Treatment of Dorsal Wrist Ganglions


- Open Resection:
    - short transverse incision directly over the mass;
    - dorsal ganglions are often located between the EPL and EDC tendons;
    - retinaculum is incised between the 2nd and 4th extensor compartments (EPL tendon sheath need not be incised);
    - main cyst and its pedicle are mobilized down to joint capsule;
    - w/ wrist in volar flexion, the joint capsule is opened along border of radius and proximal pole of scaphoid;
    - to ensure complete ganglion excision, a trianglular portion of capsule is removed between the dorsal oblique radiotriquetral
              ligament and the dorsal transverse scaphotriquetral ligament:
    - capsule is retracted distally, exposing capsular attachments of the scapholunate ligament; (see dorsal wrist ligaments);
    - ganglion & its capsular extension are excised off scapholunate ligament;
    - resection of involved portion of dorsal scapholunate ligament will show degenerative changes;
            - this resection should be tangential, and should be proximal to the distal 2-3 mm of dorsal scapholunate interosseous ligament;
    - do not excise scapholunate interosseous ligament, since this could potentially cause SLD;
    - PIN is identified as it runs past 4th dorsal compartment (nerve may be resected proximally over radius);
            - in the study by Loh YC, et al (1999), several patients were identified who had developed a neuroma of the PIN following
                  ganglion excision;
                  - whether or not the nerve is resected, the surgeon should have a clear plan for its management;
                  - ref: Neuroma of the distal posterior interosseous nerve. A cause of iatrogenic wrist pain.  
    - post op care:
            - need active wrist flexion to avoid contractures;
    - outcomes:
            - in the study by Steinberg and Kleinman (1999), 16 out of 21 patiens who underwent excision of an occult ganglion had an
                     excellent outcome; 
            - Occult scapholunate ganglion: a cause of dorsal radial wrist pain.


Outcomes of Open Dorsal Wrist Ganglion Excision in Active-Duty Military Personnel

The treatment of dorsal wrist ganglia by radical excision.

Scapholunate instability following ganglion cyst excision. A case report.

Necessity of Routine Pathological Examination After Surgical Excision of Wrist Ganglions

Color-Aided Visualization of Dorsal Wrist Ganglion Stalks Aids in Complete Arthroscopic Excision

Preliminary Report of the Effectiveness of Tetracycline Sclerotherapy in Treatment of Ganglion



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, June 17, 2016 1:51 pm