Arthroscopic dorsal wrist ganglion excision The treatment of

Arthroscopic dorsal wrist ganglion excision – The treatment of choice? Kęstutis Bliznikas, Vytautas Mikelevičius

Incidence l DWG – 80% l Volar RC – 12% l Volar STT – 8% 2011 IMUKA Presentation, “Practice for Plastic surgery” Dr. Baur, Dr. Fromberg

Anatomy

Diagnostics l Symptoms (pain, functional discomfort, aesthetic discomfort) l Lump in the wrist (not visible for occult ganglions)

MRI

Treatment methods I – Conservative (Observation, crushing, splinting, aspiration, puncture, sclerotherapy) ; II –Surgical: Ø Open excision; Ø Arthroscopic excision.

Surgery I – Open excision II – Arthrocopic excision

Advantages l Improved recovery l Better joint visualization (magnification) l Lower complication rates l Lower recurrence rates (8 -40% vs 0 -10%)* l Better cosmetic results *Edwards, S. G. and J. A. Johansen, Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg Am, 2009. 34(3): p. 395 -400

Advantages

Wrist arthroscopy l DWG stalk identification success rate 9 -100%* l Additional intraarticular pathology may be found up to 75% of patients *Ahsan, Z. S. and J. Yao, Arthroscopic dorsal wrist ganglion excision with color-aided visualization of the stalk: minimum 1 -year follow-up. Hand (N Y), 2014. 9(2): p. 205 -8

Wrist arthroscopy l Regional anesthesia l Distraction system l Tourniquet l 2, 7 mm scope l Full radius 2, 5 -3, 5 mm shaver l No radiofrequency

Wrist arthroscopy l Start with 6 R l Diagnostic arthroscopy l Identify stalk / sinovitis zone at 3 -4 portal site l 3 -4 portal introduced l Resect ganglion site / stalk, make DW capsule defect l Stop when ECRB is clearly visible

Wrist arthroscopy

Our experience l. Total 42 patients (16 lost) l. From 2011 -april till now l. Questioned 26 patients; l. Follow up from 2 to 38 months. l 1 surgeon

Our experience

Questionnaire Patient outcomes following wrist ganglion excision surgery, J. D. Craik and S. P. Walsh, J Hand Surg Eur Vol 2012 37: 673 originally published online 5 January 2012

Results What others say: l. The reason for consultation: unsightly appearance - 55. 2%, the presence of pain 28. 9%, both – 15, 8%. * l. Pain (79%) and cosmesis (71%) were the primary pre-operative symptoms. Other symptoms such as paraesthesia, numbness, weakness, and stiffness were experienced by 27– 44% of patients. ** *Gallego, S. and C. Mathoulin, Arthroscopic resection of dorsal wrist ganglia: 114 cases with minimum follow-up of 2 years. Arthroscopy, 2010. 26(12): p. 1675 -82. ** Craik, J. D. and S. P. Walsh, Patient outcomes following wrist ganglion excision surgery. J Hand Surg Eur Vol, 2012. 37(7): p. 673 -7.

Results

Results l The ganglion recurred in 3 patients (12%).

In conclusion… l Etiology and pathogenesis of ganglion is not completely clear l Conservative treatment often fails l Incision scar may be avoided using arthroscopic technique l Arthroscopic technique has definite role in management of DWG with very promising future l Our results are similar to other published data

Thanks for attention