Arthroscopic dorsal wrist ganglion excision – The treatment of choice?

Kęstutis Bliznikas, Vytautas Mikelevičius

Incidence

DWG – 80%Volar RC – 12%Volar STT – 8%

2011 IMUKA Presentation, “Practice for Plastic surgery” Dr. Baur, Dr. Fromberg

Anatomy

Diagnostics

Symptoms (pain, functional discomfort, aesthetic discomfort)

Lump in the wrist (not visible for occult ganglions)

MRI

Treatment methods

I – Conservative (Observation, crushing, splinting, aspiration, puncture, sclerotherapy) ;

II –Surgical: Open excision; Arthroscopic excision.

Surgery

I – Open excisionII – Arthrocopic excision

Advantages

Improved recoveryBetter joint visualization (magnification)Lower complication rates Lower recurrence rates (8-40% vs 0-10%)*Better cosmetic results

*Edwards, S.G. and J.A. Johansen, Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg Am, 2009. 34(3): p. 395-400

Advantages

Wrist arthroscopy

DWG stalk identification success rate 9-100%*Additional intraarticular pathology may be

found up to 75% of patients

*Ahsan, Z.S. and J. Yao, Arthroscopic dorsal wrist ganglion excision with color-aided visualization of the stalk: minimum 1-year follow-up. Hand (N Y), 2014. 9(2): p. 205-8

Wrist arthroscopy

Regional anesthesiaDistraction systemTourniquet2,7mm scopeFull radius 2,5-3,5mm shaverNo radiofrequency

Wrist arthroscopy

Start with 6RDiagnostic arthroscopyIdentify stalk / sinovitis zone at 3-4portal

site3-4portal introducedResect ganglion site / stalk, make DW

capsule defectStop when ECRB is clearly visible

Wrist arthroscopy

Our experience

Total 42 patients (16 lost)From 2011-april till nowQuestioned 26 patients;Follow up from 2 to 38 months.1 surgeon

Our experience

Questionnaire

Patient outcomes following wrist ganglion excision surgery, J. D. Craik and S. P. Walsh, J Hand Surg Eur Vol 2012 37: 673 originally published online 5 January 2012

ResultsSymptoms and concerns BEFORE surgeryPain 65%Concern regarding ganglion appearance 81%Pins and needles 0%Numbness 0%

Weakness 19%

Stiffness 27%

Interference with daily tasks 46%Other 4%

What others say:The reason for consultation: unsightly appearance - 55.2%, the presence of pain 28.9%, both – 15,8%.*Pain (79%) and cosmesis (71%) were the primary pre-operative symptoms. Other symptoms such as paraesthesia, numbness, weakness, and stiffness were experienced by 27–44% of patients.** *Gallego, S. and C. Mathoulin, Arthroscopic resection of dorsal wrist ganglia: 114 cases with minimum follow-up of 2 years. Arthroscopy, 2010. 26(12): p. 1675-82.

** Craik, J.D. and S.P. Walsh, Patient outcomes following wrist ganglion excision surgery. J Hand Surg Eur Vol, 2012. 37(7): p. 673-7.

Results

Symptoms and concerns AFTER surgeryNone 88%Painful scar 0%Concern regarding scar appearance 0%Pins and needles (12%) 0%Numbness 0%Weakness 4%Stiffness (19%) 4% Other 4%

Results

The ganglion recurred in 3 patients (12%).

Satisfacion level (1-5)Without reccurence 4,52With reccurence 4,33 p≈0,6

In conclusion…

Etiology and pathogenesis of ganglion is not completely clear

Conservative treatment often fails Incision scar may be avoided using arthroscopic

techniqueArthroscopic technique has definite role in

management of DWG with very promising futureOur results are similar to other published data

Thanks for attention