Surgical Treatment of Dorsal Carpal Ganglions: A Retrospective Clinical Trial.

Nazmi Bülent Alp,Gokhan Akdag

doi:10.7759/cureus.10252

Abstract

ObjectivesOur primary goal in this study was to investigate whether the surgical treatment we performed on the patients with dorsal carpal ganglion was effective rather than evaluating preoperative and postoperative functional results.MethodsThe retrospective study included patients who were operated with open technique due to dorsal wrist ganglion at a single center between March 1, 2015, and December 1, 2017, and were followed for at least six months. Thirty-three wrists of 32 patients (31 unilateral and 1 bilateral) were operated. During follow-ups, complication rates, patient satisfaction, and recurrence rates were evaluated.ResultsOf the 32 patients, 19 were females and 13 were males. Mean age of the patients was 38.6 ± 13.0 years (min-max = 19-60 years). Excision was performed on 28 right and 5 left wrists. The follow-up period of patients varied between 6 months and 38 months (mean = 21.7 ± 9.4 months). Recurrence was detected in four (12.5%) patients during the postoperative period. Complex regional pain syndrome occurred in two (6.25%) patients. Joint stiffness developed in six (18.75%) patients during the postoperative period. When recurrent cases were excluded from our cases, the satisfaction rate was 87.5%.ConclusionsOpen surgical excision has satisfactory results that cannot be achieved with conservative treatment in the treatment of symptomatic dorsal ganglia. In order to keep the recurrence rate at the minimum level after surgery, it is critical to excise the ganglion and pedicle without leaving any residual tissue. Proper surgical technique improves patient satisfaction by eliminating pain and cosmetic discomfort.

Highlights

Ganglia, which have been known since the time of Hippocrates, come from the term “ganglion” in Greek, which terminologically means “tissue knot”, and is the most common soft tissue tumor of the hand and wrist [1]
Excision was performed on 28 right and 5 left wrists
The vast majority of patients admit to the orthopedics or hand surgery outpatient clinics with a mass that is palpated in the dorsum of the wrist, cosmetically unwanted, causing pain and limitation in joint movements of the wrist

Summary

Introduction

Ganglia, which have been known since the time of Hippocrates, come from the term “ganglion” in Greek, which terminologically means “tissue knot”, and is the most common soft tissue tumor of the hand and wrist [1]. The vast majority of patients admit to the orthopedics or hand surgery outpatient clinics with a mass that is palpated in the dorsum of the wrist, cosmetically unwanted, causing pain and limitation in joint movements of the wrist. Dorsal carpal ganglia (DCGs) traditionally originate from where the dorsal part of the scapholunate ligament (SL) meets the joint capsule. Preoperative diagnosis can be confirmed by transillumination or needle aspiration performed on DCG, as well as with the imaging methods such as ultrasound and MRI. Mucoid degeneration, and one-way valve mechanism causing ligament injury are the most accepted factors in the etiopathogenesis [3,4,5]. Needle aspiration, cortisone injection, and splinting are performed conservatively in patients who do not want to undergo surgery. Surgical treatment options are open surgery or arthroscopic resection of ganglia, which was defined by Osterman and Raphael [6]

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