Compound Palmar Ganglion
Compound palmar ganglion is a tubercular manifestation of flexor tenosynovitis of the wrist.
Chronic flexor tenosynovitis of the wrist, commonly of tuberculous origin is also called compound palmar ganglion. Though the incidence is very less, it is not uncommon in developing countries. The clinical picture is very typical and is always confirmed by histopathology. The disease can progress and result in a gross destruction of structures around the wrist and hence requires excision without delay.
The palmar synovial bursa, covered by a dense palmar fascia, is not a common site for tuberculosis. But once infected, it can cause inflammation of all tendon sheaths about the hand and wrist resulting in median nerve compression. It can also lead to destruction of underlying bones if left untreated. Early recognition and complete surgical excision of the diseased tissue along with appropriate anti-tubercular therapy gives a better prognosis.
Etiology
In most cases it is caused by infection with the tubercle bacillus. Sometimes other organisms are responsible. A similar condition may complicate rheumatoid arthritis without demonstrable bacterial infection
Pathology
- Commonly flexor tendon sheaths in the lower foreman & hand are affected. "extensor sheath are less commonly involved. The walls of the tendon sheath may be thin & almost translucent or thick and fibrotic.
- The affected sheaths are greatly thickened & show the changes of chronic inflammation.
- The lining membrane is replaced by tubercular granulation tissue.
- The swelling may contain serous fluid, masses of fibrous material, melon seed bodies or caseous material.
- Melon seed bodies resemble grains of boiled sago.They are composed of collection of fibrin, cellular debris, and occasional tubercle bacilli.
- 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 fibers which become separated into bundles
References[edit]
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