Skip to main content

Advertisement

SpringerLink
Log in

Arthroscopic resection of occult dorsal wrist ganglia

  • Handsurgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Arthroscopic resection of dorsal wrist ganglia has become a well-accepted practice. However, there is a paucity of results on occult ganglia in the literature. The purpose of this study is to evaluate the subjective outcomes of occult dorsal wrist ganglion cysts resected arthroscopically, and to identify and examine intraarticular findings and relate them to pre-operative MRI findings and histologies.

Materials and methods

In 39 patients, 40 wrists were treated with arthroscopic resection of an occult dorsal wrist ganglion. Radio-carpal arthroscopy and mid-carpal arthroscopy were performed, and a capsular window overlying both compartments at the level of the scapholunate interval was created. The motivation to undergo operation for all patients was pain at rest and on load. In a retrospective study by telephone interview, patients were asked for pain reduction and satisfaction with the operation. 30 patients could be reached after 28.5 months on average.

Results

29 of the 30 patients were content with the operation. Reduction of pain at rest and on load was significant. MRI was performed pre-operatively in all the cases and could confirm the presence of a ganglion in 31 cases. Intraoperatively, ganglion structures were identified in 25 cases. Histology showed ganglion tissue or myxoid degeneration in 12 of 26 taken samples. Histology was positive in the cases without intraoperative visualization of typical ganglion structures and without confirmation by MRI.

Conclusion

The results of this study confirm that a high patient satisfaction can be achieved for arthroscopic treatment of occult dorsal wrist ganglia, which seem especially amenable for arthroscopic treatment. Furthermore, the results suggest that arthroscopic resection of a dorsal capsular window can be indicated if the complaints and the clinical findings are typical for dorsal wrist ganglion, even though MRI findings may be negative.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Osterman AL, Raphael J (1995) Arthroscopic resection of dorsal ganglion of the wrist. Hand Clin 11:7–12

    CAS  PubMed  Google Scholar 

  2. Chen AC, Lee WC, Hsu KY, Chan YS, Yan LJ, Chang CH (2010) Arthroscopic ganglionectomy through an intrafocal cystic portal for wrist ganglia. J Arthrosc Rel Surg 26:617–622

    Article  Google Scholar 

  3. Edwards SG, Johansen JA (2009) Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg Am 34:395–400

    Article  PubMed  Google Scholar 

  4. Gallego S, Mathoulin C (2010) Arthroscopic resection of dorsal wrist ganglia: 114 cases with minimum follow-up of 2 years. J Arthroscopic Rel Surg 26:1675–1682

    Article  Google Scholar 

  5. Ho PC, Griffiths J, Lo WN, Yen CH, Hung LK (2001) Current treatment of ganglion of the wrist. Hand Surg 6:49–58

    Article  CAS  PubMed  Google Scholar 

  6. Luchetti R, Badia A, Alfarano M, Orbay J, Indriago I, Mustapha B (2000) Arthroscopic resection of dorsal wrist ganglia and treatment of recurrences. J Hand Surg Br 25:38–40

    Article  CAS  PubMed  Google Scholar 

  7. Nishikawa S, Toh S, Miura H, Arai K, Irie T (2001) Arthroscopic diagnosis and treatment of dorsal wrist ganglion. J Hand Surg Br 26:547–549

    Article  CAS  PubMed  Google Scholar 

  8. Rizzo M, Berger RA, Steinmann SP, Bishop AT (2004) Arthroscopic resection in the management of dorsal wrist ganglions: results with a minimum 2-year follow-up period. J Hand Surg Am 29:59–62

    Article  PubMed  Google Scholar 

  9. Shih JT, Hung ST, Lee HM, Tan CM (2002) Dorsal ganglion of the wrist: results of treatment by arthroscopic resection. Hand Surg 7:1–5

    Article  PubMed  Google Scholar 

  10. Chloros GD, Wiesler ER, Poehling GG (2008) Current concepts in wrist arthroscopy. Arthroscopy 24:343–354

    Article  PubMed  Google Scholar 

  11. Culp RW (1999) Complications of wrist arthroscopy. Hand Clin 15:529–535

    CAS  PubMed  Google Scholar 

  12. Geissler WB (1998) Arthroscopic excision of dorsal wrist ganglia. Tech Hand Up Extrem Surg 2:196–201

    Article  CAS  PubMed  Google Scholar 

  13. Kang L, Akelman E, Weiss AP (2008) Arhroscopic versus open dorsal ganglion excision: a prospective, randomized comparison of rates of recurrence and of residual pain. J Hand Surg Am 33:471–475

    Article  PubMed  Google Scholar 

  14. Singh D, Culp RW (2002) Arthroscopic ganglionectomy. J Hand Surg Am 2:33–38

    Article  Google Scholar 

  15. Kim JP, Seo JB, Park HG, Park YH (2013) Arthroscopic excision of dorsal wrist ganglion: factors related to recurrence and postoperative residual pain. J Arthroscopic Rel Surg 29:1019–1024

    Article  Google Scholar 

  16. Langner I, Krueger PC, Merk HR, Ekkernkamp A, Zach A (2012) Ganglions of the wrist and associated triangular fibrocartilage lesions: a prospective study in arthroscopically-treated patients. J Hand Surg Am 37:1561–1567

    Article  CAS  PubMed  Google Scholar 

  17. Slutsky DJ, Nagle DJ (2008) Wrist arthroscopy: current concepts. J Hand Surg Am 33:1228–1244

    Article  PubMed  Google Scholar 

  18. Borisch N (2014) Arthroscopic resection of dorsal wrist ganglia. Handchir Mikrochir Plast Chir 46:307–314

    CAS  PubMed  Google Scholar 

  19. Borisch N (2016) Arthroscopic resection of dorsal wrist ganglion cysts. Oper Orthop Traumatol PMID:27074739 (Epub ahead of print)

  20. Angelides AC, Wallace PF (1976) The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg 1:228–235

    Article  CAS  Google Scholar 

  21. Cardinal E, Buckwalter KA, Braunstein EM, Mih AD (1994) Occult dorsal carpal ganglion: comparison of US and MR imaging. Radiology 193:259–262

    Article  CAS  PubMed  Google Scholar 

  22. Hwang JJ, Goldfarb CA, Gelberman RH, Boyer MI (1999) The effect of dorsal carpal ganglion excision on scaphoid shift test. J Hand Surg Br 24:106–108

    Article  CAS  PubMed  Google Scholar 

  23. Ahsan ZS, Yao J (2012) Complications of wrist arthroscopy. Arthroscopy 28:855–859

    Article  PubMed  Google Scholar 

  24. Vo P, Wright T, Hayden F, Dell P, Chidgey L (1995) Evaluating dorsal wrist pain: MRI diagnosis of occult dorsal wrist ganglion. J Hand Surg Am 20:667–670

    Article  CAS  PubMed  Google Scholar 

  25. Goldsmith S, Yang SS (2008) Magnetic resonance imaging in the diagnosis of occult dorsal wrist ganglions. J Hand Surg E 5:595–599

    Article  Google Scholar 

  26. Clay NR, Clement DA (1988) The treatment of dorsal wrist ganglia by radical excision. J Hand Surg Br 13:187–191

    Article  CAS  PubMed  Google Scholar 

  27. Crawford GP, Taleisnik J (1983) Rotatory subluxation of the scaphoid after excision of dorsal carpal ganglion and wrist manipulation—a case report. J Hand Surg 8:921–925

    Article  CAS  Google Scholar 

  28. Duncan KH, Lewis RC (1988) Scapholunate instability following ganglion cyst excision. Clin Orthop 228:250–253

    PubMed  Google Scholar 

  29. Osterwalder JJ, Widrig R, Stober R, Gächter A (1997) Diagnostic validity of ultrasound in patients with persistent wrist pain and suspected occult ganglion. J Hand Surg Am 22:1034–1040

    Article  CAS  PubMed  Google Scholar 

  30. Steinberg BD, Kleinman WB (1999) Occult scapholunate ganglion: a cause of dorsal radial wrist pain. J Hand Surg Am 24:225–231

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

I am much indebted to Corinna Linde for conducting the patient interviews and for collecting the data from the patient files.

Author information

Authors and Affiliations

  1. Abteilung für Handchirurgie, Plastische und Wiederherstellungschirurgie, Klinikum Mittelbaden, Baden-Baden Balg, Balger Str. 50, 76532, Baden-Baden, Germany

    Nicola Borisch

Authors
  1. Nicola Borisch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicola Borisch.

Ethics declarations

Conflict of interest

The author certifies that she has no financial or personal relationship with other people or organizations that could in appropriately bias this work. The named author declares that she has no conflicts of interest to disclose.

Funding

This research received no specific grant from any funding agency in the public, commercial, or non-profit sectors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Borisch, N. Arthroscopic resection of occult dorsal wrist ganglia. Arch Orthop Trauma Surg 136, 1473–1480 (2016). https://doi.org/10.1007/s00402-016-2539-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-016-2539-0

Keywords

Search

Navigation