Conservative treatment of a synovial cyst in a golden eagle (Aquila chrysaetos) with triamcinolone acetonide

In human and veterinary medicine, the treatment of synovial cysts involves medical or surgical approach. When medical treatment is chosen, triamcinolone acetonide is one of the most used drugs. In this case, intracystic triamcinolone was administered for the treatment of a non-infectious elbow synovial cyst in a subadult female Golden eagle (Aquila chrysaetos), unable to fly. The bird was brought to a wildlife rescue center after an aerial fight with a conspecific. After the treatment, no clinically detectable adverse effects were noted and there was no recurrence within two weeks. Given the improvement of the clinical conditions and the recovery of flight ability, the animal was released back into the wild 17 days after administration of the drug.

A hypothetical correlation between hyaluronic acid gel and development of cutaneous metaplastic synovial cyst

Thousands of patients receive hyaluronic acid filler injections, and the effects are generally considered acceptable. The acid rarely causes cutaneous reactions, which are only occasionally reported in the literature.The aim of the present work is to analyze a clinical case that has never been reported in the literature to our knowledge. This case is of a 26-year-old woman who presented with a cyst in the infrazygomatic region that was injected with non-animal stabilized hyaluronic acid at another centre a few months ago.Consequently, we made an external incision to remove the neoplasm: histological examination of the capsule revealed it to be a cutaneous metaplastic synovial cyst.

[Cystic lesions--diagnosis and conservative treatment]

Effective treatment of cystic lesions that we can apply in the outpatient clinic is the target for seeking a new solution in finding treatment that will produce a better percentage of recovered patients. At this moment non-surgical treatment of cystic lesions is compare with traditional methods of treatment i.e. cyst content aspiration and injection of steroids, with methods which lead to obliteration of cyst lumen and in this way closing the space being the reservoir for the cyst content. Local application of hialuronidase, aspiration, and then steroid injection is gaining more and more attention of clinicians. We also pay much more attention to local fibrinogen injection as a safe and effective method of treatment, which can be useful in the treatment of cystic lesions and topical treatment of bursitis.

Diagnostic and therapeutic injection of the wrist and hand region

Joint injection of the wrist and hand region is a useful diagnostic and therapeutic tool for the family physician. In this article, the injection procedures for carpal tunnel syndrome, de Quervain's tenosynovitis, osteoarthritis of the first carpometacarpal joint, wrist ganglion cysts, and digital flexor tenosynovitis (trigger finger) are reviewed. Indications for carpal tunnel syndrome injection include median nerve compression resulting from osteoarthritis, rheumatoid arthritis, diabetes mellitus, hypothyroidism, repetitive use injury, and other traumatic injuries to the area. For the first carpometacarpal joint, injection may be used to treat pain secondary to osteoarthritis and rheumatoid arthritis. Pain associated with de Quervain's tenosynovitis is treated effectively by therapeutic injection. If complicated by pain or paresthesias, wrist ganglion cysts respond to aspiration and injection. Painful limitation of motion occurring in trigger fingers of patients with diabetes or rheumatoid arthritis also improves with injection. The proper technique, choice and quantity of pharmaceuticals, and appropriate follow-up are essential for effective outcomes.

Synovial cyst: a rare late complication of lumbar arthrodesis?

The authors describe a rare late complication of lumbar arthrodesis, a synovial cyst occurring in association with overuse of the underlying facet joint.

[Lumbar intraspinal synovial cysts: imaging and treatment by percutaneous injection. Report of thirteen cases]

PURPOSE

The CT and MR imaging findings in 13patients with lumbar intra spinal synovial cysts were retrospectively analysed and the results of facet corticosteroid injection were evaluated.

PATIENTS AND METHODS

Over a 7 year period, 13patients with radicular pain were identified as having lumbar intra spinal synovial cysts. They ranged from 42 to 87 years of age. All patients were evaluated by CT without contrast material and underwent facet arthrography associated with corticosteroid injection and CT arthrography. MR imaging was performed in all patients either before or after percutaneous treatment. CT scans and MR images were reviewed and patient outcome was evaluated at 1and 6month followup.

RESULTS

CT scan revealed a cystic structure adjacent to a degenerated facet joint in 9 patients (69% sensitivity). MRI showed more accurately the cyst on T2 weighted and/or axial images. Complete or good relief of radicular pain and functional restrictions were achieved in 9 patients (69%) at 1 month follow up, still to be found in 6patients (46%) at 6months.

CONCLUSION

In patients with radiculopathy and facet degenerative changes, intra spinal synovial cysts must be looked for. Facet corticosteroid injection is a useful alternative to surgical removal.

Symptomatic lumbar facet joint synovial cysts: clinical assessment of facet joint steroid injection after 1 and 6 months and long-term follow-up in 30 patients

PURPOSE

To study the results of facet joint intraarticular steroid injections in patients with symptomatic lumbar facet joint synovial cysts.

MATERIALS AND METHODS

Data from 30 patients (age range, 44-82 years; mean age, 67 years) with nerve root pain due to a lumbar facet joint synovial cyst and treated with facet joint steroid injection were retrospectively studied. On the basis of MacNab criteria, the clinical course of nerve root pain was evaluated after 1 (n = 30) and 6 (n = 28) months. Data from long-term follow-up (mean, 26 months) were also available in 14 nonsurgically treated patients.

RESULTS

After 1 month, the nerve root pain outcome was excellent or good in 20 patients (67%) and fair or poor in 10 (33%). After 6 months, 10 (50%) of these 20 patients still had excellent or good results, and 18 (60%) of the 30 patients had a fair or poor clinical status, 14 of whom underwent surgery; two patients (7%) were lost to follow-up. Excellent and good results were maintained at further follow-up (range, 9-50 months).

CONCLUSION

One-third of patients with symptomatic lumbar facet joint synovial cysts had long-lasting acceptable benefit from facet joint steroid injections in this study. Steroid injection should be indicated before surgery.

[Computed tomography diagnosis of clinically well-tolerated bilateral lumbar vertebral synovial cysts]

We report two very rare cases of bilateral synovial cyst of the lumbar spine arising at the L4-L5 level. The diagnosis was made by CT without any ambiguity. The reported lesions illustrate almost the complete panel of CT findings in synovial cyst of the spine including gas formation, marginal calcifications, bone erosion of the adjacent lamina, and in one case the original development of an intracystic calcified nodule. The symptoms of the two patients improved with medical treatment only and spontaneous regression of the calcified cysts was confirmed in one case.

Multiple extra-articular synovial cyst formation: case report and review of the literature

OBJECTIVE

To investigate the clinical manifestations and the treatment strategy of a very rare entity of disease manifesting as multiple extra-articular cystic synovitis with recurrent polyarthralgia.

METHODS

A 47 year old male patient with multiple extra-articular synovial cysts was followed up prospectively for 13 years. The clinical manifestations and response to various treatments were recorded. Comparisons are made among the five reported cases (including the present case).

RESULTS

Multiple synovial cysts over the tendon sheath and bursae appeared successively with and without antecedent growth of nodules during 13 years of follow up. Although polyarthralgia and high titred rheumatoid factor persisted throughout the course, there were no roentgenographical changes of joints specific to rheumatoid arthritis (RA). The synovial cysts and arthralgia failed to respond to any of the disease modifying anti-rheumatic drugs (DMARDs) prescribed. Systemic involvements such as pulmonary interstitial fibrosis and skin ulcers were also noted, but they were not progressive.

CONCLUSIONS

Multiple extra-articular cystic synovitis is an uncommon disease entity closely related to RA. It has been reported exclusively in Japanese subjects and therefore some cultural factors, either genetic or environmental, may contribute to its development.

Conservative management of wrist ganglia. Aspiration versus steroid infiltration

Wrist ganglia were randomly allocated for conservative treatment by either aspiration or aspiration and injection of steroid. Both treatment methods had 33% success rates. Almost all ganglia which recurred after one aspiration did not resolve with further aspirations. After aspiration and explanation of the benign nature of ganglia, only a quarter of patients requested surgical treatment.

Ultrasound-guided injection of ganglia with coricosteroids

OBJECTIVE

The aim of this study was to demonstrate the use of ultrasound guidance in confirming intralesional injection of corticosteroids and local anesthetic into symptomatic ganglia, and to propose potential advantages of this technique.

DESIGN AND PATIENTS

Ten patients (five men, five women) underwent ultrasound-guided injection of a ganglion. Seven ganglia were near the wrist, one was adjacent to a finger interphalangeal joint and two were adjacent to the talus. All were injected with a 1:1 mixture of long-acting corticosteroid and local anesthetic, the actual volume being dependent on the size of the ganglion. Three patients had a second injection 9-18 months following the initial injection.

RESULTS

In four patients the ganglia resolved completely. In five patients there was significant improvement, with a reduction in size of the ganglion and symptomatic relief.

CONCLUSION

Ultrasound-guided injection insures intralesional deposition of corticosteroids and may provide an alternative to surgery in the management of ganglia.

Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment

STUDY DESIGN

This study analyzed the clinical history, physical examination, diagnostic studies, and operative and histologic findings in 19 patients with lumbar intraspinal synovial and ganglion facet cysts evaluated and treated over a 10-year period.

OBJECTIVES

The results were correlated to provide a greater understanding of lumbar facet cysts and rationale for conservative or surgical treatments.

SUMMARY OF BACKGROUND DATA

The 19 patients included 13 women and 6 men ranging in age from 38 to 79 years. 84.4% of the patients presented with radicular pain. 26.3% had significant motor deficit. 68.4% of the facet cysts were found at L4-L5, 21.1% at L5-S1, 5.2% at L1-L2, and 5.2% at L2-L3.

METHODS

The clinical history and findings on physical examination, standard radiography, myelography, computed tomography-myelography, facet arthrography, post-facet arthrograph computed tomography, magnetic resonance imaging with and without contrast, and computed tomography scans were reviewed.

RESULTS

Bilobed cysts were found on both dorsal and ventral aspects of the involved facet joints within and outside of the spinal canal on facet arthrography, computed tomography, magnetic resonance imaging, and at the time of surgery in more than 60% of the patients. Significant facet degeneration was found in 75% of standard radiographs, and on all of the magnetic resonance imaging and computed tomography scans. In six patients, symptoms improved with rest, medication, and bracing. Epidural corticosteroid injections provided short-term relief in three out of four patients. Facet corticosteroid injections provided good relief in one, partial relief in one, and no relief in one patient. Surgical decompression in eight patients resulted in three excellent, four good, and one fair outcome.

CONCLUSIONS

Most of the lumbar intraspinal facet cysts were associated with significantly degenerated facet joints. Patients with intraspinal facet cysts may respond to conservative treatments if there is no significant neurologic deficit. Surgical decompression and removal of large facet cysts usually are successful in relieving symptoms.

Nerve root pain secondary to posterior articular cysts: a report of 6 cases and review of the literature

The authors report 6 cases of posterior articular cysts responsible for nerve root pain, generally in the form of sciatica. Cysts of the posterior intervertebral joints are a rare cause of nerve root compression. Plain x-rays demonstrate posterior inter-apophyseal osteoarthritis. Demonstration of the posterior articular cyst requires the use of computed tomography with contrast injection and/or MRI. Arthrography of the posterior inter-apophyseal joint allows the cyst to be opacified and treated by infiltration of a corticosteroid.

Symptomatic intraspinal synovial cysts: opacification and treatment by percutaneous injection

Intraspinal synovial cysts are usually located in the lower lumbar spine in association with osteoarthritis of the facet joints, and they are most accurately diagnosed by using CT. Surgical removal of intraspinal synovial cysts implicated in the development of radiculopathy has resulted in symptomatic relief. A nonoperative method of treatment consists of CT-guided needle placement into the facet joint adjacent to the cyst, followed by injection of contrast material to show communication between the joint and the cyst and injection of corticosteroids. Three outpatients were treated in this fashion without complications. Complete relief of symptoms was achieved in two cases and partial relief was achieved in one. Follow-up CT scans performed 2 months after the procedure showed no change in the size of the cysts in two of the patients. A 6-month follow-up CT scan in the third patient, however, showed significant improvement in cyst size. These preliminary results suggest that this procedure is an alternative to surgical management of intraspinal synovial cysts.

Calf haematoma following anticoagulants in synovial rupture

Four cases of calf haematoma are described in which an incorrect diagnosis of deep vein thrombosis (DVT) was made of rupture of the knee synovium, and led to inappropriate anticoagulant therapy. Awareness of how closely synovial rupture of the knee can simulate DVT should prevent such mistakes. Where there is doubt venography and/or arthrography are advocated before prescribing anticoagulants which can be dangerous as there may already be bleeding from the rupture site.

Extraarticular steroid injection for hand and wrist disorders

Extraarticular injection of steroid often relieves symptoms in noninfectious inflammatory disorders of the hand and wrist that have not responded to other forms of treatment. The technique is simple and does not require specialized equipment. Complications, including infection, are practically nonexistent.

Synovial cysts in juvenile rheumatoid arthritis

In a case of juvenile rheumatoid arthritis with large synovial cysts, cyst fluid aspiration was performed to relieve pain, but recurrence was prevented with salicylate therapy alone. The mechanism of formation of synovial cysts is discussed.

[Management of para-articular cysts in progressive chronic polyarthritis]

Peri-articular cysts complicating rheumatoid arthritis give rise to a difficult therapeutic problem. The origin of these cysts is discussed with particular reference to Baker's cyst. In principle, treatment is identical with that used in chronic joint effusions. The authors have noted satisfactory results with a steroid-synoviorthesis using triamcinolone acetonide (Kenalog, Squibb, Volon, Heyden). Best results have been achieved by injecting triamcinolone into both the cyst and the corresponding joint. The total effect of intraarticular use of this drug is discussed.

Ultrasonographic demonstration of popliteal cysts in rheumatoid arthritis. A noninvasive technique

Ultrasound scanning techniques detected popliteal cysts in 14 of 24 knees affected with rheumatoid arthritis and associated with an anterior effusion. Serial scans demonstrated the persistence of cysts when effusion was not controlled by intraarticular steroid and lidocaine, and regression of cyst following control of effusion with anterior synovectomy. As the technique is noninvasive, painless, and reproducible, ultrasound scanning should be the technique of choice for the detection and assessment of popliteal cysts.

Rheumatoid plantar synovial cysts

A patient is described with rheumatoid arthritis and a painful synovial cyst, which originated from a metatarsophalangeal joint and presented as a swelling on the plantar surface of the foot. The cyst was successfully excised.

Radioactive colloidal gold. In chronic knee effusions with Baker's cyst formation

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