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Surgery of the Hand
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Norbert Kang, Ben Miranda, Dariush Nikkhah
This depends on the location of the ganglion and the preference of the patient. Anaesthesia is unnecessary for simple aspiration of a ganglion. For excision of a ganglion in the digit, most cases can be treated under local anaesthesia. However, excision of a ganglion at the wrist should be treated under regional block or general anaesthesia as deep dissection is often necessary. A tourniquet should be used in the majority of volar wrist ganglions where the radial artery is in close proximity.
Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Soft tissue lumps are mostly benign. Clinical examination may suggest a diagnosis such as ganglion or lipoma and ultrasound can be used to confirm the clinical suspicion, or to suggest an alternative diagnosis, which can be helpful in planning treatment. If ultrasound is inconclusive or the lesion is not suitable for ultrasound, MRI would be used. If there are ‘red flag’ signs or symptoms (e.g. rapid growth and increasing pain) MRI would be the primary modality due to its greater sensitivity in detecting malignant changes.
The nervous system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Holmes–Adie pupil This is distinguished by unilateral mydriasis (dilatation) and diminished or absent pupillary light reflex. It is caused by injury to the ciliary ganglion and/or postganglionic fibres. It is most commonly idiopathic or benign.
The Role of Nervous System and Immune System in Herpes Zoster Ophthalmicus Dissemination and Laterality – Current Views
Published in Ocular Immunology and Inflammation, 2023
Yue Li, Louis Tong, Chrystie Quek, Yun Feng
In immunocompetent individuals, VZV-specific cell-mediated immune responses inhibit the spread of the virus between cells, thereby preventing the reactivation of VZV. When the local immune response becomes insufficient to contain the virus, the underlying VZV in a sensory ganglion reactivates. Currently, the nature of this local immune anomaly that is limited to one sensory ganglion is not known. VZV spreads within the ganglion to the sensory nerve and the skin. This causes the characteristic rash and pain in the area of skin innervated by the affected ganglion. As sensory nerves associated with one ganglion do not cross the midline, dermatomes supplied by these nerves also respect the vertical midline. Therefore, reactivation of VZV in a ganglion produces unilateral lesions in the dermatome subserved by that affected ganglion.15
The outcome of minimally invasive surgery for digital mucous cyst: a 2-year follow-up of percutaneous capsulotomy
Published in Journal of Dermatological Treatment, 2022
Wei Hsiung, Hui-Kuang Huang, Tung-Ming Chen, Ming-Chau Chang, Jung-Pan Wang
Although inadequate excision of the stalk has been considered to be a factor leading to recurrence (10), our observation from using this minimally invasive procedure suggests that visualization of the stalk seems not to be necessary. Instead of excision of the stalk, this method destroys the base of the stalk together with the surrounding joint capsule. This idea comes from the use of arthroscopic treatment for wrist ganglion. The key is to eliminate the one-way valve system of the stalk-ganglion entity by removing part of the joint capsule or tissues surrounding the ganglion stalk base; the recurrence rate with this arthroscopic procedure was low (26). With the reported good surgical outcomes and low recurrence rates of arthroscopic capsulotomy for the treatment of wrist ganglion (29,30), it seems that destroying the joint capsule around the base of the ganglion stalk could be a good solution for the problem of the ganglion.
Intratendinous ganglion in the extensor digitorum communis
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Yoichi Sugiyama, Kiyohito Naito, Kenji Goto, Nana Nagura, Kazuo Kaneko
In surgery, a longitudinal skin incision was made right above the tumor, and the extensor retinaculum was partially dissected from the distal end, reaching into the 4th compartment. Outgrowth of the synovial membrane was noted around the EDC tendon and the synovial membrane tissue was carefully dissected and resected from the EDC tendon. The ganglion was located in the tendons of the 3rd and 4th EDC (Figure 4(A)). Moreover, aberrant synovial membrane tissue was present in the EDC tendon. The excised ganglion was attached to a part of the EDC tendon (Figure 4(B)). The EDC tendon injuries were minimal (Figure 4(C)). Partial extensor tendon lacerations in zones II, IV, VI-VIII of the fingers have been reported to allow early active motion without the use of splints or sutures [5], so we did not suture the EDC tendon in this case. On histopathological examination, cyst formation surrounded by fiber tissue was noted, being diagnosed as intratendinous ganglion (Figure 5). As of one year after surgery, no recurrence of the ganglion or tear or adhesion of the EDC tendon has occurred. No contracture of the fingers has occurred, the range of motion of the wrist joint was 85° of flexion and 85° of extension, being graded as 2/10 VAS and a Q-DASH score of 6.82/100. The patient had returned to daily life without any problem.