Volar Ganglion Research Articles

Outcome of Aspiration Alone and Aspiration with Instillation of Steroid in Ganglion Cyst of Wrist- A Comparative Study

Background: Ganglion cysts are common soft tissue swellings of hand and wrist. Main concerns patients have are the cosmetic appearance and the fear of future malignancy. Various modalities of treatment are available but known to have high rate of recurrence. Here we study mainly the recurrence rate after aspiration alone and aspiration with instillation of steroid, to compare these minimally invasive procedures that can help to treat and give symptomatic relief from this commonly occurring problem. Methodology: A Prospective, Comparative study was carried out with purposive sampling to include all patient of Ganglion cyst of wrist. After detail counseling, Patient desired among Aspiration only and Aspiration with instillation of Steroid randomly. All cases were followed up on 3rd, 6th and 12th month. Recurrence data were collected and all data were arranged and analyzed. Result: Total 113 patients were included in our study, Male female ratio was 1:1.3, Mean age was 31.3 years. 74(65.5%) patient had ganglion on right wrist and 39 (34.5%) patient had it on left wrist. Dorsal ganglion was 89 (78.8%) and Volar ganglion was 24 (21.2%). In this study 58 (51.3%) patient underwent Aspiration alone, among them total 22 (37.9%) had recurrence. 12 (20.7%) had recurrence of the ganglion within 3 months, followed by 6(10.3%) within 6 month and 4 (6.9%) within 12 month. Aspiration with instillation of steroid was done in 55 (48.7%) patients. Recurrence within 1 year was found in total 16 (29.1%) cases. 4 (7.3%) had recurrence within 3 month and 6 (10.9%) cases each had recurred within 6 and 12 month respectively. Dorsal and Volar ganglion had similar recurrence rate i.e 33% irrespective of type of procedure. Conclusion: We may conclude that Aspiration with instillation of steroid had better outcome than Aspiration alone but both have significant recurrence rate. J Bangladesh Coll Phys Surg 2023; 41: 108-113

Volar Ganglion Cyst and Echo-Guided Assistance for the Arthroscopic Removal.

The ganglion of the wrist is very common but with uncertain prognosis. The arthroscopic resection seems to improve the result compared with open procedure, in decreasing recurrence and morbidity. Volar ganglions are close to the radial artery, the flexor pollicis longus tendon, and even the median nerve. Ultrasonography combined with arthroscopy offers incomparable safety for the resection of volar ganglions. The technical steps of this combined procedure are described, and the first published series are discussed.

PROMIS Measures in Patients with Ganglion Cysts: Who Chooses Surgical Excision Over Non-Operative Management?

Background: Ganglion cysts are common soft tissue masses of the hand and wrist. It is unclear why some patients pursue surgical excision and others do not. The objective of this study is to compare Patient-Reported Outcomes Measurement Information Systems (PROMIS) scores between patients with ganglion cysts undergoing surgical versus non-surgical treatment. Methods: Patients presenting to a tertiary, academic hand clinic diagnosed with a wrist ganglion cyst, based on clinical exam, were identified. PROMIS Physical Function (PF), Pain Interference (PI), and Depression scores at the time of diagnosis were reviewed. Data were then stratified according to surgical or non-surgical intervention, with subgroup analysis of dorsal versus volar ganglions and patients that chose to trial cyst aspiration. All results were compared utilizing the appropriate statistical methods. Results: Of 757 ganglion cyst patients, 264 underwent surgical excision and 493 were treated non-surgically. No difference was noted in PROMIS PF or Depression scores. However, the surgical cohort reported significantly increased preoperative PI scores (Table 2). A higher percentage of patients treated non-surgically received an aspiration attempt compared to those who ultimately received surgery (Table 3). Finally, patients with volar ganglion cysts had significantly increased PI and depression scores, as well as lower PF scores (Table 4). Conclusions: Presenting PROMIS PI may indicate an increased tendency to pursue surgical treatments and aid in the identification of ganglion cyst patients who are more likely to pursue surgical excision. Further research should focus on correlating absolute differences in PROMIS values with clinical significance.

Buerger's Disease And Avascular Necrosis Of The Scaphoid

HISTORY: 58 year old right-hand dominant, who comes in today for evaluation of her right wrist. She awoke 1.5-2 years ago one morning with pain. Denies any trauma or falls. She saw her PCM for what was presumed to be carpal tunnel syndrome, and was supposed to be sent to a specialist; however, this did not happen. Not seen again until late July 2020 with another provider. She reports intermittent pain but predominantly stiffness and limited flexion of her wrist. Cannot lift objects heavier than a gallon of milk. Reports carpal tunnel surgery in the same wrist in 1985. Reports a 24 pack-year history and is actively trying to quit. PHYSICAL EXAMINATION: Examination revealed swelling overlying the distal radius. Flexion of the right wrist was limited to 10 degrees, and extension was limited to 45 degrees. She demonstrated normal function of the FDS/FDP/FHL tendons, along with all of her extensor tendons. Sensation to light touch was in-tact in the median, radial, and ulnar nerve distributions. DIFFERENTIAL DIAGNOSIS: 1. Avascular necrosis of the scaphoid 2. Severe osteoarthritis of the radioulnar joint 3. Scapholunate dissociation TEST AND RESULTS: XRay of the right wrist-Chronic scaphoid avascular necrosis. MRI of the right wrist without contrast 1. Fragmentation, flattening, and partial collapse of the sclerotic edematous scaphoid, with mild volar flexion, with possible chronic osteonecrosis. 2. Severe osteoarthritis at the radiocarpal joint with high-grade cartilage injury, synovitis, capsular sprain, and small volar ganglion cysts. 3. Chronic appearing scarring and degeneration of the scapholunate ligament and TFCC. 4. Mild tenosynovitis and mild tendinosis of the tendons within the first and second extensor compartments. FINAL/WORKING DIAGNOSIS: Avascular necrosis of the scaphoid as a result of Buerger's Disease TREATMENT AND OUTCOMES: 1. Smoking cessation 2. Celestone injection of the scaphoid by Ortho-Hand Surgery 3. Thumb spica splint 4. Follow-up as needed

Application of Henna as a Durable Skin Marker in Orthopedic Surgery.

BackgroundMany orthopedic procedures require skin marking well before surgery. Marks made with most conventional marking pens fade with vigorous skin preparation required before orthopedic procedures, whereas marks with henna may safely last almost up to three weeks. Thereby, we intend to describe applications of henna, a readily available, cost-effective material, as a durable skin marker for various indications in orthopedics.MethodsA total of 120 patients with varied indications for skin marking were randomized into two equal-sized groups of 60 each. Group A patients were marked with henna and group B patients with a permanent skin marker before the intended surgery. All patients had a routine pre-operative bath one day before surgery and vigorous skin preparation using chlorhexidine and ethanol-based scrubs just before surgery in the operating room. The two markers were compared for the following variables: photographic record to determine fading of the mark after scrubbing, in terms of successful execution of the procedure, patients’ acceptability of the mark, any allergy or infection, and final time of disappearance of the mark.ResultsMarking with henna was clearly visible during all but one surgical procedure even after vigorous pre-operative skin preparation, thereby ensuring minimal use of fluoroscopy in henna-marked patients. The fading of the mark and use of fluoroscopy was significantly low in group A (p<0.05). There was no complication associated with marking with either marking method. Marks with henna disappeared on an average nine days later than with permanent marker. In terms of acceptability of mark, henna was preferred by almost all patients.ConclusionsHenna paste is an ideal substance for use as a skin marker in conditions, such as foreign body removal, vertebral level identification, nail dynamization, marking tibial physis in children, and sequestrum in non-discharging osteomyelitis, and in marking blood vessel course in tumor surgery or in volar ganglion removal. Pre-operative skin marking with henna ensures minimal use of fluoroscopy, and it is particularly efficacious when ultrasound is used for localization as it can be directly applied over gel film.

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.

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.

Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series.

Objectives To describe the technique and results of the arthroscopic surgical treatment of volar ganglion cyst of the wrist. Materials and Methods The present study comprised 21 patients submitted to the arthroscopic treatment of volar ganglion cysts of the wrist from January 2015 to May 2017, with a full evaluation for at least 6 months. The technique was indicated for patients presenting pain and functional impairment for more than four months, with no improvement with the conservative treatment, or for those with cosmetic complaints and cyst present for more than three months. Results The mean age of the patients was 43.6 years; 16 (76%) patients were female, and 5 (24%) were male. The mean follow-up time from surgery to the final assessment was of 10.9 months. A total of 2 (9.6%) patients complained of mild pain after the procedure, and another patient presented slight motion restrictions. The 18 (90.4%) remaining patients reported cosmetic improvement, complete functional recovery, and pain improvement. There were no recurrences or infections. No patient required further surgery. Conclusions The arthroscopic resection of volar ganglion cysts is a useful and safe technique. It is a minimally-invasive procedure, with low morbidity and very few complications, representing a good alternative to the open technique.

A volar ganglion cyst on the wrist imitating thrombosed radial artery pseudoaneurysm

A 57-year old male patient presented to the outpatient clinic with swelling in his left wrist causing pain and numbness in his fingers. The patient had undergone multiple cardiovascular angiographic interventions in the past. The first diagnosis was thrombosed radial artery pseudoaneurysm. The intraoperative diagnosis was the volar ganglion cyst. In this report, we emphasize the importance of the complications after transradial arterial catheterizations and present our experience.

Aspiration and methylprednisolone injection to the cavity with IV cannula needle in the treatment of volar wrist ganglia

Objective:There are several types of treatment modalities recommended for wrist ganglions. The purpose of this study was to evaluate the effectiveness of cyst aspiration and methyl prednisolone acetate injection by usingdouble IV cannula, as a new technique involar ganglia treatment. Methodology:The study involves total of 24 patients who received treatment by aspiration and methyl prednisolone injection into the cavity. Two IV cannulas are pricked to the cystic cavity. Cyst fluid is drained by the distally placed IV cannula meanwhile injecting methyl prednisolone by proximally placed IV cannula. The patient records and follow-up reports are retrospectively investigated. The patient age, sex, site of the cyst, the treatment that was applied, adjacency to the artery and the nerves and recurrence are recorded. Results:The study involved 24 patients that received aspiration treatment for volar ganglion cysts between June 2011 and July 2014. Patients mean follow up time was2.4 ±0.2 years. There were 16 (63.3%) female and 8 (36.6%) male subject with volar wrist ganglia. The mean age of the patients was 30.63±6.8 years. This study didn’t reportany complication related to methyl prednisolone injection and arterial ischemia. Recurrence was observed in 4 (16.6%) patients. Conclusion:This method is found to be associated with lower recurrence rate than other aspiration therapy. We highly recommend to use IV cannula needle for ganglionic cyst aspiration and methyl prednisolone injection in treatment of volar ganglia prior to any surgical intervention.

Endoscopic Ganglionectomy of the Volar Radial Wrist Ganglion

Volar ganglion cyst of the wrist is a common hand problem faced by orthopaedic surgeons. Excision is indicated if it is painful. Arthroscopic ganglionectomy of the wrist ganglion has been reported with the advantage of minimally invasive surgery. Most of them involve elimination of the valvular mechanism and internal drainage of the ganglion fluid to the wrist joint. The access of the ganglion sac is limited especially for a multiloculated cyst. The purpose of this Technical Note is to report the technique of endoscopic resection of the volar radial wrist ganglion. This can ensure complete resection of the ganglion sac especially for the multiloculated one.

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.

Safety and Efficacy of Arthroscopic Volar Carpal Ganglion Excision: An Anatomic and Clinical Study

ABSTRACT Purpose Arthroscopic ganglionectomy is a viable alternative to open treatment and has widely been applied to treatment of dorsal ganglion pathology. The technique of arthroscopic volar carpal ganglion excision has recently been developed, and there is little peer-reviewed clinical evidence detailing its safety and efficacy. This study aims to present our experience with the development and implementation of this technique. Materials and methods In the anatomic portion of the study, three cadaver arms were positioned for wrist arthroscopy and dissected to determine the distance between the volar capsule and adjacent vital structures. Ten axial wrist MRIs were reviewed to further define the distance between the volar capsule and adjacent vital structures. In the clinical portion of the study, 15 patients (mean age 47 years) treated with arthroscopic volar carpal ganglion excision were evaluated. Final follow-up occurred at an average of 48 months (21-68 months). Fourteen patients completed a MHQ and 12 patients were able to return for clinical evaluation. Results The wrist dissection and the MRI both showed the radial artery, FPL and FCR to all be within 1 cm of the working area. The radial artery was adjacent to the capsule and at risk when the capsule was approached from the 6 R portal. Clinically, there was a small but significant difference in the Michigan Hand Questionnaire scores between the operative and nonoperative wrists postoperatively (93.3 vs 98.5, p = 0.004). There was one recurrence (6.7%), not requiring further surgery, and 1 complication (6.7%), which did require a secondary procedure. Mean time to return to work was 11.2 days (1-91 days, N = 11). Mean time to return to maximum function was 5.6 weeks (N = 11). There was a significant difference in mean wrist extension of the operative vs nonoperative wrist (58.8 vs 66.3°, p = 0.01, N = 12). There was no significant difference in mean flexion of the operative vs nonoperative wrist (71.7 vs 71.3°, p = 0.7, N = 11) or grip strength between operative and nonoperative wrists (31.8 vs 34.9 kg, p = 0.06, N = 12). Conclusion This small anatomic and clinical series demonstrates that arthroscopic volar carpal ganglion excision is a safe and effective procedure with a low recurrence rate. We no longer use the 6R portal when excising volar carpal ganglions. Level of evidence IV therapeutic Wray WH, Greenberg J, Vella JC. Safety and Efficacy of Arthroscopic Volar Carpal Ganglion Excision: An Anatomic and Clinical Study. The Duke Orthop J 2014;4(1):27-32.

A systematic review of complications and recurrence rate of arthroscopic resection of volar wrist ganglion.

The purpose of this systematic review is to determine the incidence of complications and the recurrence rate of a volar wrist ganglion following arthroscopic resection. We performed a systematic review of English and non-English articles using Google Scholar, Medline, and Web of Knowledge. Articles were screened for study inclusion by three independent reviewers using the terms "arthroscopic treatment of volar wrist ganglion" and "arthroscopic resection of volar wrist ganglion". (1) level I-V evidence, (2) documentation of the number of wrists subjected to surgery, (3) documentation of surgical techniques used on wrists, and (4) documentation of surgical or post-surgical complications and recurrence rate of a volar wrist ganglion after arthroscopic resection. A complication was defined as an adverse outcome that was directly related to the operative procedure. Between 2001 and 2012, 13 articles met the inclusion criteria. Two articles were excluded and 11 were reviewed. A total of 232 wrists underwent arthroscopic surgery with 14 recurrences. The recurrence rate ranged from 0 to 20%, with mean of 6.03%. There were 16 (6.89%) complications. There was no connection with the ganglion in six wrists, three haematomas, three cases of neuropraxia of the dorsal radial nerve, two partial lesions of the median nerve, and two lesions of a branch of the radial artery. Patients did not have a decrease in the arc range of motion. Treatment of volar ganglia of the midcarpal joint was technically difficult and associated with a higher number of complications. In general, arthroscopic resection results in fewer complications and lower recurrence rates than an open surgical approach, but there is no clear evidence of such an advantage for arthroscopic resection of a volar wrist ganglion. Additional prospective, controlled clinical trials will be essential to address this important issue.

Essential Hand Surgery Procedures for Mastery by Graduating Plastic Surgery Residents

This study was designed to establish the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. This framework can then be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach technical skills in hand surgery. Ten expert hand surgeons were surveyed regarding the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. The top 10 procedures from this survey were then used to survey all 89 Accreditation Council for Graduate Medical Education-approved plastic surgery program directors. There was a 69 percent response rate to the program director survey (n = 61). The top nine hand surgery procedures included open carpal tunnel release, open A1 pulley release, digital nerve repair with microscope, closed reduction and percutaneous pinning of metacarpal fracture, excision of dorsal or volar ganglion, zone II flexor tendon repair with multistrand technique, incision and drainage of the flexor tendon sheath for flexor tenosynovitis, flexor tendon sheath steroid injection, and open cubital tunnel release. Surgical educators need to develop objective methods to teach and document technical skill. The Objective Structured Assessment of Technical Skill is a valid method for accomplishing this task. There has been no consensus regarding which hand surgery procedures should be mastered by graduating plastic surgery residents. The authors have identified nine procedures that are overwhelmingly supported by plastic surgery program directors. These nine procedures can be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach and document technical skills in hand surgery.

Essential Hand Surgery Procedures for Mastery by Graduating Orthopedic Surgery Residents: A Survey of Program Directors

To establish the essential hand surgery procedures that should be mastered by graduating orthopedic surgery residents. This framework can then be used as a guideline for developing an Objective Structured Assessment of Technical Skill to teach and document technical skill in hand surgery. A select group of 10 expert hand surgeons was surveyed regarding the essential hand surgery procedures that should be mastered by graduating orthopedic surgery residents. The top 10 procedures from this survey were then used to survey all 155 American Council of Graduate Medical Education-approved orthopedic surgery program directors regarding the essential procedures that should be mastered by graduating orthopedic surgery residents. We had a 39% response rate to the program director survey. The top 8 hand surgery procedures as determined by the orthopedic surgery program directors included open carpal tunnel release, open A1 pulley release, open reduction internal fixation of distal radius fracture, flexor tendon sheath steroid injection, excision of dorsal or volar ganglion, closed reduction and percutaneous pinning of metacarpal fracture, open cubital tunnel release, and incision and drainage of flexor tendon sheath for flexor tenosynovitis. Surgical educators need to develop objective methods to teach and document technical skill. The Objective Structured Assessment of Technical Skill is a valid method to accomplish this task. However, there has been no consensus regarding which hand surgery procedures should be mastered by graduating orthopedic surgery residents. We have identified 8 procedures that were overwhelmingly supported by orthopedic surgery program directors. These 8 procedures can be used as a guideline for developing an Objective Structured Assessment of Technical Skill to teach and document technical skill in hand surgery. This study addresses the future of orthopedic surgery education as it pertains to hand surgery.

Aspiration and metilprednisolone injection to the cavity with branule needle in the treatment of volar wrist ganglia:new technique

Objective: There are several types of treatment modalities for wrist ganglions. The aim of the study was to assess the effectiveness of cyst aspiration and methyl prednisolone acetate injection with double IV cannula rather than sharp pointed needle, as a new technique in the treatment of volar ganglia. Methodology: The study involves total of 19 patients who received treatment by aspiration and methyl prednisolone injection into the cavity. Two IV cannulas are pricked to the cystic cavity. Cyst fluid is drained by the distally placed IV cannula meanwhile injecting methyl prednisolone by proximally placed IV cannula. The patient records and follow-up reports are retrospectively investigated. The patient age, sex, site of the cyst, the treatment that was applied, adjacency to the artery and the nerves and recurrence are recorded. Mean follow up time was 2.1±0.5 years. Results: The study involved 19 patients that received aspiration treatment for volar ganglion cysts between January 2004 and December 2009. There were 12 (63.2%) female and 7 (36.8%) male subject with volar wrist ganglion cyst. The mean age of patients was 27.63±6.6 years. Fourteen (73.7%) patients of total had cysts close to the artery. We didn’t observe any complication related to methyl prednisolone injection and arterial ischemia. Recurrence was observed in three (15.8%) patients. Conclusion: This method has lower recurrence rate than other aspiration therapy with sharp pointed needle. We prefer to use IV cannula needle for cyst aspiration and steroid injection in treatment of volar ganglia before any surgical intervention.

Ulnar Nerve Penetration by a Volar Ganglion in the Guyon Canal

Ulnar Nerve Penetration by a Volar Ganglion in the Guyon Canal

Surgical excision of wrist ganglia; literature review and nine-year retrospective study of recurrence and patient satisfaction

The main options for the treatment of wrist ganglia are reassurance, aspiration, arthroscopic resection and open excision. Variations within each option have been described and the literature is clouded by widespread variability in the results reported. We present the results of our own long-term retrospective study, review the literature and question the surgical risks and demands placed on healthcare resources. A retrospective review of the surgical results of dorsal and volar wrist ganglia excision between January 1998 and March 2005 was undertaken at a single institution. Of the 152 patients in this consecutive series, 117 (77%) patients responded to a telephone questionnaire. The mean length of follow-up in this series of 117 patients was 4.2 years (range 1.5–8.7 years). The overall recurrence rate following excision of all wrist ganglia in this series was 41.8 %. When looking just at volar ganglia, the risk of recurrence is higher at 46.8%. Should the ganglion recur, the risk of developing a moderate to severely tender scar is 34.6% and the risk of developing an unsightly scar is 8.2%. This study questions the effectiveness of surgical excision in the treatment of wrist ganglia when performed by a mixture of surgeons in that the recurrence rates are very similar to the rates seen in studies that merely observe or aspirate wrist ganglia. We propose that for symptomatic ganglia, specialists in hand surgery may be more appropriate at treating such a pathology.

Pediatric Ganglion Cysts of the Hand and Wrist: An Epidemiologic Analysis

We analyzed all hand and wrist ganglions in patients aged 12 years and younger that were treated at our institution during a 3-year period. Our patients were predominately female (1.8:1). Volar ganglions were more common (1.2:1), whereas dorsal ganglions have been reported to be more common in adults. Ganglions had a higher incidence of arising from tendon sheaths in our patients (33%) compared to what has been previously reported for ganglions in studies of all age groups (5% to 16%). While observation and/or splinting alone will likely be helpful in resolution of a majority of pediatric hand and wrist ganglions, surgical excision should be employed in those that are symptomatic and/or do not resolve with observation.