Compound palmar

ganglion

Moderators:

Dr.Surendra U Kamath
Dr Harshvardhan

Presented

by: -

Dr.Praveen Patil

Compound

Palmar Ganglion

Is a progressive swelling and

inflammation of the tendon sheath that
distends the sheath proximal & distal to
flexor retinaculum with limitation of
excursion of the involved tendons

Etiology
Infection

with the tubercle bacillus

Rheumatoid

arthritis

Pathology
Commonly

flexor tendon sheaths in the

lower foreman & hand are affected.

Extensor

involved.

The

sheath are less commonly

affected sheaths are greatly thickened

& show the changes of chronic
inflammation.

 The

lining membrane is replaced by

tuberculosis granulation tissue.

The

swelling may contain serous fluid,

masses of fibrinous material, melon seed
bodies or caseous material.

 The

visceral as well as the parietal layer of

the sheath is affected so that the tendons
itself becomes involved, granulation
tissues spreading longitudinally among the
fibres which become separated into
bundles.

Clinical features

Is a hour glass swelling

Gradual

onset of swelling with mild aching

pain, in the region of the affected tendon
sheaths.

The

pain is seldom severe, accompanies

with the stiffness of the finger.
Fusiform appearance.

 In

many cases fluctuation can be elicited

with some crepitus between the forearm
swelling & the swelling in the palm with the
flexor retinaculum in between.

At

first range of movements of the fingers

& thumb is impaired only slightly.

CROSS
FLUCTUATION

Diagnosis
Symptoms
If

& signs

an active tuberculosis lesion is found in the

body elsewhere it is reasonable to infer that
the tenosynovitis is also due to tuberculosis

Complications
The

adjacent bones, joint or tendons may

get involved, with obvious wasting of
adjacent muscles.
Rupture of tendons especially sublimes.
Discharging sinuses & involvement of
radial & ulnar bursae.
Median nerve compression in the carpal
tunnel.

Treatment
Depends on the severity of the lesions.
Conservative
Operative

Conservative
In

mild cases where the function of fingers &

thumb is not impaired, conservative treatment
is advised.

Immobilization

of the wrist & forearm with

plaster of paris for three months, fingers being
left free.

In

tuberculosis cases, a course of antitubercular drugs is given

Operative
Here

curvilinear incision, starts in the

lower forearm, skirts the thenar crease &
continues distally in the direction of the
head of the fourth metacarpal.

 If

the radial bursa involved, additional

midlateral incision is required for the thumb.

Zig-Zag

approach

provides

excellent visualization of the whole lesion &

facilitates the retention of pulleys from the fibrous
flexor sheath.

 In

case of sublimus tendon rupture,

it

is excised & the stump is restored to the

profundus by transferring the distal stump to
the adjacent tendon with intact motor.

 The

combination of surgery & antibiotics

should eradicate the disease, long term
follow up examination are needed to
ensure that other lesions have not
subsequently progressed.