Flexor tendon sheath ganglions — A new procedure to perform excision under ultrasound-guidance

Abstract

Flexor tendon sheath ganglions are a common pathology, aspiration has been reported as a cost-effective procedure despite a high risk of recurrence. Surgical excision demonstrated less recurrence but is less accessible and more expensive. We developed a new ultrasound procedure for percutaneous excision. In this series, we report our results of the first 8 cases. Over a period of one year, 8 flexor tendon sheath ganglions were operated on, 4 middle fingers and 4 fourth fingers. Clinical examination was performed after one month and telephone interviews after 3 monthsThe WALANT technique was used for local anesthesia. All procedures were performed percutaneously under ultrasound guidance (In-plane control). Surgical blades were proscribed, only a 18 gauge needle was used for skin incision. A single 2-mm portal using a 2-mm shaver blade was used. Bandages were removed by the patient the day after surgery and patients return to activities as usual. Procedures were 5 minutes long (3–8). All ganglions were fully excised. After one month, a full finger motion was observed with tenderness at the point of excision. All patients were cured after 3 months with no recurrence. The ultrasound-guided excision of flexor tendon sheath ganglion, using a 2-mm portal, under local anaesthesia was reliable and efficient, without specific morbidity. Larger data should be collected to confirm these good outcomes and the excellent cost efficiency. The ultrasound-guided excision of flexor tendon sheath ganglion, using a 2-mm portal, under local anaesthesia was reliable and efficient, without specific morbidity. Larger data should be collected to confirm these good outcomes and the excellent cost efficiency.