Surgical excision of wrist ganglia; literature review and nine-year retrospective study of recurrence and patient satisfaction

Abstract

The main options for the treatment of wrist ganglia are reassurance, aspiration, arthroscopic resection and open excision. Variations within each option have been described and the literature is clouded by widespread variability in the results reported. We present the results of our own long-term retrospective study, review the literature and question the surgical risks and demands placed on healthcare resources. A retrospective review of the surgical results of dorsal and volar wrist ganglia excision between January 1998 and March 2005 was undertaken at a single institution. Of the 152 patients in this consecutive series, 117 (77%) patients responded to a telephone questionnaire. The mean length of follow-up in this series of 117 patients was 4.2 years (range 1.5–8.7 years). The overall recurrence rate following excision of all wrist ganglia in this series was 41.8 %. When looking just at volar ganglia, the risk of recurrence is higher at 46.8%. Should the ganglion recur, the risk of developing a moderate to severely tender scar is 34.6% and the risk of developing an unsightly scar is 8.2%. This study questions the effectiveness of surgical excision in the treatment of wrist ganglia when performed by a mixture of surgeons in that the recurrence rates are very similar to the rates seen in studies that merely observe or aspirate wrist ganglia. We propose that for symptomatic ganglia, specialists in hand surgery may be more appropriate at treating such a pathology.

Ganglions of the hand and wrist: Retrospective statistical analysis of 520 cases

“…9 However, in most of the recent publications, a higher incidence of ganglions of the hand and wrist in women is clearly noticeable. [10][11][12][13][14][15][16][17][18] Although this is a well-known fact, no rational grounds for explaining it are available. According to Rollins et al, female patients are also more predisposed to ganglion recurrence.…”

“…19 The incidence of ganglions is 43 per 100,000 in women and 25 per 100,000 in men and, according to some authors, a further upward trend is observed -55 per 100,000 of the population per year. 3,12,14 The mean age of the patients included in our study was 41.3 ± 16.9 years and the median age was 39.5 years. These numbers were undoubtedly influenced by the fact that mainly adult patients are admitted to our ward and pediatric patients only sporadically.…”

“…This is consistent with the findings by Lidder et al The authors, having analyzed 117 cases treated operatively for volar retinacular ganglions (77 cases) and dorsal wrist ganglions (40 cases), calculated the mean age in their 83 female patients to be 41.9 years (range 10.4-88.7 years) and in 34 male patients to be 40.6 years (range 9.2-85.7 years). 14 In clinical practice, ganglions manifest almost solely as solitary (although sometimes multilocular) tumors, and multiple lesions located in one or more areas of the body are rare. 3 Dermon et al removed a total number of 124 wrist ganglions in 119 patients, out of which dorsal wrist Fig.…”

A Systematic Review of Complications and Recurrence Rate of Arthroscopic Resection of Volar Wrist Ganglion

“…Studies have demonstrated that open surgery for a volar ganglion is challenging. 5 The main causes of complications and recurrence are close proximity to the superficial palmar branch of the radial artery and to the palmar cutaneous branch of the median nerve. 6 , 7 Arthroscopic resection of a volar wrist ganglion was originally described by Ho et al 8 To date, one prospective, randomised controlled trial has been conducted to establish which treatment modality provides the lowest rate of complications and recurrence; however, only a small number of patients was included in this trial.…”

Blunt Force May be an Effective Treatment for Ganglion Cysts

“…1), with an average of 13% (Table 4), but has a higher incidence of complications [1,3,4,8,[12][13][14][15][20][21][22] and cost. Zubowicz et al estimated surgical management of patients costs 120,000 US dollars per 100 patients [29].…”