Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 1, January, p. 95–102

doi: 10.17219/acem/81202

Publication type: original article

Language: English

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Dorsal and volar wrist ganglions: The results of surgical treatment

Sebastian Kuliński1,A,B,C,D, Olga Gutkowska1,B,C,E, Sylwia Mizia2,C,F, Jacek Martynkiewicz1,B,C,E, Jerzy Gosk1,A,C,E,F

1 Clinic of Traumatology and Hand Surgery, Department of Traumatology, Wroclaw Medical University, Poland

2 Division of Organization and Management, Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, Poland

Abstract

Background. The wrist, especially its dorsal surface, is the most common location of ganglion cysts in the human body.
Objectives. 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.
Material and Methods. 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.
Results. 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.
Conclusion. 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.

Key words

surgery, wrist, ganglion cysts, benign tumors

References (30)

  1. Dermon A, Kapetanakis S, Fiska A, Alpantaki K, Kazakos K. Ganglionectomy without repairing the bursal defect: Long-term results in a series of 124 wrist ganglia. Clin Orthop Surg. 2011;3(2):152–156. doi:10.4055/cios.2011.3.2.152
  2. Teefey SA, Dahiya N, Middleton WD, Gelberman RH, Boyer MI. Ganglia of the hand and wrist: A sonographic analysis. AJR Am J Roentgenol. 2008;191(3):716–720. doi:10.2214/AJR.07.3438
  3. Shoaib A, Clay NR. Ganglions. Curr Orthop. 2002;16(6):451–461. doi:10. 1054/cuor.2002.0289
  4. Azzopardi EA, Gujral S, Mandal A, Kulkarni M. Rapidly expanding thenar eminence ganglion: A case report. Cases J. 2009;2:129. doi:10. 1186/1757-1626-2-129
  5. Minotti P, Taras JS. Ganglion cysts of the wrist. Journal of the American Society for Surgery of the Hand. 2002;2:102–107.
  6. Angelides AC. Ganglions of the hand and wrist. In: Green DP, Hotchkiss RN, Pederson WC, eds. Green’s Operative Hand Surgery. 3rd ed. Philadelphia, PA: Churchill Livingstone; 1998:2171–2183.
  7. Gude W, Morelli V. Ganglion cysts of the wrist: Pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med. 2008;1(3–4):205–211. doi:10.1007/s12178-008-9033-4
  8. Burke FD, Melikyan EY, Bradley MJ, Dias JJ. Primary care referral protocol for wrist ganglia. Postgrad Med J. 2003;79(932):329–331.
  9. Craik JD, Walsh SP. Patient outcomes following wrist ganglion excision surgery. J Hand Surg Eur Vol. 2012;37(7):673–677. doi:10.1177/ 1753193411434376
  10. Dias J, Buch K. Palmar wrist ganglion: Does intervention improve outcome? A prospective study of the natural history and patient-reported treatment outcomes. J Hand Surg Br. 2003;28(2):172–176.
  11. Wong AS, Jebson PJ, Murray PM, Trigg SD. The use of routine wrist radiography is not useful in the evaluation of patients with a ganglion cyst of the wrist. Hand (N Y). 2007;2(3):117–119. doi:10.1007/s11552-007-9032-8
  12. Limpaphayom N, Wilairatana V. Randomized controlled trial between surgery and aspiration combined with methylprednisolone acetate injection plus wrist immobilization in the treatment of dorsal carpal ganglion. J Med Assoc Thai. 2004;87(12):1513–1517.
  13. Singhal R, Angmo N, Gupta S, Kumar V, Mehtani A. Ganglion cysts of the wrist: A prospective study of a simple outpatient management. Acta Orthop Belg. 2005;71(5):528–534.
  14. Rocchi L, Canal A, Fanfani F, Catalano F. Articular ganglia of the volar aspect of the wrist: Arthroscopic resection compared with open excision. A prospective randomised study. Scand J Plast Reconstr Surg Hand Surg. 2008;42(5):253–259. doi:10.1080/02844310802210897
  15. Gallego S, Mathoulin C. Arthroscopic resection of dorsal wrist ganglia: 114 cases with minimum follow-up of 2 years. Arthroscopy. 2010; 26(12):1675–1682. doi:10.1016/j.arthro.2010.05.008
  16. Westbrook AP, Stephen AB, Oni J, Davis TR. Ganglia: the patient’s perception. J Hand Surg Br. 2000;25(6):566–567.
  17. Jacobs LG, Govaers KJ. The volar wrist ganglion: Just a simple cyst? J Hand Surg Br. 1990;15(3):342–346.
  18. Aydin A, Kabakaş F, Erer M, Ozkan T, Tunçer S. Surgical treatment of volar wrist ganglia. Acta Orthop Traumatol Turc. 2003;37(4):309–312.
  19. Finsen V, Håberg O, Borchgrevink GE. Surgery for ganglia of the flexor tendon sheath. Orthop Rev (Pavia). 2013;18;5(1):e6. doi:10.4081/or.2013.e6
  20. Lister GD, Smith RR. Protection of the radial artery in the resection of adherent ganglions of the wrist. Plast Reconstr Surg. 1978;61(1):127–129.
  21. Dias JJ, Dhukaram V, Kumar P. The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol. 2007;32(5):502–508.
  22. Lidder S, Ranawat V, Ahrens P. Surgical excision of wrist ganglia: Literature review and nine-year retrospective study of recurrence and patient satisfaction. Orthop Rev (Pavia). 2009;1(1):e5. doi:10.4081/or.2009.e5
  23. Rollins KE, Ollivere BJ, Johnston P. Predicting successful outcomes of wrist and finger ganglia. Hand Surg. 2013;18(1):41–44. doi:10.1142/S021881041350007X
  24. Humail SM, Abidi AR, Haq SNU, Mustafa GKK. Comparative study of two methods for treatment of dorsal wrist ganglion. J Pak Orthop Assoc. 2010;22:53–57.
  25. Yamamoto M, Natsume T, Kurimoto S, et al. Patients with benign hand tumors are indicated for surgery according to patient-rated outcome measures. J Plast Reconstr Aesthet Surg. 2017;70(4):487–494. doi:10.1016/j.bjps.2016.12.010
  26. Osterman AL, Raphael J. Arthroscopic resection of dorsal ganglion of the wrist. Hand Clin. 1995;11(1):7–12.
  27. Kang L, Weiss APC, Akelman E. Arthroscopic versus open dorsal ganglion cyst excision. Oper Tech Orthop. 2012;22(3);131–135.
  28. Rocchi L, Canal A, Pelaez J, Fanfani F, Catalano F. Results and complications in dorsal and volar wrist ganglia arthroscopic resection. Hand Surg. 2006;11(1–2):21–26.
  29. Rizzo M, Berger RA, Steinmann SP, Bishop AT. Arthroscopic resection in the management of dorsal wrist ganglions: Results with a minimum 2-year follow-up period. J Hand Surg Am. 2004;29(1):59–62.
  30. Chassat R, Nourissat G, Chaumeil G, Dumontier C. Arthroscopic treatment of dorsal ganglion cyst at the wrist. About 54 cases. Chir Main. 2006;25(3–4):146–151.
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