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Arthroscopic
Treatment of
Dorsal Wrist
Ganglions
Aaron Venouziou, MD
Orthopaedic Hand and Upper
Extremity Surgeon
St. Luke...
www.handsurgery.gr
Dorsal wrist ganglions
• The most common hand
“tumor”
• 50% to 70% of all soft
tissue hand tumors
• Dor...
www.handsurgery.gr
Anatomy
SLIOL DRC DIC
J Wrist Surg 2013
www.handsurgery.gr
Anatomy
• Dorsum of the wrist
• Communication with the
scapholunate interosseous
ligament via a pedicle...
www.handsurgery.gr
Pathogenesis
• Mostly unknown /
controversial
• Mucoid degeneration of
capsule
• In 10% to 50% a specif...
www.handsurgery.gr
Pathogenesis
Trauma/Overuse/Hyperlaxity
Synovial membrane rupture
Loss of DCSS waterproofness
Mesenchym...
www.handsurgery.gr
Treatment
• 60% spontaneous resolution
• 50% success of non-operative
management
• 35%-50% success w/ a...
www.handsurgery.gr
Treatment
• 15% recurrence rate after
excision of the cyst with its
capsule stalk
• Trading a bump for ...
www.handsurgery.gr
Arthroscopic resection
ADVANTAGES
• Trading a portal for a bump
• Less numbness
• Less stiffness
• Tx o...
www.handsurgery.gr
Surgical Technique
• Hand table
• Traction device
• Arthroscopic tower
www.handsurgery.gr
Surgical Technique
• View from 6R
• Pearl sign
• Shaving a “window”
in the dorsal capsule
• The ganglio...
www.handsurgery.gr
Postoperative care
• Volar splint for a few days
• Then full ROM program
• Strengthening at 4 weeks
pos...
www.handsurgery.gr
Complications
• Recurrence (0-15%)
• Inadequate resection
of the stalk and
capsule
• In the early surge...
www.handsurgery.gr
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Arthroscopic treatment of dorsal wrist ganglions

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Arthroscopic treatment of dorsal wrist ganglions

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Arthroscopic treatment of dorsal wrist ganglions

  1. 1. Arthroscopic Treatment of Dorsal Wrist Ganglions Aaron Venouziou, MD Orthopaedic Hand and Upper Extremity Surgeon St. Luke’s Hospital Thessaloniki www.handsurgery.gr
  2. 2. www.handsurgery.gr Dorsal wrist ganglions • The most common hand “tumor” • 50% to 70% of all soft tissue hand tumors • Dorsal wrist ganglions 70% of all ganglions
  3. 3. www.handsurgery.gr Anatomy SLIOL DRC DIC J Wrist Surg 2013
  4. 4. www.handsurgery.gr 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
  5. 5. www.handsurgery.gr Pathogenesis • Mostly unknown / controversial • Mucoid degeneration of capsule • In 10% to 50% a specific traumatic event is described • Repetitive micro trauma
  6. 6. www.handsurgery.gr Pathogenesis Trauma/Overuse/Hyperlaxity Synovial membrane rupture Loss of DCSS waterproofness Mesenchymal cells deregulation Abnormal secretion of HA
  7. 7. www.handsurgery.gr Treatment • 60% spontaneous resolution • 50% success of non-operative management • 35%-50% success w/ aspiration +/- corticosteroids
  8. 8. www.handsurgery.gr 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
  9. 9. www.handsurgery.gr Arthroscopic resection ADVANTAGES • Trading a portal for a bump • Less numbness • Less stiffness • Tx of additional intrarticular pathology (75%) • Lower recurrence rate • Osterman and Raphael, Hand Clin 1995;11:7–12
  10. 10. www.handsurgery.gr Surgical Technique • Hand table • Traction device • Arthroscopic tower
  11. 11. www.handsurgery.gr Surgical Technique • View from 6R • Pearl sign • Shaving a “window” in the dorsal capsule • The ganglion should be decompressed
  12. 12. www.handsurgery.gr Postoperative care • Volar splint for a few days • Then full ROM program • Strengthening at 4 weeks postoperatively
  13. 13. www.handsurgery.gr Complications • Recurrence (0-15%) • Inadequate resection of the stalk and capsule • In the early surgeon’s learning curve
  14. 14. www.handsurgery.gr

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