Treatment Of Dorsal Wrist Ganglia Research Articles

Outcome Evaluation of Arthroscopic Resection of Dorsal Wrist Ganglia.

Goals: Arthroscopic ganglionectomy has become an increasingly popular surgical option for dorsal wrist ganglia. The aim of this study was to describe our technique for the arthroscopic treatment of dorsal wrist ganglia and to evaluate the clinical results as well as the recurrence rate in our patients. Methods: In a prospective study, 48 patients who underwent arthroscopic treatment of dorsal ganglion of the wrist were included. Patients were evaluated preoperatively and 3 and 24 months post arthroscopy. A presence of recurrence at 24 months was recorded. The subjective outcome was evaluated with The Patient-Rated Wrist Evaluation (PRWE) and the Visual analog scale (VAS). Objective outcomes included grip strength and range of movement measurements. Results: The mean age was 36 years; the majority were women (36/48). Mean grip strength and the average flexion and extension in the wrist showed improvement after 3 months. The total PRWE score improved from 26.7 preoperatively to 10.2 at three months and 2.4 two years after surgery. After 24 months follow-up, there were only two patients with recurrence (4.2%). Conclusion: The arthroscopic resection of the dorsal wrist ganglia is a procedure with a low recurrence rate and lowest scaring and stiffness; it should be considered as a golden standard for operative treatment of the dorsal wrist ganglia.

Treatment of dorsal wrist ganglia by transfixation technique using a syringe needle

Background: Ganglion is one lesion that is frequently seen in minor surgical practice. Treatment of dorsal wrist ganglia begins from basic reassurance to advanced endoscopic excision. Many a time’s treatment not often necessary, but patients seek consultation asking for some form of definitive treatment. Recurrence is frequently seen with cyst aspiration/injection or after surgical excision. Recurrence is the common problem, whatever is the treatment modality. Materials and Methods: In this study we evaluate results of 30 dorsal wrist ganglia treated by the transfixation technique using a syringe needle. Results: Out of 30 cases included in this study 28 were completely cured of the symptoms giving a success rate of 93.33%, One patient (3.33%) had recurrence at 4 months and was painful and he had to undergo excision, One patient (3.33%) had recurrence at the end of 6 months. Discussion: Compared to various other modalities this method is cost-effective, time consumption is less, low invasion, recurrence rate is low, and can be performed under local anaesthesia, and does not require any complicated instrument and an easy-to-master technique.

A Prospective Randomized Controlled Trial of Aspiration and Fibrin Sealant Use Versus Aspiration Alone in the Treatment of Dorsal Wrist Ganglia.

Multiple treatments for dorsal wrist ganglia (DWG) exist but have high recurrence rates. We investigated whether aspiration followed by injection of Tisseel is more effective at reducing the DWG recurrence rate than aspiration alone. Adults with untreated DWG were randomly assigned to aspiration alone (A) or aspiration followed by Tisseel injection (AT). Patients were measured at baseline, 1, 6, and 12 months. Primary outcome was the rate of recurrence. Secondary outcomes included recurrent ganglion size and maximum pain experienced from the ganglion. Continuous data were compared with Student t tests and Mann-Whitney U tests. Categorical data were compared with χ2 tests and Fisher exact tests. Treatment effect was reported as relative risk or mean differences (MD) with 95% confidence intervals. Seventy-nine patients were randomized to the A (n = 39) or AT (n = 40) group. Twenty-five patients were lost to follow-up. There were no differences in recurrence risk between groups at 1, 6, or 12 months (P > .05). Ganglia were significantly smaller for both groups at 1 month versus baseline (P < .001). The A group demonstrated a significantly larger decrease in size at 1 month versus the AT group (MD = 0.75 cm2, 95% confidence interval: 0.07-1.43, P = .03). Both groups experienced significantly less pain at 1, 6, and 12 months (P < .03), but this was not significantly different between groups. Aspiration and Tisseel injection does not decrease DWG recurrence versus aspiration alone. Both interventions produced a significant decrease in pain. Although aspiration alone carries a high recurrence risk, it may provide sufficient symptomatic relief for patients with DWG.

Ganglión Dorsal de Muñeca: Resección Artroscópica con Técnica “en seco”. Seguimiento mínimo de 2 años.

&lt;p&gt;&lt;strong&gt;Introducción: &lt;/strong&gt;Describir los resultados a mediano plazo de la resección artroscópica de gangliones dorsales de muñeca utilizando la técnica “en seco”.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material y Métodos: &lt;/strong&gt;Se evaluaron retrospectivamente 22 pacientes (22 muñecas) con un seguimiento mínimo de 2 años. Once mujeres y 11 hombres con una edad promedio de 29 años (18-57). En todos los casos se realizó una evaluación clínica preoperatoria, al mes postoperatorio y en el último control. Se evaluó la movilidad y fuerza de puño comparativas, el dolor y la función según las escala visula analógica (EVA), los escores funcionales QuickDASH y Wrightington, el retorno laboral y las complicaciones intra-postquirúrgicas. Seguimiento promedio: 42 meses (24 – 60). Se realizó un análisis estadístico mediante la prueba de T.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados: &lt;/strong&gt;En 2 casos se presentó una recidiva del ganglión. No registraron otras complicaciones intra-postquirúrgicas. La movilidad y fuerza de puño comparativas mejoraron significativamente, alcanzando el 99% y 100%, respectivamente. El dolor y la función también mejoraron significativamente, al igual que el score funcional QuikDASH. Según la escala de Wrightington, 18 casos resultaron excelentes, 3 buenos, y 1 malo. Veitiuno de los 22 pacientes retornaron a sus tareas laborales sin limitaciones, refiriendo 20 de ellos estar satisfechos con el resultado obtenido.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusión: &lt;/strong&gt;La resección artroscópica utilizando la técnica “en seco” representa una alternativa segura y eficaz para el tratamiento de los gangliones dorsales de muñeca, logrando el alivio del dolor, y una mejoría funcional y estética en la mayoría de los pacientes mediante una rehabilitación temprana, con una baja incidencia de recidiva.&lt;/p&gt;

Prospective Outcomes of Arthroscopic Treatment of Dorsal Wrist Ganglia

The purpose of this study was to assess the results of arthroscopic resection of dorsal wrist ganglia. Between November 2002 and September 2007, all patients with dorsal wrist ganglia underwent arthroscopic resection in our institution. Average follow-up was 39.2 months (range, 24-71 months). Fifty-two patients (40 women and 12 men; mean age, 29.8 years) were treated with our operative technique. Symptoms at presentation were unpleasant appearance in 15 patients (28.8 %), pain in 30 (57.6%), and unpleasant appearance and pain in 7 (13.5%). The ganglion cyst site was in front of the midcarpal joint in 41 patients (78.8%), in front of the radiocarpal joint in 6 patients (11.5%), and in front of the radiocarpal and midcarpal joints in 5 patients (9.6%). Our surgical technique resulted in a significant improvement in flexion, extension, and grip strength (P≤.005). In patients with painful ganglia, treatment also had a significant effect. Nine (17.3%) recurrences were observed. Mean time off work was 14 days, but 19 patients returned to work immediately. According to the results of this study, we recommend the use of arthroscopy as the primary treatment method for dorsal wrist ganglion excision.

Treatment of dorsal wrist ganglia by transfixation technique

Ganglion is one of the common lesions seen in minor surgical practice. Treatment of dorsal wrist ganglia varies from simple reassurance to excision and advanced endoscopic excision. Irrespective of the treatment modality, recurrence is a common problem. This study evaluates results of 40 wrist ganglia treated by using the transfixation technique. Out of 40 cases included in this study 38 were completely cured of the symptoms giving a success rate of 95 percent, recurrence was seen in one patient and skin necrosis secondary to tight gauze piece was seen in one patient. Comparing with other modalities this method is cost-effective, less time consuming, minimally invasive, low rate of recurrence, and can be carried out under local anesthesia, and does not require any special instrument and an easy-to-learn technique.

The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention

We have evaluated the long-term outcome of excision, aspiration and no treatment of dorsal wrist ganglia prospectively in 236 (83%) of 283 patients who responded to a postal questionnaire at a mean of 70 months. The resolution of symptoms was similar between the treatment groups (p>0.3). Pain and unsightliness improved in all three treatment groups. The prevalence of weakness and stiffness altered only slightly in all three treatment groups. More patients with a recurrent, or persistent ganglion complained of pain, stiffness and unsightliness (p<0.0001). Patient satisfaction was higher after surgical excision (p<0.0001), even if the ganglion recurred. Twenty-three of 55 (58%) untreated ganglia resolved spontaneously. The recurrence rate was 58% (45/78) and 39% (40/103) following aspiration and excision, respectively. Eight out of 103 patients had complications following surgery. In this study, neither excision nor aspiration provided significant long-term benefit over no treatment.

Traitement arthroscopique des kystes synoviaux dorsaux du poignet

Incidentally discovered in 1987, arthroscopic treatment of dorsal wrist ganglia is based on our knowledge of their physiopathology which in turn benefits from the arthroscopic wrist evaluation. Dorsal wrist ganglia arise in the radiocarpal space from the dorsal part of the scapholunate ligament and migrate along the dorsal wrist capsule. According to their position above or under the dorsal intercarpal ligament, their cutaneous projection may vary. The basis of the arthroscopic treatment of wrist ganglia is, as with open surgery, the capsular resection in front of their origin. Arthroscopic resection is made either from dorsal radio-carpal or midcarpal approaches with little morbidity. Scars are unnoticeable, wrist mobility and strength close to normal by three months, which is the delay for dorsal wrist pain, always very limited, to disappear. The recurrence rate is however still debatable. Close to zero in some series, we had almost 20% recurrence rate in our series, with half of patients who reccur after two years follow-up. This variability in the recurrence rate also exists with open techniques. The only prospective and randomized study available to date found no differences between the two techniques, according to the recurrence rate.

Arthroscopic resection of dorsal wrist ganglia

Arthroscopic treatment of dorsal wrist ganglia offers a viable alternative to open ganglionectomy. Although a relatively recent addition to the list of arthroscopic techniques, arthroscopic treatment of dorsal wrist ganglia has been reported to have a high rate of success, low rate of recurrence, more rapid and complete return of wrist motion, and a superior cosmetic results. A tangential arthroscopic approach to the ganglion and/or its stalk via the 1,2 and the 4,5 or 6U portals offers an alternative technique which may afford better visualization of the ganglion and added protection for the scapholunate interosseous ligament.

The treatment of dorsal wrist ganglia by radical excision

The dorsal wrist ganglion is the commonest benign soft-tissue tumour of the hand. Its treatment has been the subject of discussion for centuries, many methods being accompanied by an unacceptably high recurrence rate. Surgical extirpation gives the most reliable results and success has been said to depend on the identification of an unvarying deep attachment of the ganglion to the scapholunate ligament. A previous study has suggested that if this is excised, there will be no recurrences and no residual symptoms. Our experience of 62 dorsal ganglia confirms that although a scapholunate origin is usual, ganglia may also arise from a variety of additional sites over the dorsal wrist capsule, particularly in the region of the capitate. Two ganglia have recurred and clinical review of 52 (84%) of the cases has shown that persistent discomfort following excision is not uncommon. One patient appears to have developed scapholunate instability.

The treatment of dorsal wrist ganglia by radical excision.

The dorsal wrist ganglion is the commonest benign soft-tissue tumour of the hand. Its treatment has been the subject of discussion for centuries, many methods being accompanied by an unacceptably high recurrence rate. Surgical extirpation gives the most reliable results and success has been said to depend on the identification of an unvarying deep attachment of the ganglion to the scapholunate ligament. A previous study has suggested that if this is excised, there will be no recurrences and no residual symptoms. Our experience of 62 dorsal ganglia confirms that although a scapholunate origin is usual, ganglia may also arise from a variety of additional sites over the dorsal wrist capsule, particularly in the region of the capitate. Two ganglia have recurred and clinical review of 52 (84%) of the cases has shown that persistent discomfort following excision is not uncommon. One patient appears to have developed scapholunate instability.