The effectiveness of sodium tetradecyl sulfate in the treatment of wrist ganglia

Abstract

BACKGROUND: Ganglia are the most common benign soft tissue tumours of the hand. Although benign, a significant number of patients with wrist ganglia consult with their general practitioners, and ultimately the hand surgeon, complaining of pain. A great number of patients are concerned about the cosmetic appearance, and an equally significant number genuinely believe that the ganglion is a cancer. There are several management options resulting in varying degrees of success. These include observation only, surgical excision, aspiration only, aspiration with injection of methylprednisolone, and aspiration with injection of methylprednisolone and hyaluronidase. OBJECTIVE: The main objective was to investigate the effectiveness and safety of sodium tetradecyl sulfate as a sclerosing agent after aspiration of wrist ganglia. METHODS: Initial data were collected prospectively during a period of 48 months. Following this, patients were sent a postal survey at least two years after they had received treatment to access the levels of recurrence and persistent complications. RESULTS: In the short term, 90% of the patients achieved complete resolution after one episode of aspiration and injection. However, there was only a 65% cure rate after two to five years. Complications were few and not significant. CONCLUSION: Sodium tetradecyl sulfate is an effective sclerosing agent after aspiration of wrist ganglia with an excellent short-term efficacy and a long-term cure rate comparable to that of surgical excision.

The triple technique: A simple and effective outpatient procedure for the dorsal wrist ganglion

“…To potentiate the action of this treatment modality, the injection of a sclerosant in order to obliterate the cavity has also been attempted and described. 15,24 The recurrence rate still remained around 35% in both the studies even after the addition of the sclerosant. Further, it carries the danger of inadvertent injection into a critical structure like an artery or the joint.…”

Pharmacology of Sclerotherapy

“…There have also been reports of STS administration in the treatment of varicoceles, vascular malformations of the extremities, upper gastrointestinal bleeding, variceal bleeding, hemorrhagic tumors, gallbladder ablation, lymphoceles, and percutaneous ablation of oral lesions of Kaposi sarcoma and ganglion cysts. 21,23 Animal models have demonstrated efficacy of STS in the treatment of gonadal veins, gallbladders, and renal arteries. [24][25][26][27][28] Sclerosis of canine renal arteries allows direct comparison to ethanol sclerosis.…”

A Prospective Randomized Controlled Trial of Aspiration and Fibrin Sealant Use Versus Aspiration Alone in the Treatment of Dorsal Wrist Ganglia

“…4 However, many of these methods have variable success rates and high recurrence rates. 4 Nonoperative interventions include aspiration alone, [5][6][7][8][9][10] aspiration and corticosteroid injection, 7,[10][11][12][13][14][15][16] aspiration and ethanol injection, 7 aspiration and hyaluronidase injection, 12,17 aspiration and sclerosing agent injection, 12,18,19 aspiration and multiple punctures, 9 and aspiration and electrocautery. 20 Operative interventions include both open and arthroscopic approaches, and these have been shown to have comparable recurrence rates 1 year postoperatively.…”