Document Detail

Adherence of intraneural ganglia of the upper extremity to the principles of the unifying articular (synovial) theory.
MedLine Citation:
PMID:  19435440     Owner:  NLM     Status:  MEDLINE    
OBJECT: Intraneural ganglia are nonneoplastic mucinous cysts contained within the epineurium of peripheral nerves. Their pathogenesis has been controversial. Historically, the majority of authors have favored de novo formation (degenerative theory). Because of their rarity, intraneural ganglia affecting the upper limb have been misunderstood. This study was designed to critically analyze the literature and to test the hypothesis that intraneural ganglia of the upper limb act analogously to those in the lower limb, being derived from an articular source (synovial theory). METHODS: Two patients with digital intraneural cysts were included in the study. An extensive literature review of intraneural ganglia of the upper limb was undertaken to provide the historical basis for the study. RESULTS: In both cases, the digital intraneural ganglia were demonstrated to have joint connections; the one patient in whom an articular branch was not appreciated initially had evidence on postoperative MR images of persistence of intraneural cyst after simple decompression was performed. Eighty-six cases of intraneural lesions were identified in varied locations of the upper limb: the most common sites were the ulnar nerve at the elbow and wrist, occurring 38 and 22 times, respectively. Joint connections were present in only 20% of the cases published by other groups. CONCLUSIONS: The authors believe that the fundamental principles of the unifying articular (synovial) theory (that is, articular branch connections, cyst fluid following a path of least resistance, and the role of pressure fluxes) previously described to explain intraneural ganglia in the lower limb apply to those cases in the upper limb. In their opinion, the joint connection is often not identified because of the cysts' rarity, radiologists' and surgeons' inexperience, and the difficulty visualizing and demonstrating it because of the small size of the cysts. Furthermore, they believe that recurrence (subclinical or clinical) is not only underreported but also predictable after simple decompression that fails to address the articular branch. In contrast, intraneural recurrence can be eliminated with disconnection of the articular branch.
Huan Wang; Robert Q Terrill; Shota Tanaka; Kimberly K Amrami; Robert J Spinner
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgical focus     Volume:  26     ISSN:  1092-0684     ISO Abbreviation:  Neurosurg Focus     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-05-13     Completed Date:  2009-07-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100896471     Medline TA:  Neurosurg Focus     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E10     Citation Subset:  IM    
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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MeSH Terms
Arm / innervation,  pathology,  physiopathology*
Ganglion Cysts / pathology,  physiopathology*,  surgery
Joints / innervation,  pathology,  physiopathology*
Middle Aged
Neurosurgical Procedures
Peripheral Nerves / pathology,  physiopathology*,  surgery
Peripheral Nervous System Diseases / pathology,  physiopathology*,  surgery
Pressure / adverse effects
Recurrence / prevention & control
Synovial Fluid / physiology
Synovial Membrane / innervation,  pathology,  physiopathology*

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