Volar Ganglion Research Articles

Incidence of Dorsal Radiocarpal Ligament Tears in the Presence of Other Intercarpal Derangements

The aim of this study was to examine the incidence of dorsal radiocarpal ligament (DRCL) tears in patients who underwent wrist arthroscopy for chronic pain. A chart review was performed of 64 patients who underwent diagnostic wrist arthroscopy for wrist pain. Interosseous ligament instability/tears were graded according to the Geissler classification. Tears of the triangular fibrocartilage complex (TFCC) and other intracarpal pathology were documented. Any DRCL tears were noted. The average duration of wrist pain before arthroscopy was 20 months. There were 35 of 64 patients with DRCL tears. The average duration of wrist pain before treatment was 20 months (range, 4 to 60 months). There were 5 patients who had an isolated DRCL tear. Thirteen patients in this series had a scapholunate interosseous ligament (SLIL) derangement; 7 of 13 also had a DRCL tear. Seven patients had a lunotriquetral interosseous ligament (LTIL) derangement; 2 of 7 also had a DRCL tear. Two patients had a capitohamate ligament tear; 1 of these patients also had a DRCL tear. There were 7 patients with a solitary TFCC tear; 6 of 7 were in association with a DRCL tear. One patient had a chronic ulnar styloid nonunion and a DRCL tear. Two or more lesions were present in 23 patients; DRCL tears were present in 12 of 23 patients. Three patients had generalized arthrofibrosis; 1 had a volar ganglion and 2 had a normal examination. None of these were associated with DRCL tears. DRCL tears are commonly seen with injuries to the SLIL, the LTIL, and the TFCC. Isolated DRCL tears should be treated with an arthroscopic repair. DRCL repairs in the presence of other intracarpal pathologies requires further study. Level IV, therapeutic case series.

Arthrographische Darstellung von Ganglien im Handbereich

In the genesis of ganglions synovial herniation is discussed with an existence of a valve mechanism which prevents the synovial fluid from returning into the joint space. Arthrography of the wrist was performed in 34 patients with suspicion of ganglions on the dorsal and volar aspect of the wrist. By injection of contrast medium in 6 cases directly into the ganglion no connection with the carpal joint cavity was seen. On the contrary, wrist arthrography with examination of the midcarpal and radiocarpal joint showed regularly a communication by a torturous narrow duct between the midcarpal joint and the dorsal ganglion and the radiocarpal joint and the volar ganglion. Other pathologic findings were seen, like tears of the scapholunate ligament and of the triangular fibrocartilage. The consequences for surgical therapy and conclusions for the aetiology of the ganglions are shown.

Articular ganglia of the volar aspect of the wrist: Arthroscopic resection compared with open excision. A prospective randomised study

Our aim was to compare two methods of treatment of ganglia on the volar aspect of the wrist (the open excision done through a longitudinal volar skin incision and the arthroscopic resection through two or three dorsal ports), to see if arthroscopy could reduce the risks of operating in this area and the time to healing. Twenty radiocarpal and five midcarpal volar ganglia were operated on by open approach and an equivalent group was treated by arthroscopy. Fifteen radiocarpal and five midcarpal ganglia were treated with good results in the open group and 18 radiocarpal and one midcarpal ganglia in the arthroscopic group (no visible or palpable ganglion, a full range of active wrist movement, grip strength equal to preoperatively, no pain, and a cosmetically acceptable scar). In the open group there were four injuries to a branch of the radial artery, two cases of partial stiffness of the wrist associated with a painful scar, one case of neuropraxia, and one recurrence (all of which were among the 20 radiocarpal ganglia). In the arthroscopic group there was one case of neuropraxia, one injury to a branch of the radial artery, and three recurrences (three of the complications were among the five midcarpal ganglia). The mean functional recovery time was equal to 15 (6) days in the open group and 6 (2) days in the arthroscopic group. The mean time lost from work was equal to 23 (11) days in the open group and 10 (5) days in the arthroscopic group. Our results suggest that arthroscopic resection is a reasonable alternative to open excision in treating radiocarpal volar ganglia because it has less postoperative morbidity and a better cosmetic result. Midcarpal volar ganglia, however, should still be treated by open operation.

Sonography of Wrist Ganglion Cysts

In our clinical practice, we have noted wrist ganglion cysts that do not fulfill the criteria for simple cysts. This study retrospectively evaluated the sonographic features of wrist ganglia. After Institutional Review Board approval, medical records from 1993 through 2003 were searched using International Classification of Diseases, Ninth Revision codes and key words, and sonography log books from 2000 through 2004 were reviewed, which identified 20 wrist ganglion cysts in 16 patients that were proven at surgery or aspiration. A retrospective review of sonographic images was carried out by 2 musculoskeletal radiologists by consensus. Images were evaluated for cyst location, volume, largest dimension, joint or tendon extension, echogenicity, septations, internal echogenicity, posterior acoustic enhancement, margins, lobularity, and vascularity. Of the 20 wrist ganglia, 15 were volar (10 between the flexor carpi radialis and the radial artery), and 5 were dorsal (2 over the scapholunate ligament). The mean volume was 2081 mm3 (range, 90-15,000 mm3), and the mean largest dimension was 17.3 mm (range, 7-30 mm). Seven volar ganglia showed joint communication. Ten ganglia were anechoic; 7 were hypoechoic; and 3 had anechoic and hypoechoic areas. Eight had septations; 8 had internal echogenic areas; 15 had posterior acoustic enhancement; 13 had well-defined margins; 12 were lobular; and none were vascular. Cysts that were anechoic (P < .0001) or with posterior acoustic enhancement (P = .04) were significantly larger than those that were hypoechoic or without posterior acoustic enhancement. Small wrist ganglion cysts (< or = 10 mm in the mean largest dimension) often appear hypoechoic without posterior acoustic enhancement and do not fulfill the criteria for a simple cyst.

RESULTS AND COMPLICATIONS IN DORSAL AND VOLAR WRIST GANGLIA ARTHROSCOPIC RESECTION

The authors present the procedure and results of five years of arthroscopic treatment of wrist radiocarpal and midcarpal ganglia. Thirty cases of dorsal ganglia and seventeen cases of volar ganglia were operated on arthroscopically. The technique was easy to perform in all the radiocarpal ganglia, not easy in midcarpal dorsal ganglia and very difficult in midcarpal volar ganglia. The results were recorded with a mean follow-up of 15 months. Twenty-seven cases of dorsal ganglia and twelve cases of volar ganglia had excellent results with active motion recovery, no complications, absence of scars and no recurrence. Two cases had a recurrence. There were four complications: a case of injury of a radial artery branch, a case of extensive haematoma, and two cases of neuropraxia. In three cases the procedure was converted into open surgery: they had a longer time of healing and a residual scar. The arthroscopic resection has been in our experience effective and safe for the treatment of all radiocarpal ganglia. Good results have been obtained also in the treatment of dorsal midcarpal ganglia. Concerning the uncommon cases of volar midcarpal (STT) ganglia, an open approach seems still indicated.

Arthroscopic resection of volar ganglion of the wrist: A new technique

We evaluated a new arthroscopic technique for treating volar ganglion of the wrist. Arthroscopic resection of volar wrist ganglion was performed under local anesthesia to the portal sites. Arthroscopic instruments were introduced dorsally, and the intra-articular lesion at the interval between the radioscaphocapitate (RSC) and long radiolunate (LRL) ligaments was debrided under direct view. Mucinous content of the ganglion was evacuated using suction, but the ganglion sac was not removed. The technique was successful in 5 cases between August 1997 and November 1998, with an average surgery time of 55 minutes. No complications or recurrence occurred at a mean follow-up of 16.4 months. This is the first report of arthroscopic decompression of volar wrist ganglions and provides new insight into the etiology of these lesions.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 2 (February), 2003: pp 218–221

The Hand Patient: Volar Ganglion of the wrist

No abstract available.

The simple wrist ganglion--more than a minor surgical procedure?

The operative results of 59 wrist ganglions over a ten-year period are reported. The mean follow-up time was 65 months (range: 6-133). The indication for operation was pre-operative pain in 68% of cases (40 ganglions) and cosmetic deformity in 32% of cases (19 ganglions). There were six recurrences (10%) at a mean duration of 40 months post-operatively (range: 5-70). There was no statistical differences between recurrences comparing dorsal versus volar ganglions using the chi-squared analysis. Two occult recurrences were detected on follow-up ultrasound examination giving an overall recurrence rate of 14%. Despite 92% of patients being satisfied with the operative procedure, there were 16 patients (28%) who had either persistent pain, limitation of function, were unsatisfied or had a recurrence. These results show that treatment of a simple ganglion is more than just a minor operation.

Treatment of Carpal and Digital Ganglions by Simple Aspiration, or Aspiration and Injection of Corticosteroid And/Or Hyaluronidase

This retrospective study examined the treatment outcome of 178 carpal and digital ganglion cysts by simple aspiration or aspiration and injection of corticosteroid (triamcinolone acetonide 40 mg/mL) and/or hyaluronidase in 174 patients between 1987 and 1995. A total of 106 ganglions were treated with aspiration and triamcinolone acetonide injection; the cumulative cure rates were 45.3%, 50.0% and 53.8% following one, two or three treatments, respectively. The cure rates were similar in 23 ganglions in the hyaluronidase group: 43.5%, 52.2% and 56.5%, respectively. Seventeen of the 23 ganglions treated with a combination of triamcinolone acetonide and hyaluronidase recurred, yielding success rates of 17.4% and 26.1% following two or three treatments, respectively. Twenty-six ganglions were treated with simple aspiration. Of these, 23 were volar digital ganglions. The success rates were 61.5% and 69.2% following one or two treatments, respectively. The overall success rate was 94 of 178 (52.8%) after a maximum of three treatments, regardless of the type of treatment and the anatomical location of the ganglions. This study provided baseline data following nonoperative management of ganglions; the data can be compared with those from a planned prospective randomized clinical trial involving the use of rolitetracycline as a sclerosing agent, which is currently under review by the Ethics Committee at the authors’ institution.

Ganglia in children.

Sixty-one children with ganglia treated surgically at the Singapore General Hospital were reviewed. At the wrist the predominance of dorsal ganglia over volar ganglia, which is the pattern in adults, was found only in older children. In children less than 10 years old, volar ganglia predominated. A high recurrence rate (36%) following surgery was observed, putting in question the value of surgery. An expectant regimen is therefore advocated at first. A modified technique for excision of volar wrist ganglia without attendant risk to the radial vessels is discussed.