Dorsal Ganglion Cysts Research Articles

Narcotic-Free, Over-the-Counter Pain Management After Wide-Awake Hand Surgery.

Introduction:Prescribing opioids for postoperative pain has increased steadily, and hand surgery has been no exception. Current hand surgery literature does not describe the efficacy of pain self-management postoperatively. The purpose of this study is to describe our experience with over-the-counter (OTC), narcotic-free, postoperative pain management.Methods:We have done a retrospective chart review at an academic tertiary-care facility. Patients who underwent soft-tissue hand surgery in an office-based procedure room between January 1, 2018, and March 1, 2019, done using wide-awake local anesthesia only with no tourniquet were included.Results:Eighty-one continuous patients met the inclusion and exclusion criteria. The procedures included carpal tunnel release, cubital tunnel release, trigger finger release, first dorsal compartment release, dorsal wrist ganglion cyst excision, hand or finger mass excision, percutaneous needle fasciotomy, flexor tendon repair, and extensor tendon repair. Two patients (2.4%) received a prescription for pain medication within 1 day and 4 within 1 week after discharge (total 5.6%). Nine patients were already on chronic narcotics, and four were on short-term narcotics before the surgery date. No other patients requested or received opioid prescriptions after surgery, and no complaints were reported.Discussion:This study indicates that patients can successfully self-manage their postoperative pain with OTC analgesics. They rarely request prescriptions for pain control after soft-tissue hand surgery. Our findings support current literature suggesting that narcotic prescriptions can be eliminated in select hand and upper extremity procedures and suggest that OTC postoperative pain management is sufficient.

The Effect of Tourniquet Usage and Anesthesia Method on Prognosis in the Treatment of Dorsal Wrist Ganglion Cysts by Open Surgery.

IntroductionGanglion cysts are the most common soft tissue masses seen on the wrist, which often cause pain or cosmetic complaints. The treatment of these masses includes intra-cystic injections or surgery. Recurrence rates are very high in surgical or non-surgical treatment. Inadequate excision for recurrence after surgery is blamed; however, the reasons for the recurrence still remain mysterious.ObjectivesIn this study, the effect of anesthesia selection and tourniquet use on the dorsal wrist ganglion cysts in open surgery was investigated.Materials and methodsPatients with dorsal wrist ganglion cysts, who were operated with open surgery between 2015 and 2018 and who had at least six months after the surgery, were examined. The patients were divided into two groups: patients who underwent surgery without tourniquet with local anesthesia and patients operated with tourniquet with general or regional anesthesia. Age, sex, cause of operation, visual analog scale (VAS) scores before and after surgery, limitation of movement, postoperative complications, and recurrence were compared.ResultsThere was no significant difference between the groups in terms of causes of surgery, recurrence rates, preoperative and postoperative limitations of movement, and complications. In terms of age, the group operated with local anesthesia and without tourniquet was significantly larger. There was also no significant difference between the groups in terms of preoperative pain. Postoperative pain was significantly less in the group operated by tourniquet with general-regional anesthesia.ConclusionThere is no significant difference in the recurrence and complications between patients operated under local anesthesia without tourniquets and patients operated with tourniquets under general or regional anesthesia during the open excision of the dorsal wrist ganglion cysts. However, it should be kept in mind that postoperative pain does not diminish in later ages, especially in cases of ganglion cysts, and other pathologies may also potentially cause pain in the wrist.

Outcomes After Wrist Arthroscopy for the Treatment of Scapholunate Predynamic Instability in the Young Active Patient

Purpose Predynamic instability in scapholunate (SL) ligament tears is a source of wrist pain. Despite this, identifying the proper treatment remains elusive. The purpose of this study was to evaluate return to activity after wrist arthroscopic electrothermal shrinkage for treatment of SL predynamic instability. Methods Patients enrolled in an ongoing quality assurance project of wrist arthroscopic electrothermal shrinkage surgery for treatment of SL predynamic instability in an active duty military patient cohort were included in this retrospective review. Primary outcomes at a 2-year minimum follow-up were the rate of return to full duty and the rate of return to push-up activities. Results This study identified 14 active duty patients who met inclusion criteria, mean age 29 years. Six were male and 9 of 14 had concomitant arthroscopic occult dorsal ganglion cyst removal at the time of the index surgery. The severity of SL instability was staged using the Geissler classification; the cohort distribution for stages I, II, and III was 3 patients, 10 patients, and 1 patient, respectively. At 2-year follow-up, the return to duty rate was 12 out of 14 and the return to push-ups activity rate was 11 out of 14. Pain with activities by visual analog scale was reduced from 7.1 to 1.4. Conclusions Prior studies demonstrated SL ligament electrothermal shrinkage as a useful modality for pain relief. Our study suggests that this treatment may also aid in return to duty and push-up activities for young active patients. Type of study/level of evidence Therapeutic IV.

Radiologist Identification of Occult Dorsal Wrist Ganglion Cysts on MRI.

Background Occult dorsal ganglion cysts (ODGC) require imaging or an operation for detection. It is currently unknown how often a radiologist identifies an ODGC on magnetic resonance imaging (MRI) and whether surgeon indication for MRI aids the radiologist in detection. Questions/Purposes The aim of the study was to investigate the following questions: how accurately do radiologists identify ODGC on MRIs? What factors may be associated with missed ODGCs? Patients and Methods We retrospectively studied patients who underwent an operation for an ODGC and had a preoperative wrist MRI. Radiology report and surgeon's notes were evaluated to determine whether identification of the ODGC was noted and whether the surgeon indicated that the MRI was to evaluate for an ODGC. MRIs were reviewed, dimensions of cysts measured and volume of cyst calculated. Results Twenty-four patients and 25 MRIs were analyzed. The radiologist identified the ODGC in 19 cases (76%). Fifteen of the 25 MRIs (60%) ordered had ODGC listed in the requisition comment by the ordering surgeon. Thirteen of these 15 (87%) ODGCs were seen by the radiologist. Ten of the 25 MRIs (40%) ordered did not mention ODGC in the requisition. Six of these 10 (60%) ODGCs were seen by the radiologist. The volume of the ODGCs missed by radiologists was smaller (mean, 0.049 cm 3 ) than those the radiologists identified (mean, 0.31 cm 3 ; p = 0.004). Conclusions Radiologists will not always identify the ODGC on an MRI, but they were more likely to if the surgeon was concerned for one. Hand surgeons should report suspicion of an ODGC on MRI requisition and review all imaging independently. Level of Evidence This is a Level III, prognostic study.

Sonography of Wrist Ganglion Cysts: Which Location Is Most Common?

The literature states that wrist ganglion cysts are most commonly dorsal; however, our experience suggests a volar location is more common. The purpose of this study was to identify the locations of ganglion cysts of the wrist as imaged with sonography. After Institutional Review Board approval with informed consent waived, retrospective review of wrist sonography reports from January to April 2016 was completed. Only patients who had a comprehensive evaluation that included the dorsal and volar wrist were included. Ultrasound images were reviewed to characterize wrist ganglion cysts. The study group consisted of 98 subjects (78% female, 22% male) (median age, 51 years; range 13-79) with 124 wrist ganglion cysts, where 69% (86 of 124) were volar and 31% (38 of 124) were dorsal. Ganglion cysts were located between the radial artery and flexor carpi radialis in 63% (78 of 124), followed by a dorsal location superficial to the scapholunate ligament in 20% (25 of 124), other dorsal locations in 11% (13 of 124), and other volar locations in 6% (8 of 124). With dorsal ganglion cysts, the scapholunate ligament when imaged appeared normal in 91% (20 of 22). Ganglion cysts were multilocular/multilobular in all subjects. The most common location for wrist ganglion cysts is in the volar wrist, particularly between the radial artery and flexor carpi radialis tendon, appearing multilocular or multilobular with a mean largest dimension of 1.0 cm. Given the propensity of ganglion cysts to occur at this site, attention to this area when imaging the wrist with sonography or magnetic resonance imaging should be considered.

Dorsal Wrist Pain in the Extended Wrist-Loading Position: An MRI Study.

Background The etiology of dorsal wrist pain associated with loading of the wrist in extension has not been clearly identified in the literature. Purpose Many exercise disciplines incorporate upper extremity weight-bearing exercises in an extended wrist posture, for example push-ups, plank position, and various yoga and Pilates poses. This study evaluates patients with dorsal wrist pain in the extended wrist-loading position and identifies anatomic abnormalities in the wrist using magnetic resonance imaging (MRI). Methods A retrospective chart review was performed comparing MRI of patients who complained of dorsal wrist pain while performing weight bearing in a wrist extension position with a control group of patients who complained of ulnar-sided wrist pain. The primary MRI outcome was dorsal wrist pathology, including occult dorsal ganglion cyst, scapholunate ligament tear or degeneration, and dorsal capsulitis. Results Dorsal wrist pathology was significantly more prevalent in patients with dorsal wrist pain (84%) than in the patient cohort with ulnar-sided wrist pain (12%). Occult dorsal ganglion cysts were the most common sources of pathology (76%). Conclusion MRI demonstrated an identifiable dorsal abnormality in 84% of patients with dorsal wrist pain associated with weight bearing on the extended wrist. Occult dorsal ganglion cysts are the most common cause of dorsal wrist pain, followed by partial scapholunate tears. When patients complain of dorsal wrist pain during specific extended loading wrist positions such as push-ups, yoga, or Pilates poses, an MRI may be warranted to help identify anatomic abnormalities that may help guide treatment choices. Level of Evidence Diagnostic, Level III.

DIROFILARIASIS OF TENDINOUS SHEATH OF EXTENSOR POLLICIS LONGUS IMITATING DORSAL HAND GANGLION CYSTI A CASE REPORT

Early diagnostics for parasitic diseases of musculoskeletal system is rather challenging due to rare occurrence of described pathology.The authors review a clinical case of a female patient, 49 years old, with dirofilariasis of tendinous sheath of extensor pollicis longus. The patient was admitted to hospital with a diagnosis of dorsal hand ganglion cyst. Correct diagnosis was made only after parasite extraction during surgical procedure. The authors discuss issues of differential diagnosis of such disease as well as dorsal hand ganglion. Diagnosis can be confirmed by preoperative ultrasound scans of hand soft tissues.

Considerations in performing open surgical excision of dorsal wrist ganglion cysts.

To investigate which conditions should be considered to make a successful resection of the entire ganglion complex during open excision. 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. 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. 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 III, therapeutic study. See the guidelines online for a complete description of level of evidence.

Tenosynovitis of the Hand and Wrist: A Critical Analysis Review.

Trigger FingerTrigger finger is common in patients with diabetes.Corticosteroid injections are effective in about 60% to 92% of cases.Proximal interphalangeal joint contracture may occur in long-standing cases.The outcomes of open and percutaneous releases are similar; however, surgeons are split on preferences. Intersection SyndromeThe classic finding is crepitus with wrist motion at the distal one-third of the radial aspect of the forearm. Extensor Pollicis Longus (EPL) TenosynovitisCorticosteroid injections should be used with caution because of the potential for rupture.EPL tenosynovitis is very rare. de Quervain DisorderThis condition is common in postpartum women.A positive Finkelstein test is considered to be pathognomonic of de Quervain disorder, but care should be taken to differentiate this condition from thumb carpometacarpal arthritis.Corticosteroid injections are effective in about 80% of cases.Patients in whom corticosteroid injections fail to provide relief of symptoms frequently have a separate extensor pollicis brevis (EPB) compartment.The abductor pollicis longus (APL) tendon has multiple slips; care should be taken not to confuse one of these slips as the EPB.Traction on the APL pulls up the thumb metacarpal but not the thumb tip.Traction on the EPB extends the thumb metacarpophalangeal joint.Care should be taken to avoid injury to the sensory branch of the radial nerve. Fourth Compartment TenosynovitisThis uncommon condition is most often seen in patients with rheumatoid arthritis.The condition involves a large diffuse area, as opposed to the compact dorsal ganglion cyst.

Aspiration Alone, Aspiration Plus Steroid Injection and Aspiration Plus Ethanol Injection for Treatment of Dorsal Wrist Ganglions: A Comparative Study among Three Methods

Background: There are varieties of treatment modalities to treat dorsal wrist ganglion cysts. But none of these has been the standard. So, we designed this study to compare among different treatment modalities.Objective: To compare the effects of aspiration alone, aspiration plus methylprednisone injection and aspiration plus ethanol injection into the dorsal wrist ganglions.Materials and Methods: This prospective study was performed in Dhaka Medical College Hospital, Dhaka from March 2010 to May 2011. Sixty six patients with dorsal wrist ganglions were treated in three groups –– aspiration alone in 24 patients (Group A), aspiration plus methylprednisolone injection into the cyst in 20 patients (Group B) and aspiration plus ethanol injection, then reaspiration of the ethanol from the cyst after 3–5 minutes, in 22 patients (Group C). Elastic compression bandage was applied in all patients and recommended for 3 weeks. Follow-up was done at 1, 3, 6 and 12 months and conclusive assessment was done during final visit.Results: The success rate in Group A was seen in 9 patients (37.5%), in Group B in 11 (55%) and in Group C in 14 (63.5%) patients. The most frequent side-effect was pain during ethanol injection which was relieved by reaspiration of cyst.Conclusion: Injection of ethanol into the dorsal wrist ganglion was associated with higher success rate compared to aspiration and methylprednisolone injection. Further studies with larger sample size should be performed to assess the effect of ethanol injection in this disease.J Enam Med Col 2016; 6(1): 19-22

Ultrasound-guided aspiration of wrist ganglions: a follow-up survey of patient satisfaction and outcomes.

Ganglion cysts are one of the most frequently occurring masses of the wrist, often causing pain and interfering with daily activity. Ultrasound (US)-guided aspiration is a treatment for ganglion cysts of the wrist. To examine the results and patient satisfaction of US-guided aspiration of wrist ganglion cysts. Medical records from August 2009 through December 2013 were reviewed to identify all adult patients referred to a single musculoskeletal radiologist for US-guided aspiration of a painful wrist ganglion cyst. Records were reviewed for patient demographics, cyst size, location, and morphology. Outcomes and patient satisfaction were evaluated using a telephone questionnaire at a minimum of 9 months after the procedure. Of 56 consecutive patients identified, follow-up data were available for 39 patients (69%) at a minimum of 9 months. There were 21 volar and 18 dorsal ganglion cysts. The overall recurrence rate was 20% (8 of 39 patients) and only five patients reported a pain score of greater than 2 out of 10. The mean age of patients with recurrence of the cyst was greater than that of patients without recurrence (52 vs. 35 years, P = 0.03). Satisfaction with the outcome was high and varied by recurrence. There were no acute complications including infection, hemorrhage, or allergic reaction. US-guided aspiration is a safe and potentially effective treatment for ganglion cysts of the wrist, with high patient satisfaction. US-guided aspiration may be particularly advantageous for volar ganglion cysts, and in patients who are poor surgical candidates.

The carpal boss: a review of different sonographic findings.

Carpal boss is an uncommon condition whose incidence is underestimated and that is frequently confused with other causes of development of tumor-like lesions on the dorsum of the wrist. From the clinical point of view, the main obstacle to its recognition is the nonspecificity of symptoms, frequently attributed to dorsal ganglion cysts, since both conditions share a similar location on the dorsum of the wrist. The assessment by ultrasonography allows for a correct diagnosis and appropriate management, with better chances of resolution of the clinical complaint and lower probability of iatrogenic worsening of the lesion. The present review is aimed at describing the different sonographic findings of carpal boss.

Arthroscopic Versus Open Dorsal Ganglion Cyst Excision

Dorsal ganglion cysts can be approached with either open or arthroscopic surgical treatment. With open excision, there are concerns for wrist stiffness, poor aesthetics, and cyst recurrence. Attempts to mitigate unsatisfactory results have motivated the application of wrist arthroscopy in treating these cysts. Proponents of the arthroscopic technique cite excellent outcome after prospective clinical studies, suggesting that arthroscopic excision may be superior to open excision with a notably negligible risk of recurrence. However, long-term randomized clinical outcomes, including a direct comparison of the relative costs of treatment, are still lacking. Although arthroscopic excision is arguably becoming widely accepted, open excision is a straightforward surgical technique, and the choice between the two methods remains one of surgeon experience and/or patient preference.

Prospective Outcomes and Associations of Wrist Ganglion Cysts Resected Arthroscopically

To prospectively evaluate objective and subjective outcomes of arthroscopic dorsal wrist ganglion cyst resection, and to identify and examine intra-articular pathologies associated with ganglion cysts. We prospectively evaluated 55 patients with dorsal wrist ganglion cysts who underwent arthroscopic resection with a minimum follow-up of 24 months. Ten had recurrent ganglion cysts previously treated with open resection. Grip strength, wrist motion, and Disabilities of the Arm, Shoulder, and Hand questionnaire scores were evaluated preoperatively and at 6 weeks, 6 months, and 2 years postoperatively. Intraoperative findings were reviewed. In primary ganglion cysts a discrete stalk was present in 4 of 45 cases and diffuse cystic material and redundant capsular thickening were present in 38 of 45 cases. Cystic material appeared to arise from the radiocarpal joint exclusively in 11 of 42 cases, extended into the midcarpal joint in 29 of 42 cases, and arose exclusively from the midcarpal joint in 2 of 42 cases. The scapholunate joint demonstrated instability types I (2 of 45 cases), II (22 of 45 cases), III (20 of 45 cases), and IV (1 of 45 cases). The lunatotriquetral joint demonstrated instability types II (6 of 45 cases) and III (39 of 45 cases). At 6 weeks, average grip strengths increased by 5.9 kg and wrist flexion decreased 13 degrees . Preoperative Disabilities of the Arm, Shoulder, and Hand scores improved from 14.2 to 1.7 at 6 weeks and remained stable at 2 years. At 2 years, all patients demonstrated motion to within 5 degrees of preoperative measurements, and there were no recurrences. Patients experienced significant increases in function and decreases in pain within 6 weeks after arthroscopic ganglion cyst resection, and the recurrence and complication rates appear to be comparable to open resections. Ganglion cysts also have a high association with certain interosseous laxities, and recurrent ganglion cysts originating from the midcarpal joint are not contraindications for arthroscopic resection. Assessment of the midcarpal joint is necessary for complete resection of most ganglion cysts, and identification of a discrete stalk is an uncommon finding and not necessary for successful resection.

Résection arthroscopique des kystes synoviaux dorsaux du poignet : à propos de 54 cas

Ganglion cyst of the wrist can, some time, need surgery. Different arthroscopic technical procedures have been described. We report our experience in all articular resection of dorsal ganglion cyst of the wrist. Evaluation of efficiency of resection of dorsal ganglion cyst of the wrist by of arthroscopic resection of the pedicle. Fifty-four cysts of 52 patients have been evaluated retrospectively. Operative data, pain, strength, recurrence and complications have been collected. Average follow up was 28 months (6 to 78). Return to work was 8,8 days, operative time 41 minutes (25 to 90). In 67% cases, the operation was judged easy. Three surgeries had to be performed open. Complications were one hematoma and one neurodystrophy. Pain decrease from 3,37 to 1,76 on analogical pain scale. Flexion was 89% of opposite side, extension 88%. Sixteen recurrences (29.7%) were found. Sixty percent of those recurrences occurred during the first year experience. But independently of experience, the operative performance was foun difficult in 1 time on 3. Endoarticular arthroscopic resection of the pedicle of ganglion cyst is not so reproducible. In experimented hands, it remains a difficult procedure after a long learning curve with a recurrence rate 3 times higher from what is reported in literature for open surgery. For our discharge, our long follow-up can contain some cases of de novo cyst explaining this high rate, the learning curve is certainly the main reason for our high recurrence.

Arthroscopic excision of dorsal carpal ganglion cysts

Ganglion cysts are the most common tumor in the wrist. Dorsal carpal ganglion cysts represent 60 to 70% of all ganglion cysts in the hand and wrist. Standard treatment has been limited to observation, rest, immobilization, aspiration with or without injection, and surgical excision. Arthroscopic resection of dorsal carpal ganglion cyst have been done since the late 1980s. It has the advantages of less scarring and stiffness, the ability to inspect the wrist for other pathology and wrist instability. To date, the success of arthroscopic ganglion cyst resection is at least as good (1% recurrence) as current open techniques (0 to 10% recurrence). Risks of the procedure are similar to open techniques. Patient satisfaction with the procedure is high. In the largest reported series, there have been no major complications. This technique, for those who are comfortable with wrist arthroscopy, is effective and safe in treating this common wrist mass. The technique for this procedure is described as well as a brief history of treatment for dorsal carpal ganglion cysts.

Occult scapholunate ganglion: a cause of dorsal radial wrist pain.

There are multiple causes for chronic dorsal wrist pain over the scapholunate ligament, including occult dorsal carpal ganglion cyst, scaphoid impaction syndrome, dorsal carpal capsulitis, distal posterior interosseous nerve syndrome, and dynamic scapholunate ligament instability. Patients with such pain often have normal x-rays. A retrospective study of 21 patients undergoing surgical exploration for chronic dorsal radial wrist pain who had no palpable cyst and normal x-rays revealed that 18 of the patients had occult scapholunate ganglion cysts or myxomatous degeneration within the scapholunate ligament. All had failed long-term conservative management. Surgery involved an approach through Langer's lines, resection of a large triangular portion of the capsule between the dorsal intercarpal and radiotriquetral ligaments, and tangential debridement of the area of myxoid degeneration proximal to the distal 2 to 3 mm of dorsal scapholunate interosseous ligament. None of the patients had scapholunate instability or scaphoid impacting syndrome. Of the 18 patients with histologically confirmed myxomatous changes in the scapholunate ligament, 16 had an excellent outcome as defined by rigorous criteria; 1 had a good outcome. There was 1 patient with a poor result. A compelling argument is made for surgical exploration of the scapholunate joint in patients with persistent dorsal radial wrist pain and scapholunate point tenderness.