Arthroscopic treatment of dorsal wrist ganglions

Arthroscopic Treatment of Dorsal Wrist Ganglion

Arthroscopic Treatment ofDorsal Wrist GanglionsAaron Venouziou, MDOrthopaedic Hand and Upper Extremity SurgeonSt. Lukes HospitalThessaloniki

www.handsurgery.gr

www.handsurgery.gr

1

Dorsal wrist ganglionsThe most common hand tumor

50% to 70% of all soft tissue hand tumors

Dorsal wrist ganglions 70% of all ganglions

www.handsurgery.gr

2

Anatomy

SLIOLDRCDIC

J Wrist Surg 2013

www.handsurgery.gr

3

Anatomy Dorsum of the wrist

Communication with the scapholunate interosseous ligament via a pedicle

The pedicle acts as an one-way valve mechanism, from the joint to the cyst

www.handsurgery.gr

4

Pathogenesis Mostly unknown / controversial

Mucoid degeneration of capsule

In 10% to 50% a specific traumatic event is described

Repetitive micro trauma

www.handsurgery.gr

5

PathogenesisTrauma/Overuse/Hyperlaxity

Synovial membrane rupture

Loss of DCSS waterproofness

Mesenchymal cells deregulation

Abnormal secretion of HA

www.handsurgery.gr

6

Treatment 60% spontaneous resolution

50% success of non-operative management

35%-50% success w/ aspiration +/- corticosteroids

www.handsurgery.gr

7

Treatment 15% recurrence rate after excision of the cyst with its capsule stalk

Trading a bump for a scar

Numbness around the incision

Wrist stiffness

www.handsurgery.gr

8

Arthroscopic resection

ADVANTAGESTrading a portal for a bumpLess numbnessLess stiffnessTx of additional intrarticular pathology (75%)Lower recurrence rateOsterman and Raphael, Hand Clin 1995;11:712

www.handsurgery.gr

9

Surgical TechniqueHand tableTraction device Arthroscopic tower

www.handsurgery.gr

10

Surgical TechniqueView from 6R

Pearl sign

Shaving a window in the dorsal capsule

The ganglion should be decompressed

www.handsurgery.gr

11

Postoperative careVolar splint for a few days

Then full ROM program

Strengthening at 4 weeks postoperatively

www.handsurgery.gr

12

Complications Recurrence (0-15%)

Inadequate resection of the stalk and capsule

In the early surgeons learning curve

www.handsurgery.gr

13

www.handsurgery.gr

www.handsurgery.gr

14