PMC8826100_01
(a) A 19-year-old female with occult symptomatic ganglion at drawn circle. (b, c, and d) Diagnosed by non-contrast T1 STIR MRI images:ganglion (G), scaphoid (S), and trapezium (T).
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TFOSST (Figure 1). Two of the nine cases of ganglions treated by surgical excision were recurrent.
A 71-year-old female with recurrent ganglion (G). Note the surgical scar at arrow in distal forearm to distal wrist crease.
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This patient's initial ganglion and its recurrent ganglion remained in the same location as the original primary ganglion, and both were located along the FCR tendon from the distal volar wrist crease proximal to the carpus of the hand extending into the proximal forearm (Figure 2).
A 71-year-old female T1 STIR MRI lateral images with (x) identifying intra-operative origin of ganglion at TFOSST crest:ganglion (G), radius (RAD), scaphoid (S), trapezium (T), and white line is route of flexor carpi radialis tendon to metacarpal insertion.
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Prior to a third surgical intervention, a pre-operative non-contrast MRI of the patient revealed that the physically visible forearm ganglion extended along the FCR tendon into the volar trapezium of the hand (Figure 3).
Left volar radial wrist ganglion (G) originating from trapezial fibro-osseous synovial sheath tunnel with deformed FCR tendon (Delta) with a prominent trapezial crest (+). Proximal at bottom of pictures and radial at left of pictures.
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TFOSST, the FCR tendon displaced from a posterior restrained position to about 3.0 mm anterior position and slightly ulnar toward the carpal tunnel with the wrist in neutral position consistent with the literature. There were prominent volar radial trapezial bone crests abutting against the FCR tendons in three cases with two in the recurrent ganglia and one in a primary ganglion causing deformity and attrition of the FCR tendon at the TFOSST (Figures 4-6).
Arthroscopic view of proximal fraying of interior anterior ulnar fibro-osseous synovial sheath (x); FCR tendon (Delta); and ganglion (G). Proximal at bottom of picture.
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TFOSST, the FCR tendon displaced from a posterior restrained position to about 3.0 mm anterior position and slightly ulnar toward the carpal tunnel with the wrist in neutral position consistent with the literature. There were prominent volar radial trapezial bone crests abutting against the FCR tendons in three cases with two in the recurrent ganglia and one in a primary ganglion causing deformity and attrition of the FCR tendon at the TFOSST (Figures 4-6).
(a) Volar radial ganglion (G) superficial to TFOSST. (b) FCR tendon (Delta) entering proximal TFOSST ulnar to radial trapezial crest (+). (c) Anterior ulnar displacement of FCR tendon (Delta) from floor of TFOSST and from radial trapezial crest (+) after TFOSST complete division. Proximal at bottom of pictures and radial at left of pictures.
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TFOSST, the FCR tendon displaced from a posterior restrained position to about 3.0 mm anterior position and slightly ulnar toward the carpal tunnel with the wrist in neutral position consistent with the literature. There were prominent volar radial trapezial bone crests abutting against the FCR tendons in three cases with two in the recurrent ganglia and one in a primary ganglion causing deformity and attrition of the FCR tendon at the TFOSST (Figures 4-6).