Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series

Oliveira, Ricardo Kaempf de; Brunelli, João Pedro Farina; Bayer, Leohnard Roger; Aita, Márcio; Mantovani, Gustavo; Delgado, Pedro José

doi:10.1055/s-0039-1700811

Brasil

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Original Article • Rev. bras. ortop. 54 (6) • Nov-Dec 2019 • https://doi.org/10.1055/s-0039-1700811 linkcopy

Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives To describe the technique and results of the arthroscopic surgical treatment of volar ganglion cyst of the wrist.

Materials and Methods The present study comprised 21 patients submitted to the arthroscopic treatment of volar ganglion cysts of the wrist from January 2015 to May 2017, with a full evaluation for at least 6 months. The technique was indicated for patients presenting pain and functional impairment for more than four months, with no improvement with the conservative treatment, or for those with cosmetic complaints and cyst present for more than three months.

Results The mean age of the patients was 43.6 years; 16 (76%) patients were female, and 5 (24%) were male. The mean follow-up time from surgery to the final assessment was of 10.9 months. A total of 2 (9.6%) patients complained of mild pain after the procedure, and another patient presented slight motion restrictions. The 18 (90.4%) remaining patients reported cosmetic improvement, complete functional recovery, and pain improvement. There were no recurrences or infections. No patient required further surgery.

Conclusions The arthroscopic resection of volar ganglion cysts is a useful and safe technique. It is a minimally-invasive procedure, with low morbidity and very few complications, representing a good alternative to the open technique.

Keywords musculoskeletal diseases/surgery; wrist joint; ganglion cyst; arthroscopy/use

Result	Criteria
Good	No recurrence; active movement and grip strength equal to those observed before surgery; no pain; painless and esthetically appropriate scar; no severe arterial lesions; no neurological lesions.
Moderate	No recurrence; active movement and grip strength equal to those observed before surgery; no severe arterial injury; local pain or broad or hypertrophic scar; painful scar; mild neurological injury.
Bad	Presence of one of the following criteria: recurrence; partial movement or grip strength loss; and arterial or neurological lesion.

	Identification			Cyst characteristics
	Gender	Age (years)	Dominance	Side	Size (mm)	Preoperative pain	Main complaint	Previous treatment	Lesion time (months)
1	F	42	R	R	10 × 9	6	Esthetic + pain	Co	12
2	F	54	R	R	12 × 10	7	Esthetic + pain	Co	12
3	F	35	R	R	15 × 15	4	Esthetic + pain	Co	12
4	M	20	R	L	20 × 20	6	Pain	Co	12
5	F	37	R	R	23 × 20	6	Pain	Co	10
6	M	64	R	R	20 × 30	6	Esthetic + pain	Co	36
7	F	36	L	L	15 × 20	4	Esthetic + pain	Co	18
8	F	56	R	R	10 × 20	7	Esthetic + pain	Co	12
9	F	36	L	R	30 × 30	7	Esthetic + pain	Co	6
10	M	49	R	R	20 × 20	6	Pain	Co	24
11	F	57	L	L	18 × 20	6	Esthetic + pain	Co	12
12	F	38	L	L	20 × 20	7	Esthetic + pain	Co	18
13	M	23	R	R	10 × 10	7	Pain	Co	12
14	F	74	R	L	15 × 15	6	Esthetic + pain	Co	12
15	F	40	R	R	12 × 12	8	Esthetic + pain	Co	18
16	F	68	R	L	16 × 15	5	Esthetic + pain	Co	12
17	F	63	R	L	9 × 10	7	Esthetic + pain	Co	24
18	F	41	L	R	10 × 10	4	Esthetic + pain	Co	18
19	M	37	R	R	15 × 12	3	Esthetic + pain	Co	18
20	F	18	R	L	12 × 18	3	Esthetic + pain	Co	12
21	F	29	R	R	12 × 15	3	Esthetic + pain	Co	24

	Arthroscopic procedure				Early assessment	Late assessment			Observations
	Portals	Pedicle location	Procedural time (minutes)	Immobilization time (days)	Complications	Time until final evaluation	Postoperative pain	Outcome evaluation
1	3/4,1/2, 6R	Between LRLL and RSCL	60	5	No	6	0	Good	No
2	3/4,1/2	Between LRLL and RSCL	60	5	No	6	0	Good	No
3	3/4,1/2, 6R	Between LRLL and RSCL	40	5	No	8	0	Good	No
4	3,4, 6R	Radial to RSCL	50	12	No	7	3	Moderate	Delayed range of motion recovery
5	3,4, 6R, MC	Between LRLL and RSCL	40	7	No	8	0	Good	No
6	3/4, 4/5	Between LRLL and RSCL	45	5	No	8	0	Good	No
7	3/4, 4/5, 6R	Between LRLL and RSCL	40	5	No	6	0	Good	No
8	3/4, 4/5	Between LRLL and RSCL	35	7	No	10	0	Good	No
9	3/4, 4/5	MC	50	7	No	18	0	Good	No
10	3/4, 4/5	Between LRLL and RSCL	30	7	No	6	0	Good	No
11	3/4, 4/5	Between LRLL and SRLL	50	7	No	6	0	Good	Still progressively gaining range of motion
12	3/4, 6R	Between LRLL and SRLL	30	7	No	14	0	Good	No
13	3/4, 4/5, 6R	Between LRLL and SRLL	45	7	No	36	0	Good	No
14	3/4,1/2, 6R	Between LRLL and RSCL	20	7	No	8	0	Good	No
15	3/4,1/2, 6R	Between LRLL and RSCL	30	10	No	12	0	Good	No
16	3/4,1/2, 6R	Between LRLL and RSCL	35	6	No	12	0	Good	No
17	3/4,1/2, 6R	Between LRLL and RSCL	20	7	No	12	2	Good	No
18	3/4, 6R	Between LRLL and RSCL	30	7	No	14	0	Good	No
19	3/4, 6R	Between LRLL and RSCL	35	10	No	12	0	Good	No
20	3/4,1/2, 6R	Between LRLL and RSCL	45	12	No	8	0	Good	No
21	3/4, 6R	Between LRLL and RSCL	50	8	No	12	0	Good	No

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Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
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[TFN1] Abbreviations: Co, conservative; F, female; L, left; M, male; R, right.

Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series*

Abstract

Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series^*