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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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2
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Wong CR, Karpinski M, Hatchell AC, McRae MH, Murphy J, McRae MC. Immobilization of the Wrist After Dorsal Wrist Ganglion Excision: A Systematic Review and Survey of Current Practice. Hand (N Y) 2023; 18:254-263. [PMID: 34096351 PMCID: PMC10035098 DOI: 10.1177/15589447211014631] [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: 11/15/2022]
Abstract
BACKGROUND Postoperative care after dorsal wrist ganglion (DWG) excision is highly varied. The effect of immobilization of the wrist on patient outcomes has not yet been examined. METHODS A systematic review of the literature was performed to determine whether wrist immobilization after DWG surgical excision is beneficial. A survey of hand surgeons in Canada was performed to sample existing practice variations in current immobilization protocols after DWG excision. RESULTS A systematic review yielded 11 studies that rigidly immobilized the wrist (n = 5 open excision, n = 5 arthroscopic excision, n = 1 open or arthroscopic excision), 10 studies that used dressings to partially limit wrist motion (n = 5 open, n = 5 arthroscopic), 1 study (open) that did either of the above, and 2 studies (arthroscopic) that did not restrict wrist motion postoperatively. This ranged from 48 hours to 2 weeks in open DWG excision and 5 days to 3 weeks in arthroscopic DWG excision. The survey of Canadian hand surgeons had a similarly divided result of those who chose to immobilize the wrist fully (41%), partially (14%), or not at all (55%). Most surgeons surveyed who immobilized the wrist postoperatively did so for 1 to 2 weeks. CONCLUSION The systematic review and survey of Canadian hand surgeons reveal that hand surgeons are divided regarding the need to immobilize the wrist after DWG excision. In terms of functional outcome, there is no compelling data to suggest 1 strategy is superior. The time frame for immobilization when undertaken was short at 2 weeks or less.The systematic review is registered in the PROSPERO database (PROSPERO 2016:CRD42016050877).
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Affiliation(s)
| | | | | | | | | | - Matthew C McRae
- McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
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3
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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: 2] [Impact Index Per Article: 2.0] [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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5
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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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6
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Clark D, Dingle M, Saxena S, Dworak T, Nappo K, Balazs GC, Nanos G, Tintle S. Prospective Evaluation of Push-up Performance and Patient-Reported Outcomes Following Open Dorsal Wrist Ganglion Excision in the Active-Duty Military Population. J Wrist Surg 2022; 11:493-500. [PMID: 36504534 PMCID: PMC9731736 DOI: 10.1055/s-0042-1743118] [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: 08/13/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022]
Abstract
Background Dorsal wrist ganglia (DWG) are a common wrist pathology that affects the military population. This study prospectively evaluates push-up performance, functional measures, and patient-reported outcomes 6 months after open DWG excision in active-duty patients. Methods Twenty-seven active-duty patients were enrolled and 18 had complete follow-up. Included patients had DWG diagnosis, unilateral involvement, and no previous surgery. The number of push-ups performed within 2 minutes was measured preoperatively and at 6 months. Range of motion (ROM), grip strength, Pain Catastrophization Scale (PCS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, Mayo Wrist Score, and visual analog scale (VAS) pain score were measured preoperatively and at 2 weeks, 6 weeks, 3 months, and 6 months. Results Push-up performance did not significantly change overall. Wrist flexion, extension, and radial deviation returned to preoperative ranges. Wrist ulnar deviation significantly increased from preoperative range. Grip strength deficit between operative and unaffected extremities significantly improved to 0.7 kg at 6 months from preoperative deficit of 2.7 kg. Mean scores significantly improved for the validated outcome measures-PCS from 6.3 to 0.67, VAS pain scores from 1.37 to 0.18, DASH scores from 12.8 to 4.3, and Mayo Wrist Scores from 80.3 to 89.4. No surgical complications or recurrences were reported. Conclusions Findings suggest that almost half of active patients may improve push-up performance after DWG excision at 6 months. Significant improvements were seen in wrist pain, ROM, grip strength, and all patient-reported outcomes, which is useful when counseling patients undergoing excision.
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Affiliation(s)
- DesRaj Clark
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | - Marvin Dingle
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | - Sameer Saxena
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | - Theodora Dworak
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | - Kyle Nappo
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | | | - George Nanos
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
| | - Scott Tintle
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Maryland
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7
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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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8
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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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10
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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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Van Overstraeten L, Camus EJ, Moungondo F, Schuind F. Volar Ganglion Cyst and Echo-Guided Assistance for the Arthroscopic Removal. Hand Clin 2022; 38:101-107. [PMID: 34802602 DOI: 10.1016/j.hcl.2021.08.011] [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: 02/02/2023]
Abstract
The ganglion of the wrist is very common but with uncertain prognosis. The arthroscopic resection seems to improve the result compared with open procedure, in decreasing recurrence and morbidity. Volar ganglions are close to the radial artery, the flexor pollicis longus tendon, and even the median nerve. Ultrasonography combined with arthroscopy offers incomparable safety for the resection of volar ganglions. The technical steps of this combined procedure are described, and the first published series are discussed.
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Affiliation(s)
- Luc Van Overstraeten
- Orthopedic and Traumatologic, University Hospital Erasme, Brussels, Belgium; Hand and Wrist Center, HFSU, AO Foundation, Tournai, Belgium.
| | - Emmanuel Jacques Camus
- Department of Orthopaedic and Traumatologic Surgery, University Clinical Center, Polyclinic Val de Sambre, Maubeuge, France
| | - Fabian Moungondo
- Orthopedic and Traumatologic, University Hospital Erasme, Brussels, Belgium
| | - Frédéric Schuind
- Orthopedic and Traumatologic, University Hospital Erasme, Brussels, Belgium
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12
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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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13
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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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