Articular ganglia of the volar aspect of the wrist: Arthroscopic resection compared with open excision. A prospective randomised study

Abstract

Our aim was to compare two methods of treatment of ganglia on the volar aspect of the wrist (the open excision done through a longitudinal volar skin incision and the arthroscopic resection through two or three dorsal ports), to see if arthroscopy could reduce the risks of operating in this area and the time to healing. Twenty radiocarpal and five midcarpal volar ganglia were operated on by open approach and an equivalent group was treated by arthroscopy. Fifteen radiocarpal and five midcarpal ganglia were treated with good results in the open group and 18 radiocarpal and one midcarpal ganglia in the arthroscopic group (no visible or palpable ganglion, a full range of active wrist movement, grip strength equal to preoperatively, no pain, and a cosmetically acceptable scar). In the open group there were four injuries to a branch of the radial artery, two cases of partial stiffness of the wrist associated with a painful scar, one case of neuropraxia, and one recurrence (all of which were among the 20 radiocarpal ganglia). In the arthroscopic group there was one case of neuropraxia, one injury to a branch of the radial artery, and three recurrences (three of the complications were among the five midcarpal ganglia). The mean functional recovery time was equal to 15 (6) days in the open group and 6 (2) days in the arthroscopic group. The mean time lost from work was equal to 23 (11) days in the open group and 10 (5) days in the arthroscopic group. Our results suggest that arthroscopic resection is a reasonable alternative to open excision in treating radiocarpal volar ganglia because it has less postoperative morbidity and a better cosmetic result. Midcarpal volar ganglia, however, should still be treated by open operation.

Sonography-guided Arthroscopy for Wrist Ganglion

“…Complications following arthroscopic ganglion excision are reported to be rare but include hematomas that required surgical drainage, injury to the dorsal nerves, 15 the radial nerve and artery, 6 and extensor tenosynovitis. 3 Therefore, Ho et al cautioned against advancing the shaver tip deep into the volar capsule during resection of volar ganglions to prevent damage to the important structures outside of the joint.…”

“…In fact, arthroscopic treatment for wrist ganglions has been reported to result in extensor tenosynovitis and injury to branches of the radial artery and the sensory branch of the radial nerve. 3,6 Furthermore, the ganglion and its stalk cannot be reliably observed in all cases with the arthroscopic technique. Therefore, arthroscopic surgeons need to localize the ganglion using indirect techniques, such as external pressure to the ganglion, and dissect the joint capsule until the ganglion or its stalk appear.…”

Complications of Elbow and Wrist Arthroscopy

“…More minor complications included transient nerve injury, prolonged portal site drainage or superficial infection, transient stiffness, and extensor tendon irritation. The literature includes case series 20,46,59,[62][63][64][66][67][68][69] (Table 3) and several case reports of neurological 52,57,70 and non-neurological complications (Table 4). 71 Prevention of complications involves understanding of distraction techniques, patient positioning, anatomy, and instrumentation.…”

Blunt Force May be an Effective Treatment for Ganglion Cysts

“…1), with an average of 13% (Table 4), but has a higher incidence of complications [1,3,4,8,[12][13][14][15][20][21][22] and cost. Zubowicz et al estimated surgical management of patients costs 120,000 US dollars per 100 patients [29].…”