Dorsal Ganglion Cysts Research Articles

Surgical Treatment of Synovial Cyst in Scapholunate Joint

Ganglion cysts are the most common soft-tissue mass in the hand and wrist, making up 50% to 70% of all masses. They are most common in individuals in their twenties and forties, with women being affected three times more than males. The primary symptoms reported by people with wrist ganglion cysts are pain, weakness, and a visually unappealing look. Approximately 10% of patients report a prior traumatic experience being linked to the emergence of a ganglion cyst. Surgical treatment is often performed on an outpatient basis, using general anesthesia or axillary block anesthesia. A pneumatic tourniquet ensures a field without blood. Using a magnifying loupe is recommended to avoid detecting the pedicle and its connection to the ligaments below. Dorsal ganglion cysts involve making a transverse incision immediately above the cyst, dislodging the primary cyst from surrounding tissues using tenotomy scissors. Angelides' approach involves making a curved cut through the capsule next to the cyst, allowing for the removal of capsular attachments and mucin ducts. To alleviate severe pain caused by dorsal ganglion cysts, it is recommended to surgically remove the posterior interosseous nerve above the extensor retinaculum. Volar wrist ganglion cysts involve making an incision along the radial side of the cyst, enabling both proximal and distal extension to reach distant capsular attachments. The ganglion is released from all adjacent connective tissue, and the radial artery is moved both towards the body and away from it. Precise control of bleeding is achieved using bipolar electrocautery, and the wound is thoroughly flushed with fluid. Skin margins are infused with a prolonged-acting local anesthetic, and the wound is sealed with intermittent 4-0 or 5-0 nylon sutures. Prompt mobilization is recommended, but a splint is not used until significant dissection has occurred. Article Details

Dorsal wrist ganglion: clinical and imaging correlation in symptomatic population based on high-field MRI.

To determine prevalence in the symptomatic population of dorsal mucoid cysts centered on dorsal capsuloscapholunate septum (DCSS) using high-field magnetic resonance imaging (MRI) for anatomoclinical and epidemiological correlations. This single-center retrospective study analyzed all 3-Tesla MRIs consecutively performed for painful wrists in 295 patients. Two blinded readers performed measurements. The protocol included T1 spin echo and 3D proton density sequences with fat saturation. Inter-observer reliability was assessed using kappa and intra-class correlation coefficients for cyst detection and volumetry, respectively. Disagreements concerning cyst detection were resolved by a consensus reading. Cyst size, relationship to extrinsic and scapholunate ligaments (SL), continuity of SL, minimum distance to the posterior interosseous nerve (PIN), cyst communication with joint, and anatomical classifications of cysts were analyzed. Correlation tests were performed to assess associations. Two-hundred ninety-five patients (mean age 39.6 +/- 15.6 (standard deviation), 161 males) were evaluated for detection of dorsal wrist cysts identified in 150/295. In this subgroup, the mean age was 38.7 years (15-75), the sex ratio of 0.6 (59% women), and the median volume cyst of 8.7 mm3 (0.52-2555). Cyst detection, volume, and major axis measurements showed very high agreement between observers, respectively, 0.89, 0.96, and 0.91. 42 patients had dorsal SL pain. A weak negative correlation was found between distance to PIN and dorsal SL pain (r = -0.2415; p < 0.05) and a weak positive correlation between Guérini's classification and dorsal SL pain (r = 0.2466; p < 0.05). High-field MRI is the modality of choice for the detection, anatomical, and volumetric assessment of dorsal cysts. Preoperative assessment will be aided by the proposed revised anatomical classification. High-field MRI is the modality of choice for the anatomical study of dorsal ganglion cysts. It allows the radiologist to accurately describe the anatomical relationships, size, and visibility of the pedicle, essential information for the surgeon's preoperative assessment. Dorsal mucoid wrist ganglion is a condition for which prevalence remains to be determined. High-field MRI is a reproducible imaging modality for the detection and assessment of dorsal wrist cysts. High-field MRI has a key role in the preoperative management of dorsal mucoid cysts.

Dorsal Wrist Impingement Syndrome Pain After Ganglion Cyst Removal

A ganglion cyst is a benign fluid-filled sac that typically appears on the dorsal aspect of the wrist, arising idiopathically near the joint capsule or tendon sheath. Diagnosis is primarily clinical, with MRI and ultrasound serving as confirmation tools. Treatment options range from immobilization, aspiration, hydrossection, steroid or hyaluronidase injection, to surgical intervention. Although relatively uncommon, Dorsal Ganglion Cysts (DGC) can lead to Dorsal Wrist Impingement (DWI) syndrome. This syndrome results from the thickening of the wrist capsule due to overuse, injury, or repetitive activities. This thickening can lead to the compression of the extensor carpi radialis brevis (ECRB) tendon during wrist extension and produce tenderness around the lunate. In some refractory cases, MRI findings may show recurrent ganglion cysts, while in others, they may appear "normal." Consequently, the diagnosis remains clinical, and imaging is primarily employed to rule out secondary causes. Management strategies encompass rest, immobilization, occupational therapy, non-steroidal anti-inflammatory drugs (NSAIDs), cortisone injections, and, in certain instances, surgical intervention. Despite the clinical significance of these conditions, limited studies have explored their interrelationship. In this context, we present a rare case involving a 23-year-old female with recurrent DGC accompanied by DWI syndrome. Initially, the patient reported idiopathic left dorsal wrist pain localized around the tendon sheath. Her initial X-ray did not reveal any abnormalities, but MRI identified two ganglion cysts. A series of treatments were initiated, including left tendon sheath hydrossection, corticosteroid injections into the left wrist, and the excision of ganglion cysts from the left wrist. Furthermore, occupational therapy, oral Meloxicam, and Voltaren gel treatments were integrated into the management plan. Subsequent imaging confirmed the resolution of the cysts and an overall enhancement in the range of motion and wrist strength. However, the patient experienced only minimal pain relief, and pain was still elicited during end-range wrist extension and upon dorsal wrist palpation. An electromyography (EMG) test ordered to rule out neuropathic causes did not yield any conclusive results. Nonetheless, a repeat X-ray revealed mild soft tissue swelling on the dorsal side of the wrist, and a follow-up MRI detected ganglion cysts on the dorsal aspect of the lunate and the ECRB tendons. These findings indicated a re-accumulation of dorsal ganglion cysts with a concurrent dorsal impingement syndrome component. Consequently, the patient was referred to an orthopedic surgeon for evaluation and potential revision surgery. This unique case underscores the possibility of developing DWI Syndrome after the removal of a DGC. The diagnosis of this syndrome can be elusive, particularly when X-rays, MRIs, and EMGs yield negative results. Trauma, such as repeated hand surgery or recurrent ganglion cysts, may exacerbate wrist pain despite improvements in range of motion and strength. Special consideration should be given to patients who undergo surgical cyst excisions, as this procedure heightens the risk of recurrence and can irritate the tendon sheath. Collaborative efforts between Physical Medicine and Rehabilitation (PM&amp;R), Occupational Therapy (OT), and surgical teams may play a pivotal role in managing pain associated with these conditions. We propose that future research endeavors should focus on establishing guidelines for the management of this unique condition.

A Modified Approach for Arthroscopic Excision of Dorsal Midcarpal Ganglion Cysts Using Radiocarpal Portals.

Wrist arthroscopy could be a treatment option for dorsal ganglion cysts. To achieve a thorough dorsal capsulectomy for the removal of midcarpal ganglion cysts, it is commonly necessary to combine both the radiocarpal and midcarpal portals. We present a modified method using radiocarpal portals only for arthroscopically excising dorsal midcarpal ganglion cysts. No extra midcarpal portals are necessary, and the method potentially generates satisfactory results.

Arthroscopic Dorsal Ligamentocapsulodesis in the Treatment of Occult Dorsal Wrist Ganglion Cysts Associated with Scapholunate Instability: Surgical Technique and Preliminary Clinical Results.

Background: This study aimed to evaluate our preliminary results and experience with the arthroscopic dorsal ligamentocapsulodesis in managing occult dorsal wrist ganglion cysts (ODGCs) associated with scapholunate (SL) instability. Methods: All patients who underwent arthroscopic dorsal ligamentocapsulodesis due to an ODGC with concomitant SL ligament tear were retrospectively reviewed. In addition to demographic data and length of follow-up, outcomes data that included range of motion, grip strength, modified Mayo wrist score (MMWS), complications and radiographs were collected. Results: The study included 18 patients (18 wrists; 10 female and 8 male). The mean age was 32 years (range: 19-48) and the mean follow-up was 34 months (range: 24-48). The mean preoperative extension deficit decreased from 5.5° (range: 0°-20°) to 2.7° (range: 0°-15°) at the final follow-up (p = 0.004). The mean preoperative flexion deficits decreased from 4.4° (range: 0°-15°) to 2.2° (range: 0°-10°) postoperatively (p = 0.003). The mean hand grip strength significantly increased from 27.7kg (range: 22-36) to 38.3kg (range: 31-46) at the final follow-up assessment (p < 0.001). The mean MMWS improved from 46 (range: 25-65) pre-operatively to 91 (range: 70-100) at the final follow-up (p = 0.0002). No major intra- or postoperative complications were observed. Conclusions: SL instability may have an important role in the aetiology of ODGCs, and arthroscopic dorsal ligamentocapsulodesis can provide pain relief and functional improvement without recurrence at the short- to mid-term follow-up in the treatment of ODGCs. Level of Evidence: Level IV (Therapeutic).

The effects of different anesthetic approaches on recurrence in the surgical treatment of ganglion cysts

Aim: The surgical treatment of ganglion cysts usually involves local anesthesia (LA), regional anesthesia (RA), and axillary block applications. We aimed to show the effects of these anesthesia types on recurrence in surgically treated ganglion cysts. Material and Method: Between 2017-2019,142 patients were operated on in our clinic due to the dorsal ganglion cyst of the wrist. Cysts outside the dorsal region and patients who did not regularly attend their follow-up visits for at least 12 months were excluded. One hundred and thirty-five patients, with a mean age of 39.3 (15-73) years, were included in the study. LA (Group I) was applied to the patients who stated that they could tolerate the pain, and RA was used on those who stated that they could not (Group II) after preoperative anesthesia consultations. The files of the patients in both groups were reviewed retrospectively, and the effect of anesthesia type on recurrence was investigated. Results: Recurrence rates were significantly lower in the RA group compared to those in the LA group (p=0.049). The risk of recurrence in the LA group was 2.80 (0.95-8.28) times higher than in the RA group. The mean operation time of the RA group was significantly lower than that of the local anesthesia group (p=0.0001). Conclusion: The fact that RA allows tourniquet applications with deeper and longer-lasting anesthesia compared to LA increases surgical comfort and makes way for the comfortable dissection of the cyst and total excision of all components within a short operative time.

SURGICAL RESULTS OF DIFFERENT INTERVENTIONS IN OPEN SURGERY FOR WRIST DORSAL GANGLION CYST

ABSTRACT Background A ganglion cyst is the most common benign mass on the wrist. They are frequently seen on the dorsal aspect of the wrist. These lesions, which show symptoms such as pain and limitation of movement, can become restrictive in daily life activities. Surgical methods are accepted as the gold standard in treating this lesion, with a wide range of treatment options. In our study, two new surgical methods were described for the open resection of wrist dorsal ganglion cysts, which were not previously described in the literature. Three surgical methods were compared in open surgery for wrist dorsal ganglion cysts. Materials and Methods Our study divided 180 patients with three different surgical methods into three groups. The functional results of the patients were evaluated with VAS and DASH scores at the 1st, 3rd, 6th, and 12th months. Comparisons were made in terms of developing complications and recurrence rates. Results As a result of the evaluation, it was found that the functional outcomes, recurrence, and complication rates of all three surgical methods were similar. Conclusions Considering that the results of 2 different surgical methods not described before are similar to those in the literature, the surgical techniques we described can be safely used in wrist dorsal ganglion cyst surgery.

Two-Year Clinical Outcomes after Arthroscopic Re-Excision of Recurrent Dorsal Wrist Ganglion Cyst.

Arthroscopic excision of dorsal wrist ganglion (DWG) cysts has recently become an alternative to open surgery, with the advantage of lower recurrence. However, in recurrent cases, whether re-excision using an arthroscopic approach would achieve favorable outcomes has not been determined. This study aimed to evaluate the clinical outcomes of function evaluation and recurrence rate after arthroscopic excision of recurrent DWG cysts. A total of 11 consecutive patients with clinically diagnosed recurrent DWG cysts were retrospectively reviewed between November 2017 and March 2020. Extensive re-excision of the ganglion cyst and its surrounding pathological capsule was performed using an arthroscopic approach. Magnetic resonance imaging (MRI) was routinely performed before surgery to identify the location and limits of the cyst. All patients were followed up for a minimum of 2 years. A second recurrence was recorded if a mass reappeared at the same site with a positive transillumination test. Pain during activity was evaluated using the visual analog scale (VAS). The active range of motion (ROM) of the wrist was measured using a goniometer, and the hand grip strength was measured using a digital dynamometer. Comparative analysis between the pre- and postoperative indexes was performed using Student's t-test. After a mean follow-up period of 29.3 months (range, 24-34months), no second recurrence of the cyst was recorded. The VAS score improved from 1.4 to 0.3 (t=3.833, p=0.003), and residual pain was reported by three patients (VAS score=1 for each). Active wrist flexion increased from 73.6° to 78.2° (t=2.887, p=0.016). No significant changes were found in active wrist extension or hand grip strength (p > 0.05). No major complications occurred during the study. Arthroscopic excision of a recurrent DWG cyst yielded satisfactory results with no second recurrence, significant pain relief, and good wrist function at a minimum of 2-year follow-up. Clear identification of the location and limits of the ganglion based on preoperative MRI could be helpful to achieve complete excision and therefore prevent a second recurrence.

Outcome of Dorsal Wrist Ganglion Surgical Excision

Objective: To investigate the clinical outcome of dorsal wrist ganglion treated with surgical excision. Methodology: It was a cross-sectional study performed at Kazi Hospital Lahore. Non-probability purposive sampling technique was used to enroll 50 patients of dorsal wrist ganglion who responded through a questionnaire / research proforma. Surgical excision was done under local anesthesia as day case. Results: We collected data of 55 patients. The mean age of the patients having dorsal wrist ganglion cyst was 31. Female patients were in a larger proportion than male patients. Right wrist was affected in n= 29 (58 %) of the individuals. At the end of our follow up only 2(45) patients had residual pain. Hypertrophic scar has been reported to be associated with the lower patient satisfaction (p = 0.001). Luckily in our study only two patients (4%) had this problem. Conclusion: This study concluded that the outcomes of surgical excision of dorsal wrist ganglion is effective technique with high patient satisfaction and cost effectiveness. Keywords: Dorsal wrist ganglion, aspiration, surgical excision, outcome, patient satisfaction.

Treatment of dorsal wrist ganglion cyst by establishing midcarpal volar portal using the "Kiss-in" method.

IntroductionThis paper introduces the treatment and clinical outcome of the dorsal wrist ganglion cyst utilizing the Kiss-in method to establish a midcarpal volar portal.Materials and methodsPatients with dorsal ganglia of the wrist (n = 12, 6 females, 6 males) underwent arthroscopic surgery using the Kiss-in method at our hospital between September 2018 and January 2021. All patients underwent preoperative radiological investigations, such as magnetic resonance imaging (MRI; 12 cases) or ultrasonography (12 cases). The mean age of patients was 30.7 years (range: 19–46 years). The time lost from work, the wrist motion and strength, the presence of scarring, residual symptoms, complications, and recurrence were recorded at a mean follow-up of 24 months.ResultsEleven patients showed a good prognosis with active motion recovery. One patient showed the recurrence of ganglion, and the second arthroscopic resection was performed 5 months after the first surgery for this patient. After the surgery, the patient fully recovered.ConclusionsEstablishing the midcarpal volar portal by the Kiss-in method is safe. The dorsal ganglion cyst resection through the established midcarpal volar portal is a promising approach, allowing better visualization and a broader range motion of the arthroscope.

Repair of the dorsal capsuloligamentous scapholunate septum during arthroscopic resection of painful dorsal wrist ganglion cyst: Comparative analysis of two techniques

We compared arthroscopic cyst resection (ACR) of dorsal ganglia of the wrist, either associated to reconstruction of the dorsal capsuloligamentous scapholunate septum (ACR-DCSS) in 66 cases in which the ganglia were painful on exertion, or isolated ACR in 15 pain-free cases. A single-center retrospective study analyzed data for the period April 2013 to May 2021. The main aim was to compare pre- and post-operative functional results (pain at rest (on a numerical rating scale: NRS), pain under effort (NRS), range of motion (°), grip strength (kg)) and recurrence rate between the two techniques. The study hypothesis was that DCSS repair improves recurrence of dorsal ganglion cyst and functional outcome. The ACR-DCSS group showed significant improvement in extension, pronation, supination, radial inclination, ulnar inclination, grip strength, pain at rest and pain on exertion. The ACR group showed significant improvement in pronation, ulnar inclination and pain on exertion. There was a significant difference in recurrence rate, in favor of ACR-DCSS. Recovery was also significantly better for the ACR-DCSS group in terms of extension, supination and pain at rest. Arthroscopic treatment of wrist ganglion cyst is a reliable, minimally invasive and reproducible technique that produces good results in terms of pain and recovery of range of motion, with significantly lower recurrence rate in case of DCSS repair.Level of evidence: Therapeutic III.

Efficacy of corticosteroid injections in the treatment of 85 ganglion cysts of the dorsal aspect of the wrist

IntroductionGanglion cysts of the dorsal aspect of the wrist are a benign pathology frequently encountered in consultations for hand surgery. Their treatment, irrespective of the type, presents a risk of recurrence and there is no consensus on the management to adopt. Medical treatments such as corticosteroid injections have recurrence rates between 8 and 74%. Surgical treatments seem to have better results, with less disparate failure rates, at around 15%. HypothesisThe objective of this retrospective study was to determine the effectiveness of the aspiration and injection of corticosteroids under ultrasound guidance in the treatment of 85 ganglion cysts of the dorsal aspect of the wrist. Patients and methodsWe retrospectively included 99 patients suffering from a non-occult ganglion cyst of the dorsal aspect of the wrist, who had received a referral for aspiration, and subsequent injection of corticosteroids between January 2015 and December 2020. Data collection was carried out by the analysis of files on the institution's software, and by a phone call. Data such as age, sex, pre- and post-treatment QuickDASH score, as well as recurrence and second-line treatments were collected. ResultsThe average age of our cohort was 31, with a 65% female predominance. The recurrence rate after a first injection was 73.2% with a mean follow-up of 34 months. The QuickDASH score improved significantly by 26.2 points out of 100 in non-injected patients, and by 18.6 points out of 100 after injection, whether the cyst recurred or not. ConclusionWith 73.2% recurrence, corticosteroid injections do not appear to be effective in treating dorsal ganglion cysts of the wrist. They lead to an improvement in the functional score of the wrist, but not significantly compared to treatment abstinence. Level of evidenceIV.

Scapholunate Instability Following the Surgical Excision of Dorsal Ganglion Cyst of the Wrist: A Case Report

Ganglion cysts of the dorsal wrist are generally attached to the scapholunate interosseous ligament, and surgical removal could injure this ligament. Such injury could rarely result in postoperative scapholunate instability. To date, a few cases of scapholunate instability following the excision of the dorsal ganglion cyst of the wrist have been reported. In this report, we present a 23-year-old man with scapholunate instability following the surgical resection of the dorsal ganglion cyst of his wrist. The instability was treated with open reduction and reconstruction. One year follow-up of the patient was event-free. The patient had no pain and limitation and resumed his preoperative activities. According to this case, the iatrogenic or pre-existing nature of scapholunate instability following the surgical excision of the dorsal ganglion cyst of the wrist‎‏ cannot be determined. However, the patients should be informed of this complication before undergoing surgery.

Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison.

This study directly compares the recurrence rates of dorsal wrist ganglion cysts in patients treated via open surgical excision versus arthroscopic surgical excision. We hypothesized that there would be no difference between recurrence rates with these 2 surgical options. We retrospectively reviewed the charts of all patients with a dorsal ganglion cyst undergoing either open or arthroscopic surgical excision at a single academic center with 3 fellowship-trained attending hand surgeons from 2012 to 2017. Charts were identified using Current Procedural Terminology codes and were reviewed using postoperative office notes for preoperative and postoperative symptoms, episodes of recurrence, time at which recurrence occurred, subsequent operations, and outcome at final follow-up. The charts of 172 patients undergoing either arthroscopic or open dorsal ganglion excision were reviewed. Nine of 54 (16.7%) arthroscopic excisions resulted in cyst recurrence, while 8 of 118 (6.8%) open excisions resulted in cyst recurrence (P = .044). Two of 9 (22%) recurrences after arthroscopic ganglion excision versus 2 of 8 (25%) recurrences after open ganglion excision underwent repeat surgical intervention. Time to recurrence, as well as final follow-up, was not statistically different between groups. Dorsal wrist ganglion cysts are the most common benign soft tissue mass of the upper extremity, but it remains unknown whether arthroscopic or open surgical excision leads to lower recurrence rate. Scant literature exists directly comparing these 2 methods of surgical excision. This study suggests that open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision.

Ultrasound evaluation of the scapholunate ligament and scapholunate joint space in patients with wrist complaints in a rheumatologic setting.

AimThe aims of the study were to perform an ultrasound assessment of the dorsal portion of the scapholunate interosseous ligament and scapholunate joint space in patients with wrist complaints in a rheumatologic setting, to describe ultrasound abnormalities about scapholunate interosseous ligament region, and to correlate them with clinical data, presence of dorsal ganglion cysts and diagnoses of rheumatic diseases.Material and methodsSeventy-four consecutive patients with wrist pain and/or swelling were evaluated by routine power Doppler ultrasound. Forty normal wrists were studied to confirm the normality values of the scapholunate joint.ResultsThe mean width of the normal scapholunate joint was 2.49 mm (±0.49 SD), with a coefficient of variation on repeated measurements of 3.662%. The best predictors of scapholunate interosseous ligament degeneration were: older age (p <0.0001), male gender (p = 0.0049), and radiocarpal effusion (p = 0.0156). The presence of osteophytosis and calcifications of the scapholunate joint were higher (p <0.001) in rheumatic patients. Scapholunate calcifications showed a sensitivity of 98.2% and a specificity of 61.1% for calcium pyrophosphate deposition disease. Dorsal ganglion cysts were more frequent in younger subjects (p <0.0012) without rheumatic conditions (p <0.0001) or midcarpal synovitis (p <0.0001). Larger cysts often exhibited power Doppler signal (p <0.0001). The best predictors of scapholunate dissociation were: male gender (p = 0.0002), presence of midcarpal synovitis (p <0.0137), and higher grade of scapholunate interosseous ligament degeneration (p <0.0001). Scapholunate widening was greater (p = 0.0419) in calcium pyrophosphate deposition disease or rheumatoid arthritis than in other rheumatic conditions.ConclusionsUltrasound findings of scapholunate interosseous ligament degeneration and calcification, scapholunate space enlargement, and dorsal ganglion cysts should be considered in ultrasound reporting, since they add useful information about the diagnosis of associated rheumatic conditions.

Effects of Acupotomy on a Dorsal Wrist Ganglion Cyst with Ultrasonography: A Case Report with a 7-Month Follow-up

Background: This study was conducted to evaluate the clinical effect of acupotomy, a newly upcoming acupuncture treatment method for a dorsal wrist ganglion cyst.Methods: A patient with a dorsal wrist ganglion cyst was treated with acupotomy under ultrasonographic guidance. The symptoms caused by the cyst and size of the cyst under ultrasonographic observation were used to evaluate the effect of the acupotomy treatment.Results: The numeric rating scale score reduced from 7 to 1.4 throughout the treatment period. The size and swelling of the cyst decreased following acupotomy treatment.Conclusion: Acupotomy had a positive clinical effect in the treatment of a dorsal wrist ganglion cyst in this case. Further studies are required for its additional retrospective application

Patient-Related Outcomes of Arthroscopic Resection of Ganglion Cysts of the Wrist.

Background Ganglion cysts of the wrist can cause pain and loss of functionality. No consensus exist on optimal treatment. Arthroscopic resection shows promising results but is poorly studied. Furthermore, only few studies have used patient-related outcomes to evaluate arthroscopic treatment. Purpose The purpose of this study was to assess patient-related outcomes following arthroscopic resection of wrist ganglion cysts. Patients and Methods This was a retrospective study of all consecutive patients that underwent arthroscopic resection of a dorsal or volar wrist ganglion. Minimum follow-up was 6 months. The primary outcome was the patient-rated wrist evaluation (PRWE). Secondary outcomes were recurrence rate and complications. Results A total of 53 patients were included with a mean follow-up of 13 months (interquartile range: 6-23 months). Twenty-six patients (49%) presented with a recurrence following prior treatment. Mean PRWE was 13 (standard deviation [SD] = 1.8), with no difference between patients with dorsal or volar ganglion cysts. There were five recurrences (9%), of which three occurred in the first five patients who were operated. There were three patients with complications (6%), consisting of neuropraxia, extensor carpi ulnaris tendinitis, and painful scar tissue. Conclusion Arthroscopic resection results in good patient-related outcome and low complication and recurrence rates when performed by an experienced surgeon. Recurrence and complication rates are similar to arthroscopic resections described in literature and superior to open resection and needle aspiration. Well-designed randomized clinical trials will be necessary to confirm these findings. Level of Evidence This is a level IV, retrospective study.

Efficacy of Aspiration and Steroid Injection in treatment of dorsal Ganglion Cyst of Wrist

Efficacy of Aspiration and Steroid Injection in treatment of dorsal Ganglion Cyst of Wrist

Factors Impacting Recurrence Rate After Open Ganglion Cyst Excision.

Background: The recurrence rate after open excision of ganglion cysts is approximately 20%. However, this literature is based on a small series of subjects. This study aims to determine the rate and risk of recurrence after open excision of ganglion cysts in a large patient series. Methods: This study included 628 patients who had ganglion cyst excision from 2010 to 2018. A retrospective chart review recorded the following: age, sex, laterality, volar/dorsal location, and recurrence. An overall recurrence rate was calculated. In addition, a 1-way analysis of variance test was used to compare recurrence rates among the individual surgeons, and unpaired t tests were used to compare age of recurrence, dorsal cyst recurrence, laterality of cyst, and recurrence based on sex. Finally, a comparison of recurrence rate over time was conducted for surgeon 3. Results: The overall recurrence rate was 3.8% (24 of 628). The recurrence rates for each surgeon were 3% (9 of 353), 2% (3 of 167), and 11% (12 of 107), P = .02. The age of those with and without a recurrence did not differ (32 years vs 38 years), P = .06. The recurrence rate of dorsal ganglion cysts was 4.1% (14 of 341) compared with 3.5% (10 of 286) for volar ganglion cysts, P = .69. Male patients had a recurrence in 6.4% (13 of 204) of cases compared with 2.6% (11 of 424) of female patients, P = 0.01. There was a decrease in the rate of recurrence from 42.9% to 5.3% over 5 years for surgeon 3. Conclusion: In our sample, male sex and surgeon experience were significant risk factors in ganglion cyst recurrence.

Wrist Ganglia in Children: Nonsurgical Versus Surgical Treatment

To compare the outcomes of nonsurgical and surgical treatment of children with wrist ganglia. We performed a retrospective review of children with wrist ganglia treated at 2 separate institutions. In one, a clinic setting, children were treated with observation. In the other, a hospital referral center, children had surgical excision. Information obtained included persistent or recurrent cyst, and Quick-Disabilities of the Arm, Shoulder, and Hand measure. Patients aged 17 years or less at the time of cyst appearance with at least 1 year of follow-up were included. We successfully contacted 90 patients: 50 in the nonsurgical and 40 in the surgical group. Average follow-up was 4.6 years. The persistence rate in the nonsurgical group was 52%. The recurrence rate in the surgical group was 15%. In the nonsurgical group, if a ganglion resolved, it did so within 18 months in 94% of patients. Dorsal ganglions persisted more often than volar ones (63% vs 33%). Older children had a higher rate of persistence than did younger children (58% vs 31%). For children aged 10 or less, surgery was associated with a recurrence rate of 17%, compared with 31% persistence in the nonsurgical group. For children aged 11 and more, surgery was associated with a recurrence rate of 15%, compared with 58% persistence in the nonsurgical group. There was no significant difference between Quick-Disabilities of the Arm, Shoulder, and Hand scores in any group. In a child with a wrist ganglion, if the cyst ultimately resolved, it usually did so within 18 months. Dorsal ganglion cysts and ganglion cysts in older children have a higher chance of persisting. In children treated with surgical excision, we found a 15% recurrence rate. Therapeutic IV.