Audit of Clinical and Functional Outcomes of Arthroscopic Resection of Wrist Ganglions

Postoperative Benefits of Soft Tissue Wrist Arthroscopy: Retro- and Prospective Analyses of Outcome Measures

Background: Elective soft-tissue-only wrist arthroscopy is a standard procedure in hand surgery for the diagnosis and treatment of wrist pain. A number of pathologies can be treated arthroscopically, with the aim of pain reduction and improved wrist mobility. A postinterventional evaluation of the treatment using objective and patient-reported outcome measures (PROMs) allows for an evidence-based statement about the benefits of soft-tissue-only wrist arthroscopy. Methods: A dual-center study combining retro- and prospective clinical analyses of patient outcomes after soft-tissue-only wrist arthroscopies was performed. The data were collected at two hospitals with departments specializing in hand surgery. The outcome was measured by assessing the range of motion of the wrist and its manual strength, as well as PROMs, including Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: A total of 154 soft interventions met the study criteria and could be included. Seven months after the elective soft-tissue-only wrist arthroscopies, mobility improved significantly for active extension and flexion, as well as the ulnar and radial abduction of the wrist. The grip strength also improved significantly, by an average of 6 kg, during this period. The DASH score improved significantly, from 35 points to 14 points. Additionally, wrist pain at rest was reduced significantly. Conclusions: After elective soft-tissue-only wrist arthroscopy, patients showed an overall functional improvement in their wrist, with a significant reduction in pain and improvement of mobility and grip strength. This study emphasizes the importance of wrist arthroscopy as a successful treatment option for soft tissue pathologies of the wrist.

Arthroscopic Needling Technique for the Treatment of Wrist Ganglia

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.

Outcome Evaluation of Arthroscopic Resection of Dorsal Wrist Ganglia

Goals: Arthroscopic ganglionectomy has become an increasingly popular surgical option for dorsal wrist ganglia. The aim of this study was to describe our technique for the arthroscopic treatment of dorsal wrist ganglia and to evaluate the clinical results as well as the recurrence rate in our patients. Methods: In a prospective study, 48 patients who underwent arthroscopic treatment of dorsal ganglion of the wrist were included. Patients were evaluated preoperatively and 3 and 24 months post arthroscopy. A presence of recurrence at 24 months was recorded. The subjective outcome was evaluated with The Patient-Rated Wrist Evaluation (PRWE) and the Visual analog scale (VAS). Objective outcomes included grip strength and range of movement measurements. Results: The mean age was 36 years; the majority were women (36/48). Mean grip strength and the average flexion and extension in the wrist showed improvement after 3 months. The total PRWE score improved from 26.7 preoperatively to 10.2 at three months and 2.4 two years after surgery. After 24 months follow-up, there were only two patients with recurrence (4.2%). Conclusion: The arthroscopic resection of the dorsal wrist ganglia is a procedure with a low recurrence rate and lowest scaring and stiffness; it should be considered as a golden standard for operative treatment of the dorsal wrist ganglia.

Dorsal Wrist Ganglia: Influence of Arthroscopic Dorsal Capsulodesis – A Pilot Study

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).

Arthroscopic Resection of Wrist Volar Synovial Cyst: Technique Description and Case Series

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.

Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series

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.

Ultrasound-guided percutaneous treatment of volar radiocarpal ganglion cysts: Safety and efficacy

PURPOSE

To determine the safety and efficacy of ultrasound (US)-guided percutaneous treatment of volar radiocarpal ganglion cysts.

METHODS

The institutional review board approved the retrospective study of patients referred for US-guided percutaneous treatment of a volar radiocarpal ganglion cyst over a 5-year period. Treatment consisted of a combination of aspiration, lavage using anesthetic, wall fenestration, and steroid injection. Intraprocedural imaging and procedure notes were reviewed. Followup information was retrieved from postprocedure electronic medical records.

RESULTS

Eighty-eight patients comprised our study group. Complete decompression of the ganglion cyst was achieved in 92% of cases immediately after treatment. There were no instances of hematoma or infection. Of 38 patients with available followup information, 66% had a ganglion cyst recurrence at a median time of 9 months, regardless of their initial size or the injection of steroids. Cysts with internal septa had a statistically significantly higher rate of recurrence (P = 0.033).

CONCLUSIONS

US-guided percutaneous treatment of volar radiocarpal ganglion cysts is safe and ensures immediate decompression in most cases. However, cysts may recur, even after steroid injection or lavage.

Arthroscopic Resection of Dorsal Wrist Ganglion: Results and Rate of Recurrence Over a Minimum Follow-up of 4 Years

BACKGROUND

Dorsal wrist ganglia are the most common soft tissue tumor type of the upper limb. Surgical resection, open or arthroscopic, is one of the most frequent procedures performed by hand surgeons. This study sought to perform an objective evaluation of the outcomes of arthroscopic resection of dorsal wrist ganglia and their recurrence rates over 4 years. Patients treated with arthroscopic resection were expected to have favorable outcomes and low complication rates after 4 years of follow-up.

METHODS

We evaluated 34 cases of dorsal wrist ganglia in patients who underwent arthroscopic resection. The patients were evaluated using the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) for pain, range of motion of the wrist, palmar grip strength, rates of recurrence, and complications.

RESULTS

During the postoperative period, the QuickDASH score averaged 2.3 points, the mean residual pain by VAS was 0.54, full range of wrist movement was recovered by all patients, and the mean palmar grip strength was 29.4 kgf; there was 1 case with recurrence. There were no severe postoperative complications throughout the follow-up period.

CONCLUSIONS

The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion.