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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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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 PMCID: PMC6411604 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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Fernandes CH, Miranda CDO, Dos Santos JBG, Faloppa F. A systematic review of complications and recurrence rate of arthroscopic resection of volar wrist ganglion. ACTA ACUST UNITED AC 2015; 19:475-80. [PMID: 25288295 DOI: 10.1142/s0218810414300046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED The purpose of this systematic review is to determine the incidence of complications and the recurrence rate of a volar wrist ganglion following arthroscopic resection. We performed a systematic review of English and non-English articles using Google Scholar, Medline, and Web of Knowledge. Articles were screened for study inclusion by three independent reviewers using the terms "arthroscopic treatment of volar wrist ganglion" and "arthroscopic resection of volar wrist ganglion". INCLUSION CRITERIA (1) level I-V evidence, (2) documentation of the number of wrists subjected to surgery, (3) documentation of surgical techniques used on wrists, and (4) documentation of surgical or post-surgical complications and recurrence rate of a volar wrist ganglion after arthroscopic resection. A complication was defined as an adverse outcome that was directly related to the operative procedure. Between 2001 and 2012, 13 articles met the inclusion criteria. Two articles were excluded and 11 were reviewed. A total of 232 wrists underwent arthroscopic surgery with 14 recurrences. The recurrence rate ranged from 0 to 20%, with mean of 6.03%. There were 16 (6.89%) complications. There was no connection with the ganglion in six wrists, three haematomas, three cases of neuropraxia of the dorsal radial nerve, two partial lesions of the median nerve, and two lesions of a branch of the radial artery. Patients did not have a decrease in the arc range of motion. Treatment of volar ganglia of the midcarpal joint was technically difficult and associated with a higher number of complications. In general, arthroscopic resection results in fewer complications and lower recurrence rates than an open surgical approach, but there is no clear evidence of such an advantage for arthroscopic resection of a volar wrist ganglion. Additional prospective, controlled clinical trials will be essential to address this important issue.
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Affiliation(s)
- Carlos Henrique Fernandes
- Hand Surgery Group, Department of Orthopedic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Su Y, Xie Y, Qin J, Nan G. Visualization of the wrist ganglion capsule by methylene blue staining as an aid for complete resection in children. J Hand Surg Am 2015; 40:685-7. [PMID: 25746141 DOI: 10.1016/j.jhsa.2015.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/10/2015] [Accepted: 01/12/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effectiveness of methylene blue staining during ganglion resection in children, to assess ganglion resection and minimize recurrence. METHODS From August 2007 to March 2011, 36 children with dorsal or volar wrist ganglions with an average size of 2 cm (range, 1-4 cm), including 5 recurrent cases, underwent resection performed with intraoperative methylene blue marking of the cyst wall. RESULTS We found recurrence in one patient after 2 years; no obvious complications were observed in any patient. CONCLUSIONS Methylene blue staining of the ganglion during resection may be helpful for achieving complete resection. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Yuxi Su
- Department II of Orthopaedics, Stem Cell Biology and Therapy Laboratory, Ministry of Education Key Laboratory of Child Development and Disorders, the Children's Hospital of Chongqing Medical University, Chongqing, China; Yubei Maternal and Children Health Hospital, Chongqing Medical University, Chongqing, China
| | - Yan Xie
- Department II of Orthopaedics, Stem Cell Biology and Therapy Laboratory, Ministry of Education Key Laboratory of Child Development and Disorders, the Children's Hospital of Chongqing Medical University, Chongqing, China; Yubei Maternal and Children Health Hospital, Chongqing Medical University, Chongqing, China
| | - Jiaqiang Qin
- Department II of Orthopaedics, Stem Cell Biology and Therapy Laboratory, Ministry of Education Key Laboratory of Child Development and Disorders, the Children's Hospital of Chongqing Medical University, Chongqing, China; Yubei Maternal and Children Health Hospital, Chongqing Medical University, Chongqing, China
| | - Guoxin Nan
- Department II of Orthopaedics, Stem Cell Biology and Therapy Laboratory, Ministry of Education Key Laboratory of Child Development and Disorders, the Children's Hospital of Chongqing Medical University, Chongqing, China; Yubei Maternal and Children Health Hospital, Chongqing Medical University, Chongqing, China.
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Korkmaz M, Ozturk H, Amanvermez Senarslan D, Erdogan Y. Aspiration and methylprednisolone injection to the cavity with IV cannula needle in the treatment of volar wrist ganglia: New technique. Pak J Med Sci 2013; 29:103-6. [PMID: 24353517 PMCID: PMC3809169 DOI: 10.12669/pjms.291.2655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/13/2012] [Accepted: 12/01/2012] [Indexed: 11/15/2022] Open
Abstract
Objective: There are several types of treatment modalities for wrist ganglions. The aim of the study was to assess the effectiveness of cyst aspiration and methyl prednisolone acetate injection with double IV cannula rather than sharp pointed needle, as a new technique in the treatment of volar ganglia. Methodology: The study involves total of 19 patients who received treatment by aspiration and methyl prednisolone injection into the cavity. Two IV cannulas are pricked to the cystic cavity. Cyst fluid is drained by the distally placed IV cannula meanwhile injecting methyl prednisolone by proximally placed IV cannula. The patient records and follow-up reports are retrospectively investigated. The patient age, sex, site of the cyst, the treatment that was applied, adjacency to the artery and the nerves and recurrence are recorded. Mean follow up time was 2.1±0.5 years. Results: The study involved 19 patients that received aspiration treatment for volar ganglion cysts between January 2004 and December 2009. There were 12 (63.2%) female and 7 (36.8%) male subject with volar wrist ganglion cyst. The mean age of patients was 27.63±6.6 years. Fourteen (73.7%) patients of total had cysts close to the artery. We didn’t observe any complication related to methyl prednisolone injection and arterial ischemia. Recurrence was observed in three (15.8%) patients. Conclusion: This method has lower recurrence rate than other aspiration therapy with sharp pointed needle. We prefer to use IV cannula needle for cyst aspiration and steroid injection in treatment of volar ganglia before any surgical intervention.
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Affiliation(s)
- Murat Korkmaz
- Murat Korkmaz, Assistant Professor, Dept. of Orthopedics and Traumatology, Bozok University Medical Faculty, Yozgat, Turkey
| | - Hayati Ozturk
- Hayati Ozturk, Associate Professor, Dept. of Orthopedics and Traumatology, Cumhuriyet University Medical Faculty, Sivas, Turkey
| | - Dilsad Amanvermez Senarslan
- Dilsad Amanvermez Senarslan, Lecturer, Department of Cardiovascular Surgery, Bozok University Medical Faculty, Yozgat, Turkey
| | - Yalcin Erdogan
- Yalcin Erdogan, Assistant Professor, Department of Family Physician, Bozok University Medical Faculty, Yozgat, Turkey
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Current innovations in wrist arthroscopy. J Hand Surg Am 2012; 37:1932-41. [PMID: 22916867 DOI: 10.1016/j.jhsa.2012.06.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 02/02/2023]
Abstract
It has become clear that the stability of the scapholunate joint does not depend wholly on the scapholunate interosseous ligament, but rather on both primary and secondary stabilizers, which form a scapholunate ligament complex. Each case of scapholunate instability is unique and should be treated with tissue-specific repairs, which may partly explain why one procedure cannot successfully restore joint stability in every case. Wrist arthroscopy has a pivotal role in both the assessment and treatment of the scapholunate ligament complex derangements. Tears of the foveal attachment of the triangular fibrocartilaginous complex can be an underdiagnosed cause of distal radioulnar joint instability, because the foveal fibers cannot be visualized using the standard radiocarpal arthroscopy portals. Distal radioulnar joint arthroscopy allows for direct visualization and assessment of these fibers, which in turn has spawned a number of open and arthroscopic repair methods. Wrist arthroscopy has gained wider acceptance as a method to fine-tune articular reduction during open and percutaneous fixation of distal radius fractures, and simplifies intra-articular osteotomies for malunion. It can facilitate percutaneous bone grafting of scaphoid nonunions and has a role in the diagnosis and treatment of associated soft tissue lesions. These and other recent developments will be discussed in the following article.
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Langner I, Krueger PC, Merk HR, Ekkernkamp A, Zach A. Ganglions of the wrist and associated triangular fibrocartilage lesions: a prospective study in arthroscopically-treated patients. J Hand Surg Am 2012; 37:1561-7. [PMID: 22749480 DOI: 10.1016/j.jhsa.2012.04.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 04/29/2012] [Accepted: 04/30/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Wrist ganglions are the most common soft tissue tumors of the hand and wrist and can occur at any age. Their etiology remains controversial. A high prevalence of associated intrinsic ligamentous lesions has been described. We hypothesized that painful wrist ganglions are an indicator of an underlying joint abnormality, particularly of lesions of the triangular fibrocartilage complex (TFCC). The aim of our study was to prospectively determine the prevalence of associated TFCC lesions in patients with painful wrist ganglions. METHODS Forty-six patients (35 women, 11 men; mean age, 36 ± 11 y; range, 18-57 y) with painful wrist ganglions (20 radiopalmar and 26 dorsal) had surgery from January 2008 to June 2010. There were 18 primary and 28 recurrent ganglions. Clinical examinations, pain score evaluations, disabilities in daily life evaluations, plain radiographs, and magnetic resonance imaging were obtained before arthroscopic resection. Concomitant intrinsic lesions of the wrist were assessed with magnetic resonance imaging and re-evaluated by arthroscopy. RESULTS All ganglions were successfully resected. Overall, arthroscopy identified 22 TFCC lesions (48%) and 2 intracarpal ligament lesions. The TFCC perforations were more commonly associated with radiopalmar ganglions with a positive ulnocarpal stress test result and with recurrent radiopalmar ganglions. At 1-year follow-up, all patients were meaningfully improved in terms of pain and disabilities in daily life. CONCLUSIONS Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies. Therefore, arthroscopy should be contemplated as the primary treatment option for patients with painful ganglions of the wrist if they are in a radiopalmar location with a positive ulnocarpal stress test and for patients with recurrent radiopalmar ganglions, which are also highly associated with TFCC abnormalities. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- I Langner
- Center for Hand Surgery, Department of Trauma and Reconstructive Surgery, Universitymedicine Greifswald, Greifswald, Germany.
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