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Ferreira Branco D, Botti P, Bouvet C, Abs B, Buzzi M, Beaulieu JY, Poletti PA, Bouredoucen H, Boudabbous S. Dorsal wrist ganglion: clinical and imaging correlation in symptomatic population based on high-field MRI. Eur Radiol 2024:10.1007/s00330-024-10831-3. [PMID: 38856779 DOI: 10.1007/s00330-024-10831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/26/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES To determine prevalence in the symptomatic population of dorsal mucoid cysts centered on dorsal capsuloscapholunate septum (DCSS) using high-field magnetic resonance imaging (MRI) for anatomoclinical and epidemiological correlations. MATERIALS AND METHODS This single-center retrospective study analyzed all 3-Tesla MRIs consecutively performed for painful wrists in 295 patients. Two blinded readers performed measurements. The protocol included T1 spin echo and 3D proton density sequences with fat saturation. Inter-observer reliability was assessed using kappa and intra-class correlation coefficients for cyst detection and volumetry, respectively. Disagreements concerning cyst detection were resolved by a consensus reading. Cyst size, relationship to extrinsic and scapholunate ligaments (SL), continuity of SL, minimum distance to the posterior interosseous nerve (PIN), cyst communication with joint, and anatomical classifications of cysts were analyzed. Correlation tests were performed to assess associations. RESULTS Two-hundred ninety-five patients (mean age 39.6 +/- 15.6 (standard deviation), 161 males) were evaluated for detection of dorsal wrist cysts identified in 150/295. In this subgroup, the mean age was 38.7 years (15-75), the sex ratio of 0.6 (59% women), and the median volume cyst of 8.7 mm3 (0.52-2555). Cyst detection, volume, and major axis measurements showed very high agreement between observers, respectively, 0.89, 0.96, and 0.91. 42 patients had dorsal SL pain. A weak negative correlation was found between distance to PIN and dorsal SL pain (r = -0.2415; p < 0.05) and a weak positive correlation between Guérini's classification and dorsal SL pain (r = 0.2466; p < 0.05). CONCLUSION High-field MRI is the modality of choice for the detection, anatomical, and volumetric assessment of dorsal cysts. Preoperative assessment will be aided by the proposed revised anatomical classification. CLINICAL RELEVANCE STATEMENT High-field MRI is the modality of choice for the anatomical study of dorsal ganglion cysts. It allows the radiologist to accurately describe the anatomical relationships, size, and visibility of the pedicle, essential information for the surgeon's preoperative assessment. KEY POINTS Dorsal mucoid wrist ganglion is a condition for which prevalence remains to be determined. High-field MRI is a reproducible imaging modality for the detection and assessment of dorsal wrist cysts. High-field MRI has a key role in the preoperative management of dorsal mucoid cysts.
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Affiliation(s)
- David Ferreira Branco
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.
| | - Paul Botti
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Cindy Bouvet
- Orthopedic and Traumatology Surgery Department, Hand Surgery Unit, Sion Hospital, Av. du Grand-Champsec 80, 1951, Sion, Switzerland
| | - Bilal Abs
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Marcello Buzzi
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Jean Yves Beaulieu
- Orthopedic and Traumatology Surgery Department, Hand Surgery Unit, Sion Hospital, Av. du Grand-Champsec 80, 1951, Sion, Switzerland
| | - Pierre-Alexandre Poletti
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Hicham Bouredoucen
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Sana Boudabbous
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
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Lee KH, Huang HK, Wang JP. A Modified Approach for Arthroscopic Excision of Dorsal Midcarpal Ganglion Cysts Using Radiocarpal Portals. Tech Hand Up Extrem Surg 2024; 28:12-15. [PMID: 37694879 DOI: 10.1097/bth.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Wrist arthroscopy could be a treatment option for dorsal ganglion cysts. To achieve a thorough dorsal capsulectomy for the removal of midcarpal ganglion cysts, it is commonly necessary to combine both the radiocarpal and midcarpal portals. We present a modified method using radiocarpal portals only for arthroscopically excising dorsal midcarpal ganglion cysts. No extra midcarpal portals are necessary, and the method potentially generates satisfactory results.
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Affiliation(s)
- Kun-Han Lee
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Departments of Orthopaedics
| | - Hui-Kuang Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi
- Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Departments of Orthopaedics
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Kaempf O R, Gómez G, Brunelli JPF, Aita MA, Carratalà V, Delgado S PJ. Arthroscopic Needling Technique for the Treatment of Wrist Ganglia. J Wrist Surg 2023; 12:377-382. [PMID: 37564625 PMCID: PMC10411058 DOI: 10.1055/s-0042-1751015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/16/2022] [Indexed: 10/17/2022]
Abstract
Background Synovial cysts (SCs) are the most frequent wrist tumors; the arthroscopic treatment presents good results when surgery is indicated for symptomatic or patients with cosmetic concerns. The tumoral lesion should be arthroscopically decompressed or drained toward the inside of the joint through pedicle opening and resection of a small portion of the capsule. Hence, the cyst pedicle must be found for the success of this technique. Description of Technique Some tricks have already been described to facilitate SC location during arthroscopy. We describe an indirect technique that employs an 18-G needle to enhance SC pedicle location and drainage. The technique involves a puncture on the interval of the carpal extrinsic ligaments where the pedicle is suspected to be remain. When found, cyst is drained with a single-puncture motion of the need which promotes cyst content extravasation due to pressure toward the joint. Patients and Methods This method has been employed in 16 patients, including 9 with dorsal cysts, and seven with volar cysts. Results All patients presented complete recovery and symptom improvement in up to 30 days, with total disappearance of the cyst. There were no relapses or severe complications within the 12-month follow-up. Conclusion This is a safe, useful technique that facilitates location of intra-articular cyst pedicle, thus avoiding unnecessary damage in healthy tissues with no increased costs.
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Affiliation(s)
- Ricardo Kaempf O
- Department of Hand Surgery, Santa Casa de Misericórdia de Porto Alegre Hospital and Mãe de Deus Hospital, Porto Alegre, Brazil
| | - Gustavo Gómez
- CLIMBA (Clinica de La Mano Buenos Aires), Buenos Aires, Argentina
| | - João P. F. Brunelli
- Department of Hand Surgery, Santa Casa de Misericórdia de Porto Alegre Hospital and Mãe de Deus Hospital, Porto Alegre, Brazil
| | - Marcio A. Aita
- Department of Hand Surgery, ABC Medical School, Santo André, Brazil
| | - Vicente Carratalà
- Department of Orthopedic Surgery, Traumatology Service, Unión de Mutuas and Quirónsalud Hospital of Valencia, Spain
| | - Pedro J. Delgado S
- Department of Hand Surgery, Hospital Universitário HM (Hospitales de Madrid) Montepríncipe, Madrid, Spain
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Karjalainen VL, Harris IA, Räisänen M, Karjalainen T. Minimal invasions: is wrist arthroscopy supported by evidence? A systematic review and meta-analysis. Acta Orthop 2023; 94:200-206. [PMID: 37114362 PMCID: PMC10141317 DOI: 10.2340/17453674.2023.11957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND PURPOSE Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on wrist arthroscopy and synthesize the evidence of the benefits and harms of wrist arthroscopic procedures. METHODS We searched CENTRAL, MEDLINE, and Embase for randomized controlled trials comparing wrist-arthroscopic surgery with corresponding open surgery, placebo surgery, a non-surgical treatment, or no treatment. We estimated the treatment effect with a random effect meta-analysis using patient reported outcome measure (PROM) as primary outcome where several studies assessed the same intervention. RESULTS Of 7 included studies, none compared wrist arthroscopic procedures with no treatment or placebo surgery. 3 trials compared arthroscopically assisted reduction with fluoroscopic reduction of intra-articular distal radius fractures. The certainty of evidence was low to very low for all comparisons. The benefit of arthroscopy was clinically unimportant (smaller than what patients may consider meaningful) at all time points. 2 studies compared arthroscopic and open resection of wrist ganglia, finding no significant difference in recurrence rates. 1 study estimated the benefit of arthroscopic joint debridement and irrigation in intra-articular distal radius fractures, showing no clinically relevant benefit. 1 study compared arthroscopic triangular fibrocartilage complex repair with splinting in distal radioulnar joint instability in people with distal radius fractures, finding no evidence of benefits for repair at the long-term follow-up but the study was unblinded, and the estimates imprecise. CONCLUSION The current limited evidence from RCTs does not support benefits of wrist arthroscopy compared with open or non-surgical interventions.
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Affiliation(s)
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South West-ern Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Mikko Räisänen
- Department of Orthopae-dics and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Teemu Karjalainen
- Department of Surgery, Hospital Nova of Central Finland, Jyvaskyla, Finland and Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Malvern, Australia.
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Saremi H, bolbanabad MM, Abdollahian AR, Mohammadi Y. Clinical Results of Arthroscopic Resection of Dorsal Wrist Ganglion with a Minimum of 3 Years Follow-up. J Wrist Surg 2023; 12:52-55. [PMID: 36644718 PMCID: PMC9836768 DOI: 10.1055/s-0042-1756673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
Introduction Ganglion cysts are the most common benign tumors of the wrist. Their arthroscopic resection is becoming common. However, there are a limited number of studies comparing arthroscopic and open surgeries. This study evaluated the subjective and objective results of arthroscopy with a minimum of 3 years follow-up. Patients and Methods Patients with dorsal wrist ganglion who underwent arthroscopic ganglionectomy were evaluated regarding pain (using visual analog scale) and satisfaction as subjective results. We also evaluated their scar (with the Vancouver scar scale), range of motion, and recurrence as objective results. Results There were 20 patients in the study. Mean of follow-up time was 52.5 months. Recurrence rate was 5%, and visual analog scale of pain decreased from 3.7 to 0.5 at the final follow-up. Sixteen patients were completely satisfied, three patients were partially satisfied, and one patient was unsatisfied. The mean of Vancouver scar scale was 1.4 (range of 0-3). Improvement in range of flexion and extension of the wrist was significant without a significant complication. Conclusion Arthroscopic excision of dorsal wrist ganglion in the way described in this study is a safe and effective method that improves pain and range of motion of the wrist without major complications. The rate of recurrence was less than those reported for open surgery in long-term follow-up. The surgery scar has a promising score in Vancouver scar scale.
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Affiliation(s)
- Hossein Saremi
- Department of Orthopedics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | | | - Younes Mohammadi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Ganglions in the Hand and Wrist: Advances in 2 Decades. J Am Acad Orthop Surg 2023; 31:e58-e67. [PMID: 36580047 DOI: 10.5435/jaaos-d-22-00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/12/2022] [Indexed: 12/30/2022] Open
Abstract
Ganglion cysts represent the most common soft-tissue mass in the hand and wrist. Ganglion cysts are most commonly encountered at the dorsal or volar aspects of the wrist, although cysts may arise from the flexor tendon sheath, interphalangeal joint, and extensor tendons. Intraosseous and intraneural ganglion cysts have also been described. Diagnosis of ganglion cysts relies primarily on history and physical examination. Transillumination and aspiration of masses may be useful adjuncts to diagnosis. Imaging such as radiography and ultrasonography may be indicated to evaluate for associated conditions, such as degenerative joint disease, or to rule out a solid or heterogeneous mass. Advanced imaging such as MRI is generally reserved for patients in whom occult ganglions, intraosseous ganglions, or solid tumors, including sarcoma, remain a concern. Treatment of ganglion cysts includes observation, aspiration or puncture with possible corticosteroid injection, and surgical excision. Nonsurgical management may result in cyst resolution in over 50% of patients. Surgical excision is associated with recurrence rates of 7% to 39%. Advances in surgical techniques have allowed surgeons to conduct arthroscopic ganglion excision, with recurrence rates similar to those of open management. This study highlights the advances in diagnosis, treatment, and outcomes that have taken place over the past 2 decades for this common condition affecting the hand and wrist in the adult population.
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Federer AE, Yoo M, Stephens AS, Nelson RE, Steadman JN, Tyser AR, Kazmers NH. Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis. J Hand Surg Am 2023; 48:9-18. [PMID: 36402604 PMCID: PMC9812920 DOI: 10.1016/j.jhsa.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/19/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Dorsal wrist ganglions are treated commonly with aspiration, or open or arthroscopic excision in operating room (OR) or procedure room (PR) settings. As it remains unclear which treatment strategy is most cost-effective in yielding cyst resolution, our purpose was to perform a formal cost-minimization analysis from the societal perspective in this context. METHODS A microsimulation decision analytic model evaluating 5 treatment strategies for dorsal wrist ganglions was developed, ending in either resolution or a single failed open revision surgical excision. Strategies included immediate open excision in the OR, immediate open excision in the PR, immediate arthroscopic excision in the OR, or 1 or 2 aspirations before each of the surgical options. Recurrence and complications rates were pooled from the literature for each treatment type. One-way sensitivity and threshold analyses were performed. RESULTS The most cost-minimal strategy was 2 aspiration attempts before open surgical excision in the PR setting ($1,603 ± 1,595 per resolved case), followed by 2 aspirations before open excision in the OR ($1,969 ± 2,165 per resolved case). Immediate arthroscopic excision was the costliest strategy ($6,539 ± 264 per resolved case). Single aspiration preoperatively was more cost-minimal than any form of immediate surgery ($2,918 ± 306 and $4,188 ± 306 per resolved case performed in the PR and OR, respectively). CONCLUSIONS From the societal perspective, performing 2 aspirations before surgical excision in the PR setting was the most cost-minimal treatment strategy, although in reference to surgeons who do not perform this procedure in the PR setting, open excision in the OR was nearly as cost-effective. As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Economic Decision Analysis II.
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Affiliation(s)
- Andrew E Federer
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Minkyoung Yoo
- Department of Economics, University of Utah, Salt Lake City, UT
| | | | - Richard E Nelson
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Jesse N Steadman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
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Konigsberg MW, Tedesco LJ, Mueller JD, Ball JR, Wu CH, Kadiyala RK, Strauch RJ, Rosenwasser MP. Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison. Hand (N Y) 2023; 18:133-138. [PMID: 33789496 PMCID: PMC9806526 DOI: 10.1177/15589447211003184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study directly compares the recurrence rates of dorsal wrist ganglion cysts in patients treated via open surgical excision versus arthroscopic surgical excision. We hypothesized that there would be no difference between recurrence rates with these 2 surgical options. METHODS We retrospectively reviewed the charts of all patients with a dorsal ganglion cyst undergoing either open or arthroscopic surgical excision at a single academic center with 3 fellowship-trained attending hand surgeons from 2012 to 2017. Charts were identified using Current Procedural Terminology codes and were reviewed using postoperative office notes for preoperative and postoperative symptoms, episodes of recurrence, time at which recurrence occurred, subsequent operations, and outcome at final follow-up. RESULTS The charts of 172 patients undergoing either arthroscopic or open dorsal ganglion excision were reviewed. Nine of 54 (16.7%) arthroscopic excisions resulted in cyst recurrence, while 8 of 118 (6.8%) open excisions resulted in cyst recurrence (P = .044). Two of 9 (22%) recurrences after arthroscopic ganglion excision versus 2 of 8 (25%) recurrences after open ganglion excision underwent repeat surgical intervention. Time to recurrence, as well as final follow-up, was not statistically different between groups. CONCLUSIONS Dorsal wrist ganglion cysts are the most common benign soft tissue mass of the upper extremity, but it remains unknown whether arthroscopic or open surgical excision leads to lower recurrence rate. Scant literature exists directly comparing these 2 methods of surgical excision. This study suggests that open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision.
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Affiliation(s)
| | - Liana J. Tedesco
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - John D. Mueller
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - Jacob R. Ball
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - Chia H. Wu
- Baylor College of Medicine, Houston,
TX, USA
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Zheng T, Huang X, Yang Y, Li B, Li F, Li Z. Two-Year Clinical Outcomes after Arthroscopic Re-Excision of Recurrent Dorsal Wrist Ganglion Cyst. Orthop Surg 2022; 15:480-487. [PMID: 36465035 PMCID: PMC9891941 DOI: 10.1111/os.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Arthroscopic excision of dorsal wrist ganglion (DWG) cysts has recently become an alternative to open surgery, with the advantage of lower recurrence. However, in recurrent cases, whether re-excision using an arthroscopic approach would achieve favorable outcomes has not been determined. This study aimed to evaluate the clinical outcomes of function evaluation and recurrence rate after arthroscopic excision of recurrent DWG cysts. METHODS A total of 11 consecutive patients with clinically diagnosed recurrent DWG cysts were retrospectively reviewed between November 2017 and March 2020. Extensive re-excision of the ganglion cyst and its surrounding pathological capsule was performed using an arthroscopic approach. Magnetic resonance imaging (MRI) was routinely performed before surgery to identify the location and limits of the cyst. All patients were followed up for a minimum of 2 years. A second recurrence was recorded if a mass reappeared at the same site with a positive transillumination test. Pain during activity was evaluated using the visual analog scale (VAS). The active range of motion (ROM) of the wrist was measured using a goniometer, and the hand grip strength was measured using a digital dynamometer. Comparative analysis between the pre- and postoperative indexes was performed using Student's t-test. RESULTS After a mean follow-up period of 29.3 months (range, 24-34 months), no second recurrence of the cyst was recorded. The VAS score improved from 1.4 to 0.3 (t = 3.833, p = 0.003), and residual pain was reported by three patients (VAS score = 1 for each). Active wrist flexion increased from 73.6° to 78.2° (t = 2.887, p = 0.016). No significant changes were found in active wrist extension or hand grip strength (p > 0.05). No major complications occurred during the study. CONCLUSION Arthroscopic excision of a recurrent DWG cyst yielded satisfactory results with no second recurrence, significant pain relief, and good wrist function at a minimum of 2-year follow-up. Clear identification of the location and limits of the ganglion based on preoperative MRI could be helpful to achieve complete excision and therefore prevent a second recurrence.
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Affiliation(s)
- Tong Zheng
- Sports Medicine ServiceBeijing Jishuitan HospitalBeijingChina
| | - Xingjian Huang
- Hand Surgery DepartmentBeijing Jishuitan HospitalBeijingChina
| | - Yong Yang
- Hand Surgery DepartmentBeijing Jishuitan HospitalBeijingChina
| | - Bin Li
- Hand Surgery DepartmentBeijing Jishuitan HospitalBeijingChina
| | - Feng Li
- Hand Surgery DepartmentBeijing Jishuitan HospitalBeijingChina
| | - Zhongzhe Li
- Hand Surgery DepartmentBeijing Jishuitan HospitalBeijingChina
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Kajita Y, Iwahori Y, Harada Y, Takahashi R, Deie M. Arthroscopic treatment of massive acromioclavicular joint ganglion cysts with color-aided visualization: a case series of 4 patients. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:526-534. [PMID: 37588464 PMCID: PMC10426531 DOI: 10.1016/j.xrrt.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Acromioclavicular joint ganglion cysts are rare lesions that mainly arise from the degeneration of the acromioclavicular joint in elderly patients. Although surgical management may be required because of their high recurrence rate after aspiration, few reports have described arthroscopic surgical procedures to treat acromioclavicular ganglion cysts. We report the surgical results of arthroscopic ganglionectomy with color-aided visualization for massive acromioclavicular ganglion joint cysts. Methods This retrospective case series examined patients identified with massive ganglion cysts that were localized above the acromioclavicular joint. All patients underwent an arthroscopic removal of subacromial synovium and subsequent injection of indigo carmine into the ganglion. The distal end of the clavicle was excised arthroscopically from the inferior surface, and the ganglion stalk was confirmed using indigo carmine for enhanced visualization and magnification. A ganglion portal was created, and the ganglion cyst was resected with the aid of the dye. Results Four female patients, aged 78-90 years, were identified with a massive acromioclavicular joint ganglion cyst. Plain radiography showed joint degeneration in the acromioclavicular joint, and magnetic resonance imaging scans showed fluid-filled mass formation. Although all patients initially underwent multiple aspirations of the ganglion cyst, we opted for surgical intervention because of its persistent recurrence. Three patients exhibited concurrent rotator cuff tears, and one patient had a prior history of cuff repair with no retear. After arthroscopic ganglionectomy with color-aided visualization for massive acromioclavicular ganglion joint cysts, none of the patients have shown recurrences at 2 years postoperatively. Conclusion Novel aspects of this case series include the use of indigo carmine to provide a better visualization and identification of the ganglion stalk under arthroscopy. Furthermore, a ganglion portal is useful for achieving complete resection of the indigo carmine-stained ganglion cyst. Color-aided visualization using indigo carmine and the construction of a ganglion portal were useful techniques for performing arthroscopic ganglionectomy in patients with a massive acromioclavicular joint ganglion cyst.
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Affiliation(s)
- Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Asahi, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Aichi, Japan
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Grégoire C, Guigal V. Efficacy of corticosteroid injections in the treatment of 85 ganglion cysts of the dorsal aspect of the wrist. Orthop Traumatol Surg Res 2022; 108:103198. [PMID: 35031514 DOI: 10.1016/j.otsr.2022.103198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Coline Grégoire
- Clinique du Parc, 155, bis boulevard Stalingrad, 69006 Lyon, France.
| | - Vincent Guigal
- Clinique du Parc, 155, bis boulevard Stalingrad, 69006 Lyon, France
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Chen B, Wang L, Liang K, Wang B, Jiang S, Shi H. Treatment of dorsal wrist ganglion cyst by establishing midcarpal volar portal using the “Kiss-in” method. Front Surg 2022; 9:944396. [PMID: 36117835 PMCID: PMC9473313 DOI: 10.3389/fsurg.2022.944396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction This paper introduces the treatment and clinical outcome of the dorsal wrist ganglion cyst utilizing the Kiss-in method to establish a midcarpal volar portal. Materials and methods Patients with dorsal ganglia of the wrist (n = 12, 6 females, 6 males) underwent arthroscopic surgery using the Kiss-in method at our hospital between September 2018 and January 2021. All patients underwent preoperative radiological investigations, such as magnetic resonance imaging (MRI; 12 cases) or ultrasonography (12 cases). The mean age of patients was 30.7 years (range: 19–46 years). The time lost from work, the wrist motion and strength, the presence of scarring, residual symptoms, complications, and recurrence were recorded at a mean follow-up of 24 months. Results Eleven patients showed a good prognosis with active motion recovery. One patient showed the recurrence of ganglion, and the second arthroscopic resection was performed 5 months after the first surgery for this patient. After the surgery, the patient fully recovered. Conclusions Establishing the midcarpal volar portal by the Kiss-in method is safe. The dorsal ganglion cyst resection through the established midcarpal volar portal is a promising approach, allowing better visualization and a broader range motion of the arthroscope.
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Affiliation(s)
- Bo Chen
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Leining Wang
- Department of Surgery of Hand and Foot, Beilun People's Hospital, Ningbo, China
| | - Kejiong Liang
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bing Wang
- Department of Surgery of Hand and Foot, Beilun People's Hospital, Ningbo, China
| | - Shuai Jiang
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Haifei Shi
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Correspondence: Haifei Shi
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Ribau M, Ribeiro EFM, Barros CAS, Ribeiro JM, Varanda PMS, Rodrigues LFP. Dorsal Wrist Ganglia: Influence of Arthroscopic Dorsal Capsulodesis – A Pilot Study. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2022. [DOI: 10.1055/s-0042-1748852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Background Dorsal wrist ganglia are the commonest soft tissue tumor in the upper extremity. Management with arthroscopic excision yields good results and few complications, but recurrence is still a matter of concern.
Purpose To address the influence of dorsal capsulodesis in postoperative results.
Patients and Methods Two groups with eight patients each were evaluated: group A – simple arthroscopic resection (SAR), and group B – arthroscopic resection combined with dorsal capsulodesis (ARDC).
Results The mean age of group A was of 36.10 ± 7.96 (range: 28–53) years, and that of group B was of 34.17 ± 29.60 (range 18–44) years. The duration of the follow-up was of 30.67 ± 13.90 (range: 13.45–53.55) months and 29.60 ± 16.80 (range 12.68–62.13) months, respectively. Both groups achieved a a significant decrease in the postoperative score on the Visual Analog Scale (VAS) (of around 2/10), and the scores on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were below 5/100. All the functional parameters (range of motion and strength) were above 80% on the contralateral side, with no differences between groups. More than 75% of the patients were completely satisfied. Group A (37.5%) had a significantly higher recurrence rate than that of group B (12.5%).
Conclusions In conclusion, SAR and ARDC provided good clinical results, with no significant differences. Dorsal capsulodesis resulted in an important decrease in the recurrence rate.
Level of Evidence Level III (Retrospective Comparative Study).
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Affiliation(s)
- Melanie Ribau
- Department of Orthopedic Surgery and Trauma, Hospital de Braga, Braga, Portugal
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de Villeneuve Bargemon JB, Prenaud C, Quérel D, Bismuth Y, de Keyzer PB, Gras M. Repair of the dorsal capsuloligamentous scapholunate septum during arthroscopic resection of painful dorsal wrist ganglion cyst: Comparative analysis of two techniques. HAND SURGERY & REHABILITATION 2022; 41:457-462. [DOI: 10.1016/j.hansur.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
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Chen KP, Ma CH, Wu CH, Jou IM, Tu YK. Arthroscopic resection of recurrent wrist ganglions - A retrospective study of 17 patients. J Orthop Sci 2022; 27:389-394. [PMID: 33676789 DOI: 10.1016/j.jos.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/21/2020] [Accepted: 01/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Arthroscopic resection has become a favorable alternative for wrist ganglions. However, for recurrent wrist ganglions, arthroscopic resection is relatively contraindicated. The purpose of this study was to evaluate the clinical outcomes of arthroscopic resection for recurrent wrist ganglions and to identify their safety and efficacy. METHODS From June 2011 to February 2017, 17 patients with recurrent wrist ganglion were treated with arthroscopic resection. We evaluated the visual analog scale, modified Mayo wrist score, and Disabilities of Arm, Shoulder and Hand Outcome Measure preoperatively and at the final follow-up. Patients were questioned for pain reduction, pain during pushups, and any difficulty in returning to work. Recurrence and complications were also assessed at each follow-up visit. RESULTS We enrolled 17 patients and median follow-up was 58 months. The reduction in pain was significant. Only 2 of the 17 patients had residual pain after arthroscopic resection. One female patient showed recurrences 3 years later. Although 2 cases of stiffness were noted after the operation, no significant complication was present 3 months postoperatively. Most patients had good recovery and could resume work; however, 2 patients reported fair recovery. CONCLUSION The results of this study confirmed that arthroscopic excision could be an effective and safe treatment for recurrent ganglions; therefore, should not be contraindicated for treating recurrent wrist ganglions. Nevertheless, further prospective studies with larger patient numbers are needed to establish a stronger evidence for arthroscopic resection of recurrent wrist ganglions.
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Affiliation(s)
- Kuan-Po Chen
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan.
| | - Ching-Hou Ma
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
| | - Chin-Hsien Wu
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
| | - I-Ming Jou
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
| | - Yuan-Kun Tu
- Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Abstract
Background: The recurrence rate after open excision of ganglion cysts is approximately 20%. However, this literature is based on a small series of subjects. This study aims to determine the rate and risk of recurrence after open excision of ganglion cysts in a large patient series. Methods: This study included 628 patients who had ganglion cyst excision from 2010 to 2018. A retrospective chart review recorded the following: age, sex, laterality, volar/dorsal location, and recurrence. An overall recurrence rate was calculated. In addition, a 1-way analysis of variance test was used to compare recurrence rates among the individual surgeons, and unpaired t tests were used to compare age of recurrence, dorsal cyst recurrence, laterality of cyst, and recurrence based on sex. Finally, a comparison of recurrence rate over time was conducted for surgeon 3. Results: The overall recurrence rate was 3.8% (24 of 628). The recurrence rates for each surgeon were 3% (9 of 353), 2% (3 of 167), and 11% (12 of 107), P = .02. The age of those with and without a recurrence did not differ (32 years vs 38 years), P = .06. The recurrence rate of dorsal ganglion cysts was 4.1% (14 of 341) compared with 3.5% (10 of 286) for volar ganglion cysts, P = .69. Male patients had a recurrence in 6.4% (13 of 204) of cases compared with 2.6% (11 of 424) of female patients, P = 0.01. There was a decrease in the rate of recurrence from 42.9% to 5.3% over 5 years for surgeon 3. Conclusion: In our sample, male sex and surgeon experience were significant risk factors in ganglion cyst recurrence.
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Affiliation(s)
| | - John R. Fowler
- University of Pittsburgh Medical Center,
PA, USA,John R. Fowler, Department of Orthopaedics,
University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA
15213, USA.
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Kaempf DE Oliveira R, Farina Brunelli JP, Aita MA, Mantovani Ruggiero G. Volar Wrist Ganglion Originating at the Dorsal Scapholunate Ligament - A Report of Two Patients. J Hand Surg Asian Pac Vol 2022; 27:200-203. [PMID: 35172703 DOI: 10.1142/s2424835522720067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ganglion cysts are common wrist lesions and, in about 20% of patients, they appear on a volar and radial location. Volar ganglions typically arise from the volar radiocarpal joint in the interval between the radioscaphocapitate (RSC) and the long radiolunate (LRL) ligaments. We report two patients with volar and radial ganglion cysts that originated at the dorsum of the scapholunate (SL) ligament. This may lead to inadequate treatment with a risk of recurrence. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
| | | | | | - Gustavo Mantovani Ruggiero
- Cirurgião de mão do Hospital Beneficência Portuguesa de São Paulo, Brazil; Università degli Studi di Milano, Milan, Italy
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Hinchcliff KM, Munaretto N, Dutton LK, Ramazanian T, Kakar S. Wrist Arthroscopy Using the 2R Portal: Is It Safer Than the 1,2 Portal? Hand (N Y) 2022:15589447221075668. [PMID: 35144498 DOI: 10.1177/15589447221075668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUD The purpose of this study was to compare the 1,2 with a novel 2R portal in terms of proximity to critical structures. METHODS Wrist arthroscopy was performed on 8 fresh frozen cadavers via the 1,2 and 2R portals. External anatomy was then dissected under loupe magnification. The closest distance between the portals and surrounding anatomical structures was measured in millimeters using digital calipers. RESULTS The 1,2 portal was significantly closer to radial artery and first extensor compartment tendons than the 2R portal. The radial artery was on average 1.32 mm from the 1-2 portal and 14.25 mm from the 2R portal. The 2R portal was significantly closer to the second and third extensor compartment tendons. The closest branch of the superficial branch of the radial nerve (SBRN) was on average 2.04 mm from the 1-2 portal and 7.59 mm from the 2R portal, but this was not statistically significant. CONCLUSIONS We advocate using the 2R portal preferentially to the 1,2 portal when treating radial sided wrist pathology to decrease the risk of iatrogenic radial artery and SBRN injury.
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Shakya A, Garje V, Rathore A. The triple technique: A simple and effective outpatient procedure for the dorsal wrist ganglion. J Clin Orthop Trauma 2021; 23:101619. [PMID: 34650906 PMCID: PMC8498456 DOI: 10.1016/j.jcot.2021.101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dorsal ganglia are the most common types of wrist ganglia. Though largely asymptomatic, they can cause pain, stiffness and require treatment. The different methods described for the management have high recurrence rates even up to 70%. We describe a new method which combines 3 of these methods thus aiming to achieve the best from each of the techniques. METHODS A prospective observational study was undertaken to include patients requiring surgery for dorsal ganglion. The method involved a combination of aspiration, steroid instillation and tranfixation with silk suture for 3 weeks. Various demographic parameters, operative variables and functional criteria like QuickDASH Score and Numerical Pain Rating scale (NPRS) were used. The patients were followed up for atleast 24 months. Overall satisfaction rate was also recorded. RESULTS 83 patients were included with a mean age of 31.7 ± 12.4 years. The mean duration of surgery was 12.0 ± 4.9 min and follow up was 29.8 ± 7.1 months. 15 patients had complex multilobulated ganglia. The most common indication for surgery was cosmesis. 4 complications were encountered of which 2 were superficial infections, 1 whitish discoloration locally and 1 case of persistent pain. We achieved a success rate of 95.2% with only 4 recurrences with a mean reduction in size to be 82.2 ± 5.8%. NPRS and QuickDASH scores improved significantly. Mean satisfaction rate was 89% and 84.3% wished to have the surgery again for a similar complaint. The loss of work was 2.5 ± 1.4 days. CONCLUSIONS Triple Technique is an effective and safe technique with <5% recurrence at 2 years.
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Affiliation(s)
- Akash Shakya
- Department of Orthopaedics, ESIC Hospital, Mumbai, India,Corresponding author. Department of Orthopaedics, ESIC Hospital, Mumbai, India
| | - Vinayak Garje
- Department of Orthopaedics, ESIC Hospital, Mumbai, India
| | - Amisha Rathore
- Department of Obstetrics and Gynaecology, ESIC Hospital, Mumbai, India
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de Oliveira RK, Brunelli JPF, Carratalá V, Aita M, Mantovani G, Delgado PJ. Arthroscopic Resection of Wrist Volar Synovial Cyst: Technique Description and Case Series. J Wrist Surg 2021; 10:350-358. [PMID: 34381641 PMCID: PMC8328555 DOI: 10.1055/s-0040-1721438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/28/2020] [Indexed: 10/22/2022]
Abstract
Background Arthroscopy nowadays has become a widespread technique for the treatment of orthopaedic pathologies. Small-joint arthroscopy has evolved and, through direct visualization, enables diagnosis and immediate treatment of intra-articular lesions. The arthroscopic resection has become a minimally invasive alternative for the open technique. We intend to describe the technique, literature review, and results of arthroscopy for the surgical treatment of wrist volar synovial cysts. Methods Thirty-nine patients submitted to arthroscopy for the treatment of wrist volar synovial cyst were included and assessed in this study, during the period of January 2015 to May 2017 with a complete assessment in minimum follow-up of 6 months. The technique was indicated for patients with pain and functional impairment for longer than 4 months, with no improvement with conservative measures, or for patients with cosmetic complaints, or those who presented the cyst for more than 3 months. Results We demonstrated good outcomes in regard to pain, range of motion, and complications in arthroscopic resection of volar wrist ganglion. Conclusion Arthroscopic resection of volar synovial is a useful and safe technique. It is a low-morbidity, minimally invasive procedure that carries few complications and is a good alternative to the open technique.
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Affiliation(s)
- Ricardo Kaempf de Oliveira
- Department of Hand Surgery, Mãe de Deus Hospital, Porto Alegre, Brazil
- Department of Hand Surgery, Santa Casa de Misericórdia Hospital, Porto Alegre, Brazil
| | | | - Vicente Carratalá
- Traumatology Service, Unión de Mutuas and Quirónsalud Hospital of Valencia, Spain
| | - Márcio Aita
- Department of Hand Surgery, ABC Medical School, Santo André, Brazil
| | - Gustavo Mantovani
- Department of Hand Surgery, Hospital Beneficência Portuguesa, São Paulo, Brazil
- Università degli Studi di Milano, Milano, Italy
| | - Pedro J. Delgado
- Department of Hand and Upper Limb Surgery, Hospital Universitário Madrid Montepríncipe, San Pablo CEU University, Boadilla del Monte, Madrid, Spain
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Chai HL, Pérez CÁ, Yu WPF, Ho PC. Arthroscopic Resection of Wrist Scaphotrapeziotrapezoidal (STT) Joint Ganglia. J Wrist Surg 2020; 9:440-445. [PMID: 33042648 PMCID: PMC7540656 DOI: 10.1055/s-0040-1710498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Background Volar wrist ganglion is the second most common wrist mass and accounts for 20% of all cases. Surgery is the gold standard for persistent and symptomatic ganglia. Arthroscopic resection has gained popularity in the past two decades. Application of this technique to ganglia in less accessible locations, such as the scaphotrapeziotrapezoidal (STT) joint, however, remains controversial. Case Description To date, no literature has described using the STT -ulnar (STT-u) and STT -radial (STT-r) joint portals for ganglionic resection. Literature Review In this report, two cases of arthroscopic ganglionic resection utilizing the STT-u and STT-r joint portals at our institution were described. Clinical Relevance Arthroscopic resection of STT joint ganglion under portal site local anesthesia is a technically feasible, safe, and effective approach. There was no recurrence observed for both cases at 50 months of follow-up.
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Affiliation(s)
- Ho Lam Chai
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hospital Authority, Shatin, New Territories, Hong Kong, People's Republic of China
| | - Cabello Álvaro Pérez
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hospital Authority, Shatin, New Territories, Hong Kong, People's Republic of China
| | - Wai Ping Fiona Yu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People's Republic of China
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hospital Authority, Shatin, New Territories, Hong Kong, People's Republic of China
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Alp NB, Akdag G. Surgical Treatment of Dorsal Carpal Ganglions: A Retrospective Clinical Trial. Cureus 2020; 12:e10252. [PMID: 32923296 PMCID: PMC7478616 DOI: 10.7759/cureus.10252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives Our primary goal in this study was to investigate whether the surgical treatment we performed on the patients with dorsal carpal ganglion was effective rather than evaluating preoperative and postoperative functional results. Methods The retrospective study included patients who were operated with open technique due to dorsal wrist ganglion at a single center between March 1, 2015, and December 1, 2017, and were followed for at least six months. Thirty-three wrists of 32 patients (31 unilateral and 1 bilateral) were operated. During follow-ups, complication rates, patient satisfaction, and recurrence rates were evaluated. Results Of the 32 patients, 19 were females and 13 were males. Mean age of the patients was 38.6 ± 13.0 years (min-max = 19-60 years). Excision was performed on 28 right and 5 left wrists. The follow-up period of patients varied between 6 months and 38 months (mean = 21.7 ± 9.4 months). Recurrence was detected in four (12.5%) patients during the postoperative period. Complex regional pain syndrome occurred in two (6.25%) patients. Joint stiffness developed in six (18.75%) patients during the postoperative period. When recurrent cases were excluded from our cases, the satisfaction rate was 87.5%. Conclusions Open surgical excision has satisfactory results that cannot be achieved with conservative treatment in the treatment of symptomatic dorsal ganglia. In order to keep the recurrence rate at the minimum level after surgery, it is critical to excise the ganglion and pedicle without leaving any residual tissue. Proper surgical technique improves patient satisfaction by eliminating pain and cosmetic discomfort.
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Affiliation(s)
- Nazmi Bülent Alp
- Orthopaedics and Traumatology, Bursa City Training and Research Hospital, Bursa, TUR
| | - Gokhan Akdag
- Orthopaedics and Traumatology, Istanbul Bahcelievler State Hospital, Istanbul, TUR
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Oliveira RKD, Brunelli JPF, Bayer LR, Aita M, Mantovani G, Delgado PJ. Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series. Rev Bras Ortop 2019; 54:721-730. [PMID: 31875073 PMCID: PMC6923645 DOI: 10.1055/s-0039-1700811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 10/23/2018] [Indexed: 10/26/2022] Open
Abstract
Objectives To describe the technique and results of the arthroscopic surgical treatment of volar ganglion cyst of the wrist. Materials and Methods The present study comprised 21 patients submitted to the arthroscopic treatment of volar ganglion cysts of the wrist from January 2015 to May 2017, with a full evaluation for at least 6 months. The technique was indicated for patients presenting pain and functional impairment for more than four months, with no improvement with the conservative treatment, or for those with cosmetic complaints and cyst present for more than three months. Results The mean age of the patients was 43.6 years; 16 (76%) patients were female, and 5 (24%) were male. The mean follow-up time from surgery to the final assessment was of 10.9 months. A total of 2 (9.6%) patients complained of mild pain after the procedure, and another patient presented slight motion restrictions. The 18 (90.4%) remaining patients reported cosmetic improvement, complete functional recovery, and pain improvement. There were no recurrences or infections. No patient required further surgery. Conclusions The arthroscopic resection of volar ganglion cysts is a useful and safe technique. It is a minimally-invasive procedure, with low morbidity and very few complications, representing a good alternative to the open technique.
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Affiliation(s)
- Ricardo Kaempf de Oliveira
- Grupo de Cirurgia de Mão, Hospital Mãe de Deus, Porto Alegre, RS, Brasil
- Grupo de Cirurgia de Mão, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Leohnard Roger Bayer
- Grupo de Cirurgia de Mão, Hospital Mãe de Deus, Porto Alegre, RS, Brasil
- Grupo de Cirurgia de Mão, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Márcio Aita
- Grupo de Mão, Serviço de Ortopedia e Traumatologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | - Gustavo Mantovani
- Grupo de Mão, Serviço de Ortopedia e Traumatologia, A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
- Università degli Studi di Milano, Milão, Itália
| | - Pedro José Delgado
- Unidade de Cirurgia de Mão, Hospital Universitario Madrid Montepríncipe, Universidad CEU San Pablo, Boadilla del Monte, Madri, Espanha
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Uludağ A, Tosun HB, Yasar MM, Gunay A, Aydin Turk B, Uludağ Ö. The Effect of Tourniquet Usage and Anesthesia Method on Prognosis in the Treatment of Dorsal Wrist Ganglion Cysts by Open Surgery. Cureus 2019; 11:e5981. [PMID: 31803563 PMCID: PMC6874420 DOI: 10.7759/cureus.5981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Ganglion cysts are the most common soft tissue masses seen on the wrist, which often cause pain or cosmetic complaints. The treatment of these masses includes intra-cystic injections or surgery. Recurrence rates are very high in surgical or non-surgical treatment. Inadequate excision for recurrence after surgery is blamed; however, the reasons for the recurrence still remain mysterious. Objectives In this study, the effect of anesthesia selection and tourniquet use on the dorsal wrist ganglion cysts in open surgery was investigated. Materials and methods Patients with dorsal wrist ganglion cysts, who were operated with open surgery between 2015 and 2018 and who had at least six months after the surgery, were examined. The patients were divided into two groups: patients who underwent surgery without tourniquet with local anesthesia and patients operated with tourniquet with general or regional anesthesia. Age, sex, cause of operation, visual analog scale (VAS) scores before and after surgery, limitation of movement, postoperative complications, and recurrence were compared. Results There was no significant difference between the groups in terms of causes of surgery, recurrence rates, preoperative and postoperative limitations of movement, and complications. In terms of age, the group operated with local anesthesia and without tourniquet was significantly larger. There was also no significant difference between the groups in terms of preoperative pain. Postoperative pain was significantly less in the group operated by tourniquet with general-regional anesthesia. Conclusion There is no significant difference in the recurrence and complications between patients operated under local anesthesia without tourniquets and patients operated with tourniquets under general or regional anesthesia during the open excision of the dorsal wrist ganglion cysts. However, it should be kept in mind that postoperative pain does not diminish in later ages, especially in cases of ganglion cysts, and other pathologies may also potentially cause pain in the wrist.
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Affiliation(s)
- Abuzer Uludağ
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | | | - Mehmet Mete Yasar
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Abdussamed Gunay
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Bilge Aydin Turk
- Pathology, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Öznur Uludağ
- Anesthesiology and Reanimation, Adıyaman University Faculty of Medicine, Adıyaman, TUR
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Llopis E, Restrepo R, Kassarjian A, Cerezal L. Overuse Injuries of the Wrist. Radiol Clin North Am 2019; 57:957-976. [DOI: 10.1016/j.rcl.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abehsera E, Nedellec G, Limousin M, Fontaine C, Strouk G. Arthroscopic resection of wrist ganglia: About 30 cases. J Orthop 2019; 16:216-219. [PMID: 30906126 DOI: 10.1016/j.jor.2018.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/23/2018] [Indexed: 10/27/2022] Open
Abstract
Introduction The synovial wrist ganglion is a particularly common pathology of which the first "complication" is recidivism. The main objective of our study was to determine the rate of recurrence of this pathology in a series of arthroscopic patients. The secondary objective was to assess patient satisfaction well after the operation. Material and methods Our study was observational and retrospective and involved 30 patients (17 dorsal and 13 palmar cases) aged 41 years on average. The patients underwent an arthroscopic procedure for a palmar or dorsal ganglion of the wrist between March 2007 and April 2013. The data were collected by re-reading the files and conducting telephone interviews. Each patient answered a questionnaire about the operation, after-treatment, and their satisfaction well after the surgery. At the end of the interview, we calculated the Patient Rated Wrist Evaluation (PRWE) score. Results The mean follow-up was 4.6 years. A recurrence was noted in 4 (13%) cases, at an average delay of 9 months (6 months-1 year). There were only 2 patients (6.7%) that experienced the complication of complex regional pain syndrome type 1. Twenty-eight (93%) patients experienced improvement in postoperative pain. For 27 (90%) patients, firm-handed activities could be practised without limitation. The average time to resumption of activities of daily living was 27.1 days (1-240 days), resumption of firm-handed activities was 56 days (15-360 days), and return to work was 47.5 days (1-360 days). The mean PRWE score was 6.9/50 (0-34) for pain and 1.38/50 (0-8) for function. Conclusion The 13% recurrence rate is on the average of what is observed in the literature. Later satisfaction with the intervention is very good, and complications remain rare.Studies tend to show a lower rate of complications and recurrence following arthroscopic treatment, but to date, no randomized comparative series between the two methods has yet revealed any significant difference in these two points. A study of this type on a large scale could make it possible to highlight one of these treatment approaches.
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Affiliation(s)
- Eric Abehsera
- Service d'Orthopédie B, Hôpital Roger Salengro, CHRU Lille, Avenue du Professeur Emile Laine, 59037, Lille, France
| | - Guillaume Nedellec
- Service d'Orthopédie B, Hôpital Roger Salengro, CHRU Lille, Avenue du Professeur Emile Laine, 59037, Lille, France
| | - Marc Limousin
- Centre de Chirurgie Orthopédique, Clinique de Saint-Omer, 71 Rue Ambroise Paré, 62575, Blendecques, France
| | - Christian Fontaine
- Service d'Orthopédie B, Hôpital Roger Salengro, CHRU Lille, Avenue du Professeur Emile Laine, 59037, Lille, France
| | - Guillaume Strouk
- Centre de Chirurgie Orthopédique, Clinique de Saint-Omer, 71 Rue Ambroise Paré, 62575, Blendecques, France
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