Arthroscopic treatment of dorsal wrist ganglions
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Arthroscopic Treatment of Dorsal Wrist Ganglions Aaron Venouziou, MD Orthopaedic Hand and Upper Extremity Surgeon St. Luke’s Hospital Thessaloniki www.handsurgery.gr
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Transcript of 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
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Dorsal wrist ganglionsThe most common hand tumor
50% to 70% of all soft tissue hand tumors
Dorsal wrist ganglions 70% of all ganglions
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Anatomy
SLIOLDRCDIC
J Wrist Surg 2013
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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
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Pathogenesis Mostly unknown / controversial
Mucoid degeneration of capsule
In 10% to 50% a specific traumatic event is described
Repetitive micro trauma
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PathogenesisTrauma/Overuse/Hyperlaxity
Synovial membrane rupture
Loss of DCSS waterproofness
Mesenchymal cells deregulation
Abnormal secretion of HA
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Treatment 60% spontaneous resolution
50% success of non-operative management
35%-50% success w/ aspiration +/- corticosteroids
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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
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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
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Surgical TechniqueHand tableTraction device Arthroscopic tower
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Surgical TechniqueView from 6R
Pearl sign
Shaving a window in the dorsal capsule
The ganglion should be decompressed
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Postoperative careVolar splint for a few days
Then full ROM program
Strengthening at 4 weeks postoperatively
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Complications Recurrence (0-15%)
Inadequate resection of the stalk and capsule
In the early surgeons learning curve
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www.handsurgery.gr
www.handsurgery.gr
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