Dorsal wrist ganglia treated with arthroscopic "dry technique". Two years followup.
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Published:
Jul 28, 2017
Keywords:
wrist arthroscopy, dorsal wrist ganglia, ganglionectomy.
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Abstract
Background: The purpose of this study is to describe the medium-term results of arthroscopic resection of dorsal wrist ganglia using the “dry technique". Methods: Twenty two patients (22 wrists) were retrospectively evaluated with a minimum follow-up of 2 years. Eleven women and 11 men with an average age of 29 years (18-57). In all cases a clinical evaluation was performed preoperatively, at 1 month, and at the last control. Comparative wrist motion and grip strength, pain and function according with the Visual Analog Scale (VAS), functional scores QuickDASH and Wrightington, labor return and intra-postoperative complications were evaluated. Mean follow-up was 42 months (24-60). Statistical analysis was performed by testing T.Results: Two cases of ganglion recurrence appeared. No other intra-surgical complications was reported. Wrist motion and grip strength improved significantly, reaching 99% and 100%, respectively. Pain and function also improved significantly, as the functional score QuikDASH. According to the score of Wrightington, 18 cases were excellent, 3 good, and 1 poor. Twenty one of the 22 patients returned to their tasks without limitation, referring 20 of them to be satisfied with the final result.Conclusion: Arthroscopic resection using the "dry technique " represents a safe and effective alternative for the treatment of dorsal wrist ganglia, achieving pain relief, and functional and aesthetic improvement in most patients with early rehabilitation and a low incidence of recurrence.Level of Evidence: IVKey words: wrist arthroscopy, dorsal wrist ganglia, ganglionectomy.
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Donndorff, A. G., Gallucci, G. L., & De Carli, P. (2017). Dorsal wrist ganglia treated with arthroscopic "dry technique". Two years followup. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 82(3), 195-205. https://doi.org/10.15417/601
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Clinical Research
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References
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14. Rizzo M, Berger RA, Steinmann SP, Bishop AT. Arthroscopic resection in the management of dorsal wrist ganglions: results with a minimum 2-years follow-up period. J Hand Surg 2004; 29A: 59-62.
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20. Crawford GP, Taleisnik J. Rotary subluxation of the scaphoid after excision of dorsal carpal ganglion and wrist manipulation – a case report. J Hand Surg 1983; 8: 921-925.
21. Del Piñal F. Dry arthroscopy and its applications. Hand Clin 2011; 27: 335-345.
22. Del Piñal F, García-Bernal FJ, Pisani D. Dry arthroscopy of the wrist: surgical technique. J Hand Surg 2007; 32A: 119-123.
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24. Clembosky G, Perrotto C. Artrosc (B. Aires) 2009; 16 (3): 212-216.
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27. Ho PC, Griffiths J Lo WN, Yen CH, Hung LK. Current treatment of ganglion at the wrist. Hand Surg 2001; 6: 49-58.
28. Yao J, Trindade MCD. Color-aided visualization of dorsal wrist ganglion stalks aids in complete arthroscopic excision. Arthroscopy 2011; 27: 425-429.
29. Chassat R, Nourissat G, Chaumeil G, Dumontier C. Arthroscopic treatment of dorsal ganglion cyst at the wrist. About 54 cases. Chir Main 2006; 25: 146-151.
30. Bishop AT, Rizzo M, Berger RA, Steinmann SP. In reply. J Hand Surg 2004; 29A: 958-959.
31. Slater RR. Arthroscopic ganglionectomy? J Hand Surg 2004; 29A: 958-959.
32. Chen ACY, Lee WC, Hsu KY, Chan YS, Yuan LJ, Chang CH. Arthroscopic ganglionectomy through an intrafocal cystic portal for wrist ganglia. Arthroscopy 2010; 26: 617-622.
33. Povlsen B, Peckett WR. Arthroscopic findings, in patients with painfull wrist ganglions. Scand J Plast Reconstr Surg Hand Surg 2001; 35: 323-328.
34. Mathoulin C, Hoyos A, Pelaez J. Arthroscopic resection of wrist ganglions. Hand Surg 2004; 9: 159-164.
35. Langner I, Krueger PC, Merk HR, Ekkernkamp A, Zach A. Ganglions of the wrist and associated triangular fibrocartilage lesions: a prospective study in arthroscopically treated patients. J Hand Surg 2012: 37A: 1561-1567.
2. McEvedy BV. The simple ganglion: a review of modes of treatment and an explanation of the frecuent failures of surgery. Lancet 1954; 266 (6803): 135-6.
3. Angelides AC, Wallace PF. The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg 1976; 1A(3): 228-35.
4. Richman JA, Gelberman RH, Engber WD, Salamon PB, Bean DJ. Ganglions of the wrist and digits: results of treatment by aspiration and cyst wall puncture. J Hand Surg 1987; 12A: 1041-43.
5. Stephen AB, Lyons AR, Davis TR. A prospective study of two conservative treatments for ganglia of the wrist. J Hand Surg 1999; 24Br: 104-5.
6. Zubowics VN, Ishii CH. Management of ganglión cysts of the hand by simple aspiration. J Hand Surg 1987; 12A: 618-20.
7. Varley GW, Needoff M, Davis TR, Clay NR. Conservative management of wrist ganglia. Aspiration versus steroid infiltration. J Hand Surg 1997; 22Br: 636-7.
8. Clay NR, Clement DA. The treatment of dorsal wrist ganglia by radical excision. J Hand Surg 1988; 13Br: 187-191.
9. Dias JJ, Dhukaram V, Kumar P. The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervantion. J Hand Surg 2007; 32Eu: 502-508.
10. Faithfull DK, Seeto BG. The simple wrist ganglion – more than a minor surgical procedure? J Hand Surg 2000; 5A: 138-43.
11. Bienz T, Raphael JS. Arthroscopic resection of the dorsal ganglia of the wrist. Hand Clin 1999; 15: 429-34.
12. Osterman AL, Raphael J. Arthroscopic resection of dorsal ganglión of the wrist. Hand Clin 1995; 11: 7-12.
13. Luchetti R; Badia A; Alfarano M, Orbay J, Indriago I, Mustapha B. Arthroscopic reseection of dorsal wrist ganglia and treatment of recurrences. J Hand Surg 2000; 25Br: 38-40.
14. Rizzo M, Berger RA, Steinmann SP, Bishop AT. Arthroscopic resection in the management of dorsal wrist ganglions: results with a minimum 2-years follow-up period. J Hand Surg 2004; 29A: 59-62.
15. Shih JT, Hung ST, Lee HM, Tan CM. Dorsal ganglion of the wrist: results of treatment by arthroscopic resection. Hand Surg 2002; 7: 1-5.
16. Kang L, Akelman E, Weiss APC. Arthroscopic versus open dorsal ganglión excision: a prospective, randomized comparison of rates of recurrence and of residual pain. J Hand Surg 2008; 33A: 471-75.
17. Aslani H, Najafi A, Zaaferani Z. Prospective outcomes of arthroscopic treatment of dorsal wrist ganglia. Orhopedics 2012; 35: e365-70.
18. Clay NR, Clement DA. The treatment of dorsal wrist ganglia by radical excision. J Hand Surg 1988; 13Br: 187-191.
19. Duncan KH, Lewis RC. Scapholunate instability following ganglión cyst excision. Clin Orthop 1988; 228: 250-253.
20. Crawford GP, Taleisnik J. Rotary subluxation of the scaphoid after excision of dorsal carpal ganglion and wrist manipulation – a case report. J Hand Surg 1983; 8: 921-925.
21. Del Piñal F. Dry arthroscopy and its applications. Hand Clin 2011; 27: 335-345.
22. Del Piñal F, García-Bernal FJ, Pisani D. Dry arthroscopy of the wrist: surgical technique. J Hand Surg 2007; 32A: 119-123.
23. Wong AS, Jebson PJL, Murray PM, Trigg SD. The use of routine wrist radiography is not useful in the evaluation of patients with a ganglion cyst of the wrist. Hand 2007; 2: 117-119.
24. Clembosky G, Perrotto C. Artrosc (B. Aires) 2009; 16 (3): 212-216.
25. Gallego S, Mathoulin C. Arthroscopic resection of dorsal wrist ganglia: 114 cases with a minimum follow-up of 2 years. Arthroscopy 2010; 26: 1675-1682.
26. Edward SG, Johansen JA. Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg 2009; 34A: 395-400.
27. Ho PC, Griffiths J Lo WN, Yen CH, Hung LK. Current treatment of ganglion at the wrist. Hand Surg 2001; 6: 49-58.
28. Yao J, Trindade MCD. Color-aided visualization of dorsal wrist ganglion stalks aids in complete arthroscopic excision. Arthroscopy 2011; 27: 425-429.
29. Chassat R, Nourissat G, Chaumeil G, Dumontier C. Arthroscopic treatment of dorsal ganglion cyst at the wrist. About 54 cases. Chir Main 2006; 25: 146-151.
30. Bishop AT, Rizzo M, Berger RA, Steinmann SP. In reply. J Hand Surg 2004; 29A: 958-959.
31. Slater RR. Arthroscopic ganglionectomy? J Hand Surg 2004; 29A: 958-959.
32. Chen ACY, Lee WC, Hsu KY, Chan YS, Yuan LJ, Chang CH. Arthroscopic ganglionectomy through an intrafocal cystic portal for wrist ganglia. Arthroscopy 2010; 26: 617-622.
33. Povlsen B, Peckett WR. Arthroscopic findings, in patients with painfull wrist ganglions. Scand J Plast Reconstr Surg Hand Surg 2001; 35: 323-328.
34. Mathoulin C, Hoyos A, Pelaez J. Arthroscopic resection of wrist ganglions. Hand Surg 2004; 9: 159-164.
35. Langner I, Krueger PC, Merk HR, Ekkernkamp A, Zach A. Ganglions of the wrist and associated triangular fibrocartilage lesions: a prospective study in arthroscopically treated patients. J Hand Surg 2012: 37A: 1561-1567.