Ganglion Excision: Wrist

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Patient preference
  • Symptomatic ganglia
  • Secondary changes due to ganglia, such as pressure atrophy
CONTRAINDICATIONS
  • Needle rupture of radial-side volar ganglia
    • Risk damaging the radial artery
EQUIPMENT
  • No special equipment necessary for open excision
  • Arthroscopy
    • Finger traps attached to index, middle, and ring fingers with 3-4 kg of countertraction
    • 1.9 mm or 2.7 mm arthroscope
    • 2-mm or 2.9-mm full-radius shaver or end-cutting resector
ANATOMY
  • Scapholunate ligament links the scaphoid and lunate bones
  • There are six dorsal tendon compartments:
    • I: abductor pollicis longus, extensor pollicis brevis
    • II: extensor carpi radialis longus, extensor carpi radialis brevis
    • III: extensor pollicis longus
    • IV: extensor digitorum communis, extensor indicis
    • V: extensor digiti minimi
    • VI: extensor carpi ulnaris
  • Summary of dorsal ligaments during exposure
    • During the dorsal wrist ganglion approach, the following ligaments are identified and retracted ulnarly:
      • Extensor indicis proprius (EIP)
      • Extensor digitorum communis (EDC)
    • The following ligaments are identified and retracted radially:
      • Extensor carpi radialis brevis (ECRB)
      • Extensor carpi radialis longus (ECRL)
      • Extensor pollicis longus (EPL)

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
TECHNIQUES
  • Post-Procedure: Excision of Dorsal Wrist Ganglion
  • Post-Procedure: Excision of Volar Wrist Ganglion
  • Post-Procedure: Arthroscopic Resection of Dorsal Wrist Ganglion

Post-Procedure: Excision of Dorsal Wrist Ganglion

POST-PROCEDURE CARE
  • Splint wrist in mild extension for 2 weeks.
  • Remove sutures at 2 weeks.
  • Range of motion exercises are initiated after suture removal.
COMPLICATIONS
  • Recurrence
  • Joint stiffness
  • Scar sensitivity
  • Distal numbness
ANALYSIS OF RESULTS

Cure rates are best (94%) when the procedure is performed under general anesthesia or axillary block.

OUTCOMES AND EVIDENCE
  • Cure rates (Nelson et al)
    • General anesthesia or axillary block cyst removal: 94%
    • Local anesthesia and tourniquet cyst removal: 84%
    • Rupture by pressure or rupture with a needle after injection of cortisone: 65%
Procedure: Excision of Dorsal Wrist Ganglion

Post-Procedure: Excision of Volar Wrist Ganglion

POST-PROCEDURE CARE
  • Splint wrist in mild extension for 2 weeks.
  • Remove sutures at 2 weeks.
  • Range of motion exercises are initiated after suture removal.
COMPLICATIONS
  • Recurrence
  • Joint stiffness
  • Scar sensitivity
  • Distal numbness
ANALYSIS OF RESULTS

Cure rates are best (94%) when the procedure is performed under general anesthesia or axillary block.

OUTCOMES AND EVIDENCE
  • Cure rates (Nelson et al)
    • General anesthesia or axillary block cyst removal: 94%
    • Local anesthesia and tourniquet cyst removal: 84%
    • Rupture by pressure or rupture with a needle after injection of cortisone: 65%
Procedure: Excision of Volar Wrist Ganglion

Post-Procedure: Arthroscopic Resection of Dorsal Wrist Ganglion

POST-PROCEDURE CARE
  • Mobilize wrist twice a day.
  • Remove splint after 1 week.
  • Receive physiotherapy for 2 weeks.
  • Avoid strenuous work for at least 3 weeks.
COMPLICATIONS
  • Recurrence
  • Joint stiffness
  • Scar sensitivity
  • Distal numbness
ANALYSIS OF RESULTS

Cure rates and frequency of complications are similar for arthroscopic and open resection.

OUTCOMES AND EVIDENCE
  • Arthroscopic resection of dorsal wrist ganglions:
    • Luchetti et al
      • No complications and 2 recurrences at 16 months in 30 dorsal wrist ganglia
    • Rizzo et al
      • No major complications and 2 recurrences at 4 years in 41 patients
Procedure: Arthroscopic Resection of Dorsal Wrist Ganglion
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