Intratendinous ganglion cyst of extensor indicis propius tendon: A case report

INTRODUCTION AND IMPORTANCE: The intratendinous ganglion cyst is an extremely rare entity. Thus, the global incidence has not been reported yet. The literature search showed scarce case reports and none has reported its occurrence in extensor indicis propius (EIP) tendon. The benign nature and the region at the dorsal hand mimic to the more common dorsal wrist ganglion. However, the surgical treatment arises significant risk to the function and may require subsequent tendon graft or tendon transfer. CASE PRESENTATION: A 51-year-old-female presented with 4 years history of a slow-growing lump over the dorsal region of the right hand with discomfort during finger motions. The ultrasonography confirmed the diagnosis of dorsal wrist ganglion. CLINICAL DISCUSSION: Intraoperatively, unlike the common presentation which is the well encapsulated mass originating from the carpal joint, the mass was found within the EIP tendon sheath and infiltrate the tendon substance. Surgical debulking was done and left the tendon partially intact. The frayed part was trimmed to ensure a smooth gliding. On the 6 month follow up, patient was symptom-free without any recurrence. CONCLUSION: The intratendinous growth of a ganglion must be identified preoperatively for a proper management plan and inform consent. The intratendinous ganglion cysts frequently weaken the tendon. Hence, surgical excision is necessary with the preparation of secondary tendon reconstruction.