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Surgical Excision of Dorsal Ganglion Cyst

February 10, 2018

Contributors: Amos Dai, BS; Mikael Starecki, MD; Nader Paksima, DO; Nader Paksima, DO

Purpose: The true etiology of ganglion cysts is unclear. Patients typically have a fluctuant mass that has been present for weeks to years. Ganglion cysts may cause a dull ache and difficulty with grip strength and the push-up position. Surgical treatment is indicated in patients in whom pain and activity restriction substantially affect quality of life and patients in whom the mass recurs despite nonsurgical treatment. This video demonstrates the surgical technique for excision of a dorsal ganglion cyst. Methods: The video discusses the case presentation of an 18-year-old woman with right wrist pain and a fluctuant mass over the dorsum of her wrist. Her pain is worse with activity, and she has weakness gripping objects. A trial of aspiration and bracing was attempted; however, the cyst recurred, and the patient elected to undergo surgical removal of the mass. The surgical steps for excision of the cyst included identification of the tendons of the second, third, and fourth extensor compartments, retraction of the second and third compartments radially, resection of the fourth compartment ulnarly, identification and excision of the ganglion cyst via a cone-down technique, assessment of the integrity of the scapholunate ligament, and cauterization of the root and stalk of the ganglion cyst. Results: The video reviews postoperative rehabilitation and potential complications. Conclusions: Ganglion cysts may substantially impede wrist function and quality of life. Using the proper technique, including identification and retraction of the surrounding structures, cone-down excision, and cauterization of the root and stalk, ganglion cysts can be removed safely and effectively.

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