Abstract
Purpose
To investigate which conditions should be considered to make a successful resection of the entire ganglion complex during open excision.
Methods
We reviewed 52 patients who underwent open surgical excision of dorsal wrist ganglions. The inclusion criterion was a symptomatic ganglion causing pain, weakness and limitation of range of motion. The mean follow-up was 26 (range 12–45) months. We recorded operative details including whether or not the stalk was identified, how the ganglia were resected, and where the stalk originated. Intentional rupture of cyst was performed when the stalk was not easily identified with dissection. Pain score was measured using a visual analog scale system pre-operatively and post-operatively. Recurrence was also described.
Results
A stalk was identified in eight cases using dissection and in 43 cases by rupturing the cyst. The entire ganglion complex was resected in 50 cases. The stalk originated most commonly in the radio-lunate joint. The average pain score improved from 3.9 to 1.8 after ganglion removal. The ganglion recurred in two cases where incomplete resection of the ganglion was made.
Conclusions
In the majority of ganglions, it is difficult to identify the stalk and its capsular attachment due to a large cyst with severe adhesion to adjacent soft tissues including joint capsule. Rupturing a cyst on purpose helps to identify the stalk and minimize capsular loss. A ganglion over the radiolunate joint was most commonly found and excision of joint capsule over scapholunate joint without identification of the stalk and its capsular attachment might result in recurrence. Recurrence was definitely related to incomplete resection which was more commonly made in ganglions over uncommon sites.
Level of evidence
Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.
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References
Athanasian E (2011) Bone and soft tissue tumors. In: Wolfe SHR, Pederson C, Kozin S (eds) Green’s operative hand surgery. Churchill Livingstone, New York, pp 2150–2195
Gude W, Morelli V (2008) Ganglion cysts of the wrist: pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med 1(3–4):205–211
Angelides AC, Wallace PF (1976) The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg 1(3):228–235
Clay NR, Clement DA (1988) The treatment of dorsal wrist ganglia by radical excision. J Hand Surg 13(2):187–191
Thornburg LE (1999) Ganglions of the hand and wrist. J Am Acad Orthop Surg 7:231–238
Osterman AL, Raphael J (1995) Arthroscopic resection of dorsal ganglion of the wrist. Hand Clin 11:7–12
Rizzo M, Berger RA, Steinmann SP, Bishop AT (2004) Arthroscopic resection in the management of dorsal wrist ganglions: results with a minimum 2-year follow-up period. J Hand Surg 29:59–62
Soren A (1982) Pathogenesis, clinic, and treatment of ganglion. Arch Orthop Trauma Surg 99:247–252
Luchetti R, Badia A, Alfarano M, Orbay J, Indriago I, Mustapha B (2000) Arthroscopic resection of dorsal wrist ganglia and treatment of recurrences. J Hand Surg (Br) 25:38–40
Mathoulin C, Hoyos A, Pelaez J (2004) Arthroscopic resection of wrist ganglia. Hand Surg 9:159–164
Nishikawa S, Toh S, Miura H, Arai K, Irie T (2001) Arthroscopic diagnosis and treatment of dorsal wrist ganglion. J Hand Surg (Br) 26:547–549
Shih JT, Hung ST, Lee HM, Tan CM (2002) Dorsal ganglion of the wrist: results of treatment by arthroscopic resection. Hand Surg 7:1–5
Gallego S, Mathoulin C (2010) Arthroscopic resection of dorsal wrist ganglia: 114 cases with minimum follow-up of 2 years. Arthroscopy 26(12):1675–1682
Geissler WB (2005) Excision of dorsal wrist ganglia. In: Wrist arthroscopy. Springer, New York, pp 139–144
Kang L, Akelman E, Weiss AP (2008) Arthroscopic versus open dorsal ganglion excision: a prospective, randomized comparison of rates of recurrence and of residual pain. J Hand Surg [Am] 33:471–475
Yao J, Trindade MCD (2011) Color-aided visualization of dorsal wrist ganglion stalks aids in complete arthroscopic excision. Arthroscopy 27(3):425–429
Derbyshire RC (1966) Observations on the treatment of ganglia with a report on hydrocortisone. Am J Surg 112(5):635–636
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Kim, J.Y., Lee, J. Considerations in performing open surgical excision of dorsal wrist ganglion cysts. International Orthopaedics (SICOT) 40, 1935–1940 (2016). https://doi.org/10.1007/s00264-016-3213-4
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DOI: https://doi.org/10.1007/s00264-016-3213-4