[Arthroscopic resection of dorsal wrist ganglion cysts]

Efficacy of corticosteroid injections in the treatment of 85 ganglion cysts of the dorsal aspect of the wrist

INTRODUCTION

Ganglion cysts of the dorsal aspect of the wrist are a benign pathology frequently encountered in consultations for hand surgery. Their treatment, irrespective of the type, presents a risk of recurrence and there is no consensus on the management to adopt. Medical treatments such as corticosteroid injections have recurrence rates between 8 and 74%. Surgical treatments seem to have better results, with less disparate failure rates, at around 15%.

HYPOTHESIS

The objective of this retrospective study was to determine the effectiveness of the aspiration and injection of corticosteroids under ultrasound guidance in the treatment of 85 ganglion cysts of the dorsal aspect of the wrist.

PATIENTS AND METHODS

We retrospectively included 99 patients suffering from a non-occult ganglion cyst of the dorsal aspect of the wrist, who had received a referral for aspiration, and subsequent injection of corticosteroids between January 2015 and December 2020. Data collection was carried out by the analysis of files on the institution's software, and by a phone call. Data such as age, sex, pre- and post-treatment QuickDASH score, as well as recurrence and second-line treatments were collected.

RESULTS

The average age of our cohort was 31, with a 65% female predominance. The recurrence rate after a first injection was 73.2% with a mean follow-up of 34 months. The QuickDASH score improved significantly by 26.2 points out of 100 in non-injected patients, and by 18.6 points out of 100 after injection, whether the cyst recurred or not.

CONCLUSION

With 73.2% recurrence, corticosteroid injections do not appear to be effective in treating dorsal ganglion cysts of the wrist. They lead to an improvement in the functional score of the wrist, but not significantly compared to treatment abstinence.

LEVEL OF EVIDENCE

IV.

Arthroscopic Treatment of Intraosseous Ganglion Cysts of the Carpus

Objective

To investigate the application and the clinical efficacy of wrist arthroscopy in the treatment of carpal intraosseous ganglion cysts (IGCs).

Methods

A retrospective case study method was adopted to analyze the clinical data of 28 patients with carpal IGCs admitted to the Sixth Hospital of Ningbo from April 2012 to January 2019. A hypodensity in the bone was shown by X-ray before the operation, with hypodensity and cystic change in the bone being confirmed by computed tomography and magnetic resonance imaging. Arthroscopic open window of the wrist, cystectomy, and autologous iliac bone graft implantation were conducted. Regular postoperative X-ray combined with CT follow-ups were conducted to observe the healing after bone implantation. Patients were followed up regularly and assessed by the Modified Mayo Wrist Score in four aspects of the postoperative pain, wrist mobility, grip, and function to provide an objective overall assessment of the therapeutic outcome.

Results

All 28 patients were followed up for 8–16 months, with an average follow-up duration of 10 months. After the operation, pain disappeared completely for 25 patients, and 3 cases showed significant improvement. All cases were pathologically confirmed as ganglion cysts and had first-stage bony healing after bone grafting with an average healing time of 10.8 weeks. The grip returned to normal for all patients, and wrist flexion and extension were the same as the healthy wrist for 25 patients, with a Modified Mayo Wrist Score of excellent in 19 cases and good in 9 cases. No recurrence was observed.

Conclusion

In patients with symptomatic carpal IGCs, the application of arthroscopic open window, cystectomy, and autologous bone graft implantation could achieve satisfactory clinical therapeutic effects.