Ganglion Excision: Wrist

• Patient preference
• Symptomatic ganglia
• Secondary changes due to ganglia, such as pressure atrophy

• Needle rupture of radial-side volar ganglia
• Risk damaging the radial artery

• 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

• 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)

• 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%

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%

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