- Aspiration:
- aspiration followed by 3 weeks of immobilization may be successful in 30-50% of patients;
- usually a 16 gauge needle is required inorder to successfully aspirate the
-
note: aspiration the characteristic gelatinous fluid is also useful to rule out the rare occurance of a malignant tumor masquerading as a cyst;
- in the case of a malignant tumor, it is unfortunate to make the diagnosis, only after a transverse incision has been made across the wrist;
- references:
-
Aspiration of ganglia.
-
Management of ganglion cysts of the hand by simple aspiration.
-
Efficacy of immobilization following aspiration of carpal and digital 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 YC Loh et al (JBJS 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. YC Loh et al. JBJS. Vol 80-B. No 4. July 1998. p 629.
-
post op care:
- need active wrist flexion to avoid contractures;
-
outcomes:
- in the study by Steinberg and Kleinman JHS 1999, 16 out of 21 patiens who underwent excision of an occult ganglion had an excellent outcome;
Dorsal wrist pain and the occult scapholunate ganglion.
The treatment of dorsal wrist ganglia by radical excision.
Scapholunate instability following ganglion cyst excision. A case report.
Occult scapholunate ganglion: a cause of dorsal wrist pain. BD Steinberg MD and WB Kleinman MD. J. Hand Surg. Vol 24-A. No 2. Mar 1999 p 227.
