Wrist Ganglion Research Articles

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.

Arthroscopic excision of wrist ganglions: does trans-cystic or cystic-sparing portal technique affect clinical outcomes?

The preliminary results of arthroscopic wrist ganglionectomy were contradictory. The approach used for the arthroscopic excision of wrist ganglions may play an important role. We analyzed two surgical approaches for arthroscopic excision of wrist ganglions. Between April 2009 and October 2014, 49 patients with wrist ganglions who underwent arthroscopic excision in our institute were retrospectively classified into two treatment groups, namely the trans-cystic portal technique (TCP) and cyst-sparing portal technique (CSP). The visual analog scale (VAS), Mayo wrist scores, and disabilities of the arm, shoulder, and hand (DASH) scores were measured for clinical assessment. Recurrence, residual pain, and complications were evaluated at follow-up. No significant differences were found between the groups in terms of demographic data, and preoperative clinical assessment, as well as with regard to postoperative VAS score (p = 0.898), Mayo wrist score (p = 0.526), DASH score (p = 0.870), recurrence (p = 0.491), residual pain (p = 0.690), and complications (p = 0.352). Recurrence was found in 2 of the 47 patients and they were both in the CSP group. At the final follow-up, residual pain was found in four patients in the TCP group and three in the CSP group. For performing arthroscopic resection of wrist ganglions, both techniques are safe regarding the complication rates. In recurrence rate, no significant difference was found between the two groups, but no recurrence was observed when the TCP technique was used.

Ultrasound-Guided Aspiration Does Not Reduce the Recurrence Rate of Ganglion Cysts of the Wrist

Background Ganglion cysts are the most frequent soft tissue tumor encountered in the upper extremity and are commonly treated by aspiration or by surgical excision. Ultrasound is a promising addition to traditional aspiration, as it allows for visualization of the needle within the ganglion before aspiration. Questions Are ganglion cysts of the wrist less likely to reoccur if they are aspirated under ultrasound guidance versus "blind" aspiration without the use of ultrasound guidance? Does patient functionality change based on whether or not the cyst recurred? Patients and Methods In total, 52 patients were successfully contacted and recurrence rates were compared between those whose cyst was treated with ultrasound-guided (13 patients) with those whose cyst was treated with blind aspiration (39 patients). Mean follow-up time was 2.9 years. Results Recurrence rates were 69% (9 patients) and 74% (29 patients) for the ultrasound-guided and blind aspiration groups, respectively ( p -value: 0.73), showing no significant difference in recurrences of wrist ganglion between the two groups. A metric of functionality (Quick-DASH [Disabilities of the Arm, Shoulder, and Hand]) revealed worse outcomes in patients who experienced return of ganglion cyst after aspiration versus those who did not. Conclusion Additional studies with improved sample sizes are needed to demonstrate the superiority of ultrasound-guided aspiration versus blind aspiration. Due to a high recurrence rate following aspiration (both ultrasound-guided and blinded), a lower threshold for surgical intervention is likely reasonable. Level of Evidence This is a Level IIIb study.

Dorsal and volar wrist ganglions: The results of surgical treatment.

The wrist, especially its dorsal surface, is the most common location of ganglion cysts in the human body. The purpose of this study was to present our experience in the treatment of wrist ganglions and to evaluate the results obtained with the operative management of this type of lesion. A total of 394 patients (289 females and 105 males, aged 10-83 years) treated operatively for wrist ganglions between 2000 and 2014 were included in the study. The results of surgical treatment were evaluated after a minimal 2-year-long follow-up in 69.4% of patients operated on for dorsal wrist ganglions and in 70.6% of patients after the excision of volar wrist ganglions. The shape and size of postoperative scar, range of motion of the wrist, grip strength, severity of pain, and presence/absence of ganglion recurrence were assessed. The influence of demographic factors on the risk of recurrence was statistically analyzed. Persistent limitation of wrist palmar flexion was observed in 6 patients after the removal of dorsal wrist ganglions. There were no cases of postoperative grip strength weakening. An unesthetic scar developed in 15 patients after the excision of dorsal wrist ganglions and in 6 patients after the removal of volar wrist ganglions. Postoperative pain was observed in 7 patients with ganglion recurrence and in 17 patients without recurrence. Ganglion cysts recurred in 12.1% of patients treated for dorsal wrist ganglions and in 10.4% of patients operated on for volar wrist ganglions. No influence of patient gender, age, body side, or cyst location on ganglion recurrence was detected. Operative treatment is a widely recognized method of management of wrist ganglions. The rate of resulting persistent complications is low. Recurrence of ganglion cysts is unpredictable and independent of patient demographic factors. It can be observed even in cases, in which a perfect surgical technique has been used.

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.

Depression and Pain Interference Correlate With Physical Function in Patients Recovering From Hand Surgery.

Background: Patient-reported outcome measures vary more than expected based on underlying pathology, in part due to the substantial influence of mood and coping strategies. Methods: This study addressed the primary null hypothesis that the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function score 1 month (range, 3-8 weeks) after hand surgery is not associated with PROMIS Depression and PROMIS Pain Interference scores prior to surgery, accounting for other factors. Using an institution-wide database of routinely collected patient-reported outcomes, we identified adult patients who underwent wrist ganglion excision, trapeziometacarpal arthroplasty, hand ganglion excision, trigger digit, De Quervain, and carpal tunnel release. Measures collected included the PROMIS Physical Function Computerized Adaptive Test (CAT), PROMIS Pain Interference CAT, and PROMIS Depression CAT. We sought factors associated with postsurgical PROMIS Physical Function scores and change between preoperative and postoperative score using multivariable linear regression, accounting for age, sex, surgery type, provider, and time from surgery to postsurgical measurement. Results: Higher postoperative PROMIS Physical Function score was independently associated with lower PROMIS Pain Interference scores, lower PROMIS Depression scores, younger age, and treatment by provider team 3. Greater change in PROMIS Physical Function score was independently associated with greater PROMIS Pain Interference scores, greater time from surgery, and treatment by provider team 3. Conclusions: Mood and effective coping strategies affect the level of symptoms and limitations during recovery from hand surgery and represent important treatment opportunities for enhancing recovery.

Second Commentary on "Partial Wrist Denervation: The Evidence Behind a Small Fix for Big Problems".

Second Commentary on "Partial Wrist Denervation: The Evidence Behind a Small Fix for Big Problems".

Perioperative Antibiotics for Clean Hand Surgery: A National Study.

Given that surgical site infections remain a common performance metric in assessing the quality of health care, we hypothesized that prophylactic antibiotics are overutilized in soft tissue hand surgery when antimicrobials are not indicated. We studied insurance claims from the Truven MarketScan Databases to identify patients who underwent 1 of 5 outpatient hand surgery procedures: open or endoscopic carpal tunnel release, trigger finger release, de Quervain release, and wrist ganglion excision between 2009 and 2015 (n= 305,946). Hospital payment claims for preoperative intravenous antibiotics and prescriptions filled for postoperative oral antibiotics were analyzed. We examined the rate and temporal trend of prophylactic antibiotics use and identified risk factors using multivariable logistic regression. We also calculated health care expenditures related to prophylaxis. Prior to surgery, 13.6% (2009-2015) of patients received prophylactic intravenous antibiotics and trend analysis showed a statistically significant increase from 2009 (10.6%) to 2015 (18.3%), an increase of 72.5%. Preoperative prophylaxis was used most often prior to trigger finger release (17.5%) and least often prior to endoscopic carpal tunnel release (11.2%). Younger age, male sex, lower income, and obese patients had higher odds of receiving antibiotics. The total charge of prophylactic antibiotics medication used in this study equaled $1.6 million. In 2015, prophylactic intravenous antibiotics were administered to nearly 1 in 5 patients prior to clean soft tissue hand surgery. Although consensus guidelines indicate prophylaxis is not indicated, their use has increased steadily in the United States from 2009 to2015. Therapeutic II.

Pediatric Ganglion Cysts: A Retrospective Review

Background: Ganglion cysts are the most common type of soft tissue tumors of the hand. In the pediatric population, monitoring may be appropriate unless cysts are painful, interfering with range of motion or parental concerns exist. Reported recurrence rates after surgical removal of pediatric ganglion cysts vary widely in the literature. Notably, recurrence rates are higher for children than adults, ranging from as low as 6% to as high as 35%. Methods: A retrospective review was performed of a single pediatric hand surgeon's patients undergoing excision of primary and recurrent ganglion cysts from 2010 to 2015. Variables measured included patient age at diagnosis of ganglion cyst, time to presentation, location of cyst, hand dominance, previous therapy, previous surgery, length of surgery, tourniquet time, length of follow-up, any associated complications, and recurrence of cyst. Results: Ninety-six patients were identified with an average age of diagnosis 10.2 years. Indications for surgery: 95.8% for pain or decreased range of motion, 4.2% for cosmetic or parental concern. About 75% of the cysts were dorsally located, with the remaining 24.2% being volar. A total of 5 (5.3%) recurrences were recorded. Tourniquet time was on average 9.8 minutes longer for cases that resulted in recurrence. Multivariate analysis of the data demonstrated a 25% increased risk of recurrence with patients who had a previous aspiration. Conclusions: This is a retrospective review of a single pediatric hand surgeon's outcomes of pediatric wrist ganglion cysts. Our recurrence rate of 5.3% is low for a pediatric population indicating potential merit in this surgeon's operative and postoperative techniques. We demonstrate significantly increased rates of recurrence when a cyst had been previously aspirated, possibly indicating scarring and disruption of planes resulting in difficult dissection, increased tourniquet times, and incomplete excision.

Arthroscopic Resection of Dorsal Wrist Ganglion: Results and Rate of Recurrence Over a Minimum Follow-up of 4 Years.

Dorsal wrist ganglia are the most common soft tissue tumor type of the upper limb. Surgical resection, open or arthroscopic, is one of the most frequent procedures performed by hand surgeons. This study sought to perform an objective evaluation of the outcomes of arthroscopic resection of dorsal wrist ganglia and their recurrence rates over 4 years. Patients treated with arthroscopic resection were expected to have favorable outcomes and low complication rates after 4 years of follow-up. We evaluated 34 cases of dorsal wrist ganglia in patients who underwent arthroscopic resection. The patients were evaluated using the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) for pain, range of motion of the wrist, palmar grip strength, rates of recurrence, and complications. During the postoperative period, the QuickDASH score averaged 2.3 points, the mean residual pain by VAS was 0.54, full range of wrist movement was recovered by all patients, and the mean palmar grip strength was 29.4 kgf; there was 1 case with recurrence. There were no severe postoperative complications throughout the follow-up period. The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion.

A simple method for wrist ganglion staining with diluted surgical marking pen ink in arthroscopic resection and avoiding dye leakage-related subcutaneous discoloration

Arthroscopic resection of the wrist ganglion is commonly performed nowadays, and has a recurrence rate comparable to open excision. It is preferred by some surgeons due to the smaller and more cosmetic operative scar. When using the arthroscopic procedure, identification of the stalk of the ganglion can facilitate accurate resection. In order to achieve this, staining and enhancement of the ganglion through the use of surgical dye injection has been proposed by some surgeons. However, sterile surgical dye is sometimes not easily available, and leakage-related subcutaneous discoloration is sometimes a problem. We propose an easy method by using diluted surgical marking pen ink for wrist ganglion staining. Also, any subcutaneous leakage of the diluted dye, if it occurs, can be easily cleaned up during the arthroscopic ganglion resection.

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.

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;

Survey of hand surgeons’ and therapists’ perceptions of the benefit of common surgical procedures of the hand

Objective: The objectives of this survey were (1) to study if surgeons’ perceptions of the benefit of six surgical procedures differ if they consider themselves as patients instead of treating a patient, (2) to evaluate the role of five predetermined factors that may influence decision-making, and (3) to assess how uniformly hand surgeons and hand therapists perceive the benefits of the surgical treatments.Methods: The members of the national societies for Hand Surgery and Hand Therapy were asked to participate in the survey. Six patient cases with hand complaint (carpal tunnel syndrome, flexor tendon injury, dorsal wrist ganglion, thumb amputation, boxer’s fracture, and mallet fracture) and a proposed operative procedure were presented, and the respondents rated the procedures in terms of the expected benefit. Half of the surgeons were advised to consider themselves as patients when filling out the survey.Results: A survey was completed by 56 surgeons (61%) and 59 therapists (20%). Surgeons who considered themselves as patients had less confident perception on the benefit of carpal tunnel release compared with surgeons, who considered treating patients. Hand surgeons and hand therapists had similar perception of the benefits of surgery. The expected functional result was regarded as the most important factor in directing the decision about the treatment.Conclusions: Surgeons tended to be more unanimous in their opinions in cases, where there is limited evidence on treatment effect. The agreement between surgeons and therapists implies that the clinical perspectives are similar, and probably reflect the reality well.

Clinical observation on wheat grain-sized cone moxibustion combined with fire needle for dorsal wrist ganglion

To observe the clinical effect of wheat grain-sized cone moxibustion combined with fire needle therapy in the treatment of dorsal wrist ganglion (DWG). A total of 63 patients with DWG were randomized into a treatment group (n=32) and a control group (n=31). Cases in the control group were treated with fire needle therapy. Based on the therapy given to the control group, cases in the treatment group were additionally given wheat grain-sized cone moxibustion therapy. Then the therapeutic efficacies and recurrence rate were evaluated. After treatment, the overall effective rate was 93.8% in the treatment group, versus 77.4% in the control group, and the between-group comparison showed a statistical significance (P<0.05); 6 months after the treatment, the recurrence rate in the treatment group was obviously lower than that in the control group (P<0.05). The long-term and short-term effects of wheat grain-sized cone moxibustion combined with fire needle therapy in the treatment of DWG are better than those of fire needle therapy alone, and therefore, worth popularizing.

Ganglions of the hand and wrist: Retrospective statistical analysis of 520 cases.

Ganglions constitute the most common tumor type of the hand and wrist region. They have a non-neoplastic character and affect patients of all ages. The purpose of this work was to analyze the epidemiological data of a representative group of patients diagnosed with ganglions of the hand and wrist. Five-hundred-and-twenty patients operated on for ganglions of the hand and wrist between the years 2000 and 2014 were included in the study. For the statistical analysis, STATISTICA v. 10 was used. Categorical data was analyzed using the χ2. The distribution of two and more independent samples was compared through the Mann-Whitney U test and Kruskal-Wallis test followed by pairwise comparisons for significant test statistics, respectively. In the studied group of patients, ganglions affected females more often than males, with a 2.8 : 1 ratio. No statistically significant differences in age distribution between women and men (median age 38 vs. 40 years) were found. Ganglions affected both sides of the body with comparable equality. Wrist ganglions predominated (76%). The patients diagnosed with hand ganglions were statistically significantly older (p < 0.001), and the right hand was affected more often (p = 0.003). A statistically significant difference in age distribution between the patients with DWG (dorsal wrist ganglions) and VRG (volar retinacular ganglions) was observed (p < 0.001). DWG affected the left side (p = 0.003) and VRG the right side (p = 0.005) of the body more often. Statistical analysis of our patients confirmed much of the previously published data. Although the diagnosis and treatment of ganglions of the hand and wrist are relatively uncomplicated, the pathophysiology of their formation is still waiting to be thoroughly explained.

Causes of Residual Pain after Open Excision of Wrist Ganglion

Causes of Residual Pain after Open Excision of Wrist Ganglion

Comparison of efficacy of methyl prednisolone and triamcinolone in wrist ganglion using double dart technique and its application in an Indian population

Background: Ganglion cysts are benign soft-tissue tumors most commonly encountered in the wrist. Treatment modalities described for ganglion cysts include conservative therapy, aspiration, steroid injection, and surgical excision. The purpose of the study was to compare the efficacy of methyl prednisolone and triamcinolone in wrist ganglia using the double dart technique in an Indian population. Methods: All wrist ganglia (dorsal and volar) were included in the study. Patients with diabetes mellitus, tuberculosis, or rheumatoid arthritis were not included in the study. The patients included in the study were randomly divided in two groups: in one group (n=24), aspiration and methyl prednisolone acetate, 1 mL (40 mg) was injected, and in the other group (n=24) aspiration and triamcinolone acetonide, 1 mL (40 mg) was injected using the double dart technique. Results: Of the 48 patients included in the study, 36 (75%) were women and 12 (25%) were men, showing a female preponderance. The mean age of the patients was 37.18±6.38 yr. There was no significant difference between the methyl prednisolone group and the triamcinolone group in terms of recurrence (Fisher’s exact test, P=1.6). There were no complications in either group, but the triamcinolone group reported more pain at the injection site. Conclusions: Injection with methyl prednisolone is as effective as injection with triamcinolone and avoids post-injection pain.

Incidence and Risk Factors for Volar Wrist Ganglia in the U.S. Military and Civilian Populations

To identify the incidence and demographic factors associated with volar wrist ganglia in both military and civilian beneficiary populations. The U.S. Department of Defense Management Analysis and Reporting Tool (M2) accesses a comprehensive database of all health care visits by military personnel and their dependents. Because there is no specific code for ganglions of the wrist, the database was searched for all military personnel and civilian beneficiaries with an International Classification of Diseases, 9th Revision, diagnosis of 727.41 (ganglion of a joint) or 727.43 (ganglion, unspecified location) between 2009 and 2014. Two random samples of 1000 patients were selected from both the military and the civilian beneficiary cohorts, and their electronic medical records were examined to identify those with volar wrist ganglia. The proportion of volar wrist ganglia was then applied to the overall population data to estimate the total incidence with a 95% confidence interval and 5% margin of error. Unadjusted incidence rates and adjusted incidence rate ratios were determined using Poisson regression, controlling for age, sex, branch of military service, and military seniority. The unadjusted incidence of volar wrist ganglia is 3.72 per 10,000 person-years (0.04%/y) in female civilian beneficiaries, 1.04 per 10,000 person-years (0.01%/y) in male civilian beneficiaries, 7.98 per 10,000 person-years (0.08%/y) in female military personnel, and 3.73 per 10,000 person-years (0.04%/y) in male military personnel. When controlled for age, military personnel have a 2.5-times increased rate of volar wrist ganglia, and women have a 2.3-times increased rate. In the military cohort, female sex, branch of service, and seniority were significantly associated with the diagnosis of a volar wrist ganglion when controlled for age. In the civilian beneficiary cohort, only female sex was significant. Military service members have higher rates of volar wrist ganglia diagnoses than their age- and sex-matched civilian counterparts. Women are significantly more likely to be diagnosed with a volar wrist ganglion, regardless of age or military status. The epidemiology of volar wrist ganglia is poorly defined, and few studies have firmly defined demographic factors associated with the diagnosis. We provide the overall incidence rate of the diagnosis and report a significant association with female sex even when controlled for age.

Surgical Excision Versus Aspiration Combined with Intralesional Triamcinolone Acetonide Injection Plus Wrist Immobilization Therapy in the Treatment of Dorsal Wrist Ganglion; A Randomized Controlled Trial

Ganglion is the most common benign soft tissue tumour of hand and represents about 60-70% of all such soft tissue tumours. Treatment options include observation, aspiration, intralesional steroids and surgical and arthroscopic excision. Aspiration with intralesional steroid, with its many advantages, may be an alternative choice for its treatment but the operative treatment is the best method when considering the recurrence rate. To compare the result of surgical excision versus aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization therapy in the treatment of dorsal wrist ganglion. November 2007 to October 2009. 36 patients above 15years of age, having the disease for first time, having no history of wrist injury and with no history of use of steroid or any allergy to it, were selected for the study. The study was undertaken at SKIMS Medical College Hospital, Bemina Srinagar Kashmir. Patients were randomly allocated to undergo either surgical excision (group A, n = 18) or aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization (group B, n = 18) using table of random numbers. All the patients were operated under local anaesthesia. Fisher-exact-test, Chi-square test were used for statistics. The success rate of surgery was 94.4% and that of aspiration with triamcinolone acetonide injection plus wrist immobilization was 61.1%. The difference in success rate was statistically significant(p = 0.041). Surgery is the most successful form of treatment when considering the cure rate of dorsal wrist ganglion.