso , Humanos , Masculino , Dor nas Costas/etiologia , Hemorragia/complicações , Radiculopatia/etiologia , Doenças da Coluna Vertebral/complicações , Cisto Sinovial/complicações , Dor nas Costas/cirurgia , Hemorragia/cirurgia , Imageamento por Ressonância Magnética , Radiculopatia/cirurgia , Doenças da Coluna Vertebral/cirurgia , Cisto Sinovial/cirurgia , Resultado do TratamentoRESUMO
Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.
Assuntos
Dor nas Costas/etiologia , Hemorragia/complicações , Radiculopatia/etiologia , Doenças da Coluna Vertebral/complicações , Cisto Sinovial/complicações , Idoso , Dor nas Costas/cirurgia , Hemorragia/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Radiculopatia/cirurgia , Doenças da Coluna Vertebral/cirurgia , Cisto Sinovial/cirurgia , Resultado do TratamentoRESUMO
Una de las patologías más comunes en nuestras consultas es el síndrome del hombro doloroso. Tiene diversos factores que pueden originario (tendinopatía del manguito rotador, bíceps, inestabilidad, hernia de disco cervical.). Sin embargo, es importante conocer que existen otras causas menos frecuentes. Presentamos, por su rareza, el caso de un paciente masculino de de 34 años con limitación funcional progresiva a la abducción del miembro superior izquierdo; tratado con analgésicos-antiinflamatorios y rehabilitación sin mejoría clínica. Al realizar resonancia magnética nuclear se descubre ganglión supraglenoideo y SLAP. Se solicita electromiograma que describe el atrapamiento del nervio supraescapular. Su tratamiento fue por artroscopía.