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Two cases of neuropathy of a motor branch caused by a midpalmal ganglion are presented. In the first case the ganglion originated from the midcarpal joint, protruded into the thenar muscle, and compressed the motor branch of the median nerve. In the second case the ganglion, distal to the fibrous arch of the hypothenar muscles, originated from the third carpometacarpal joint and compressed the motor branch of the ulnar nerve. In both cases muscle weakness and finger deformity recovered well after resection of the ganglion. This clinical condition is rare compared with carpal tunnel syndrome and Guyon's tunnel syndrome, which are caused by a ganglion in the wrist.

Forty-one patients with a symptomatic digital mass or swelling of suspected ganglionic origin were examined by ultrasound. Findings were classified into 4 groups: group 1, solitary cyst appearing as a well-defined solitary oval anechoic mass (27 digits); group 2, multiple cysts having multiple oval anechoic masses (3 digits); group 3, solid tumor indicating a heterogeneous hypoechoic mass (6 digits); and group 4, tenosynovitis with no abnormal echoic mass (5 digits). Treatment was determined by lesion classification. In group 1, 26 of the 27 solitary cysts were punctured, and a jellylike material was aspirated from 24 cysts. Postaspiration ultrasound examination revealed that a cyst was still present in 2 cases, and these were excised surgically. In group 2, all the cysts were surgically removed. A ganglion with multiple cysts was confirmed on pathological examination. In group 3, the lesions were removed surgically; among the diagnoses were tendon sheath ganglion, giant-cell tumor of tendon sheath, neurilemmoma, and hemangioma. In group 4, no abnormal masses had appeared at follow-up examination. The 24 patients whose ganglions were treated by aspiration, as well as the 8 patients whose ganglions were excised, were monitored for more than 12 months. None of these 32 patients experienced residual pain or lesion recurrence. These results indicate that ultrasound is useful, in cases in which flexor tendon sheath ganglion are suspected, for assisting in diagnosis and determining whether patients should undergo aspiration or surgical excision.

A rare case of bilateral intraosseous ganglia of the lunate is reported. The patient had had 7 months of pain in both wrists and a cystic lesion in both lunates. Curettage and bone grafting resulted in complete relief of pain.