We have evaluated the long-term outcome of excision, aspiration and no treatment of dorsal wrist ganglia prospectively in 236 (83%) of 283 patients who responded to a postal questionnaire at a mean of 70 months. The resolution of symptoms was similar between the treatment groups (p>0.3). Pain and unsightliness improved in all three treatment groups. The prevalence of weakness and stiffness altered only slightly in all three treatment groups. More patients with a recurrent, or persistent ganglion complained of pain, stiffness and unsightliness (p<0.0001). Patient satisfaction was higher after surgical excision (p<0.0001), even if the ganglion recurred. Twenty-three of 55 (58%) untreated ganglia resolved spontaneously. The recurrence rate was 58% (45/78) and 39% (40/103) following aspiration and excision, respectively. Eight out of 103 patients had complications following surgery. In this study, neither excision nor aspiration provided significant long-term benefit over no treatment.

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Shoulder subluxation is subjectively assessed by a palpable increase in the distance between the acromion and the humerus. Diagnostic ultrasound has potential for objective assessment of this distance. We used portable ultrasound to measure the distance between the acromion and greater tuberosity (acromion-greater tuberosity [AGT] distance) and tested the intrarater reliability in healthy individuals prior to testing on stroke patients. Thirty-two healthy participants aged 51-85 years (mean 64.2+/-10.5) were recruited. Seated participants were scanned by a physiotherapist trained in shoulder ultrasound. Measurements were recorded on day 1 and again within 2 weeks. Reliability was assessed by intraclass correlation coefficients. The mean AGT distance was 1.68+/-0.41 cm for the left and 1.78+/-0.40 cm for the right shoulder. Within-day intrarater reliability coefficients were 0.99 and 0.98 for the left and right shoulders, respectively. Corresponding values for day-to-day reliability were 0.96 and 0.97. Portable diagnostic ultrasound is a quick and reliable method of assessing AGT distance in healthy individuals when measured by the same examiner.

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The ultrasound method can detect minor asymmetry (≤0.5 cm) and has the potential advantage over the fingerbreadth palpation method of identifying patients with minor subluxation.