Double dart technique of instillation of triamcinolone in ganglion over the wrist

Abstract

Background:Ganglia are the most common benign cystic swellings found over both the dorsal and volar aspects of the wrist. In spite of technical advancement, both operative and non-operative interventions achieve more or less similar results. Complete evacuation of gelatinous fluid followed with intra cystic instillation of triamcinolone has given encouraging results.Aims:To assess the efficacy and safety of drainage of cyst and instillation of triamcinolone in wrist ganglion.Materials and Methods:A prospective study was conducted on patients with simple ganglion cysts on the wrist. Total of 219 patients underwent this study. Out of this, 105 patients underwent the aspiration of the cyst fluid followed by intracystic instillation of triamcinolone, and 114 patients underwent surgical excision of wrist ganglia. Two years follow up was done for recurrence.Results:Most ganglia of wrist occurred in the extensor aspect. Complications noted among the surgically excised group were post operative pain and restricted mobility of wrist with a recurrence rate of 21.5%. Instillation of Triamcinolone into the ganglion yielded early resolution with a low recurrence of 8.4%.Conclusions:Intracystic instillation of triamcinolone after complete evacuation of cyst fluid is a simple and effective technique for treatment of ganglion.

Chemical Substances Used in the Treatment of Ganglions Located in the Hand and Wrist

“…In the two-year observation period, ganglion recurrence was noted in eight out of the 105 patients in the group treated with aspiration (8.4%) and in 14 out of the 114 patients who were treated surgically (12.2%). In this study no adverse effects, including skin hypopigmentation, were observed after administration of triamcinolone [17]. This was in contrast to the aforementioned study by Chatterjee et al [10], who reported hypopigmentation in five out of 60 patients (8.3%) who were treated with triamcinolone.…”

“…Local adverse effects can result from both the properties of a given chemical substance and an incorrect injection technique. Many authors have proposed specific injection techniques to minimize the risk of injecting the chemical substance in an inappropriate location [10,15,17].…”

“…Limpaphayom and Wilairatana, like Chatterjee et al [10,15], employed the technique that most of the authors used: ganglion aspiration followed by injection of a chemical substance with the use of a single needle and two syringes. Paramhans et al [17] modified this technique: two needles were inserted in the cyst, opposite each other; one was used to aspirate the fluid from the cyst and then removed, and the chemical substance was injected through the other needle in a volume comparable to the volume of the ganglion. It is worth noting, however, that neither of these techniques precludes the possibility of rupturing the very thin ganglion wall or leakage of the chemical substance at the injection site.…”

“…After a mean follow-up period of 2.5 years, ganglion recurrence was observed in three children (14%) [16]. The effect of triamcinolone treatment of ganglions in adults was studied by Paramhans et al [17]. The aim of the prospective study conducted by this team was to compare the outcomes of surgical resection of ganglions with the results of ganglion aspiration and injections of 2 mL of 10% triamcinolone.…”

Surgical Excision Versus Aspiration Combined with Intralesional Triamcinolone Acetonide Injection Plus Wrist Immobilization Therapy in the Treatment of Dorsal Wrist Ganglion; A Randomized Controlled Trial

“…Surgery offers higher success rates in most series [2]. Surgical excision is effective, with a recurrence rate of around 5% if care is taken to completely excise the stalk of the cyst along with a small portion of joint capsule-The recurrence rate may vary from 1% (Angilides et.al) to 49% (Zachariae et.al) [2] Aspiration with intralesional steroid, with its many advantages, may be an alternative choice for the patient if the success is comparable to surgical excision [3,4].…”