Arthroscopic treatment of dorsal wrist ganglions

1. Arthroscopic
Treatment of
Dorsal Wrist
Ganglions
Aaron Venouziou, MD
Orthopaedic Hand and Upper
Extremity Surgeon
St. Luke’s Hospital
Thessaloniki
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Dorsal wrist ganglions
• The 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
SLIOL DRC DIC
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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Pathogenesis
Trauma/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
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

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Surgical Technique
• Hand table
• Traction device
• Arthroscopic tower

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Surgical Technique
• View from 6R
• Pearl sign
• Shaving a “window”
in the dorsal capsule
• The ganglion should
be decompressed

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Postoperative care
• Volar 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 surgeon’s
learning curve

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