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      Multiple Intraosseous Cysts of the Carpal Bones Presenting as Unilateral Carpal Tunnel Syndrome


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          Intraosseous ganglion cysts (IGC) of the carpal bones are frequently reported in the literature, involving at most two carpal bones of the same wrist. Only one case recently described the presence of multiple intraosseous ganglion lesions in the capitate, lunate, and triquetrum, resulting in chronic wrist pain. The following study reports the first case of multiple IGCs causing a unilateral carpal tunnel syndrome (CTS), in a 56-year-old woman, with no previous history of trauma. Failure of conservative management prompted carpal tunnel release and the surgical excision of the ICGs, followed by autologous bone grafting to fill in the defects. Consequently, IGCs must be considered in the differential diagnosis of unilateral CTS due to the expansile nature of the bone lesions.

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          Most cited references9

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          Relationship between dorsal ganglion cysts of the wrist and intraosseous ganglion cysts of the carpal bones.

          Soft tissue ganglion cysts are the most common benign tumours of the wrist; their pathogenesis remains controversial. We prospectively screened the radiographic appearance of the wrists of 51 patients presenting to a single surgeon with dorsal wrist ganglions during a one-year period. Postero-anterior and lateral radiographs were systematically performed looking for possible associated intraosseous ganglion cysts. There were 51 dorsal soft tissue ganglion cysts in 51 patients. We detected 29 associated intraosseous ganglia in 24 patients (47%): 16 ganglia in the lunate bone (55%), 5 in the capitate bone, 7 in the scaphoid and 1 in the trapezoid. Mean size of the intraosseous ganglia was 3 mm (range, 2 to 5 mm). This high prevalence of intraosseous ganglia in association with soft tissue ganglia has to our knowledge never been reported previously. A common aetiology for these two types of ganglion cysts may explain this high association rate.
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            Intraosseus ganglia of the wrist.

            To determine the prevalence of intraosseous ganglion cysts in patients with unexplained wrist pain and evaluate the radiographic methods used for their detection.
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              Cystic lesion in carpal bone.

              M. Ikeda, Y Oka (2000)
              Six cases of symptomatic cystic lesions of carpal bones which underwent operative treatment were reviewed. Definite diagnosis, etiology and treatment were also discussed. The lesions occurred in the scaphoid, lunate, capitate and triquetrum, and were multiple lesions in four of the six cases. Juxta-articular bone cyst was diagnosed in three cases: intraosseous cavity surrounded by fibrous membrane containing gelatinous material, and "bone cyst-like pathologic change" in three cases which contained fibrous connective tissue resembled the thick inner wall of juxta-articular bone cyst histologically. They were treated by curettage and cancellous bone grafting; the outcomes were favourable without complication. It is suggested that the minor trauma resulting from the carpal loading serves as a basis for intraosseous lesion, which initiates intramedullary metaplasia followed by fibrous connective tissue proliferation with/without mucin secretion, and forms cystic cavity.

                Author and article information

                Case Rep Orthop
                Case Rep Orthop
                Case Reports in Orthopedics
                24 May 2023
                : 2023
                : 4110616
                1Department of Orthopedic Surgery and Traumatology, Saint George Hospital University Medical Center, Balamand University, P.O. Box 166378, Achrafieh, Beirut 1100 2807, Lebanon
                2Faculty of Medicine, Saint-Joseph University, P.O. Box 17-5208, Mar Mikhael, Beirut, Lebanon
                Author notes

                Academic Editor: Akio Sakamoto

                Author information
                Copyright © 2023 Raymonde Dahdouh et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 3 October 2022
                : 13 April 2023
                : 26 April 2023
                Case Report



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