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Ganglion Cyst of the Wrist and Hand

Ganglion cysts are the most common mass or lump in the hand. They are not cancerous and, in most cases, are harmless. They occur in various locations, but most frequently develop on the back of the wrist.

Surgical Excision of Dorsal Ganglion Cyst

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.

Ganglions of the hand and wrist.

Ganglions of the hand and wrist are common benign lesions. They most frequently arise adjacent to joints and tendons, but may also be intratendinous or intraosseous. Treatment options include observation, aspiration, and surgical excision. Observation is acceptable in most instances. Indications for more aggressive treatment include pain, interference with activity, nerve compression, and imminent ulceration (in the case of some mucous cysts). The recurrence rate after puncture and aspiration is greater than 50% for cysts in most locations, but is less than 30% for cysts in the flexor tendon sheath. Surgical excision is effective, with a recurrence rate of only 5% if care is taken to completely excise the stalk of the cyst along with a small portion of joint capsule. Surgical treatment of occult ganglions is successful with accurate assessment of the source of the pain. Arthroscopic treatment of dorsal wrist ganglions is still experimental, but early results are encouraging. Ganglion surgery requires a formal operative environment and careful technique in order to minimize injury to adjacent structures and minimize the likelihood of recurrence.

Dorsal Wrist Ganglion Cyst Aspiration

A dorsal wrist ganglion is a smooth hard swelling on the dorsum of the wrist usually between the scaphoid and lunate bones. The cyst may be mobile and fluctuant just beneath the extensor retinaculum of the wrist. Typically the ganglion is filled with clear mucinous fluid that represents concentrated synovial fluid. The aspiration is performed with a large gauge needle to handle the thick viscous liquid. To fully visualize the extent of the ganglion, flex the wrist slightly over the table edge or a rolled bandage. Insert the needle through the subcutaneous tissue and into the ganglion mass. With your free hand, compress the ganglion, and displace the thick fluid toward the needle during the aspiration procedure. As you compress the mass, it may be necessary to adjust the needle slightly right or left to break small cavities within the ganglion. After withdrawal of the needle, gently massage the deflated cyst to express any remaining fluid. A sterile dressing and light compressive bandage is applied following the procedure.

Dorsal Wrist Ganglion

Ganglions are the most common benign soft-tissue tumors of the hand and wrist. The most common location for these lesions, in 60% to 70% of patients, is the dorsum of the hand and wrist (dorsal wrist ganglions). Mostly, they arise from the wrist joint and extensor tendon sheath, but they may also be intratendinous. Nonsurgical treatment of dorsal wrist ganglions includes observation, splinting of the hand and wrist for comfort, and aspiration of the cyst. Surgical treatment involves open marginal excision of the cyst that includes the body of the cyst and the stalk from which the cyst arises. Open marginal excision is an effective surgical treatment for dorsal wrist ganglions, with a recurrence rate ranging from 5% to 10%. Arthroscopic resection is a relatively new option, and provides a minimally invasive and effective alternative to open ganglionectomy, with comparable outcomes.

Cysts About the Knee: Evaluation and Management

Popliteal (Baker) cysts, meniscal cysts, proximal tibiofibular joint cysts, and cruciate ligament ganglion cysts are cystic masses commonly found about the knee. Popliteal cysts form when a bursa swells with synovial fluid, with or without a clear inciting etiology. Presentation ranges from asymptomatic to painful, limited knee motion. Management varies based on symptomatology and etiology. Meniscal cysts form within or adjacent to the menisci. These collections of synovial fluid are thought to develop from translocation of synovial cells or extravasation of synovial fluid into the meniscus through a tear. Joint-line pain and swelling are common symptoms. Management entails partial meniscectomy with cyst decompression or excision. Proximal tibiofibular joint cysts are rare, and their etiology remains unclear. Pain and swelling secondary to local tissue invasion is common, and management consists of surgical excision. Cruciate ligament ganglion cysts have no clear etiology but are associated with mucoid degeneration of the anterior and posterior cruciate ligaments, knee trauma, and synovial translocation into these ligaments. Knee pain and limited range of motion, especially with exercise, are common presenting symptoms. In symptomatic cases, arthroscopic excision is commonly performed.

Excision of a Ganglion Cyst From the Guyon Canal

This video shows removal of a ganglion cyst from the Guyon canal in a patient with symptoms of ulnar nerve compression. Indications, contraindications, technical pearls, and potential pitfalls are discussed. Preoperative and postoperative imaging studies are presented. An open technique is used for removal of a ganglion cyst from the Guyon canal. Historical results and outcomes from the literature are presented and discussed.

Proximal Tibiofibular Joint Ganglion Cyst: Surgical Treatment

INTRODUCTION: Proximal tibiofibular joint (PTFJ) ganglion cyst is a rare pathology, which may cause pain, sensory and/or motor deficit by direct compression on the common peroneal nerve (CPN). Pathogenesis of PTFJ ganglion cyst is still uncertain. The most accredited theory is the degenerative theory in which these cysts are considered as out pouching of joint capsule secondary to intra-articular pressure rise. Usually these cysts present as palpable and tender mass over the lateral aspect of the proximal fibula. Patients may complain of lateral joint tenderness, pain, and/or sensor or motor deficit. Imaging studies include plain x-ray and MRI that usually show uniloculated or multiloculated lesions that may be extended through periarticular tissues or in to the proxiamal fibular bone. The treatment is indicated only for symptomatic lesions and include excision of the cyst; however due to high rate of recurrence PTFJ arthrodesis can be advisable. The aim of this video is to show the surgical technique of PTFJ ganglion cyst excision and PTJF arthrodesis.

METHODS: Eight male patients were included in our study in which one of them is shown in this video. All the patients were symptomatic. The diagnosis was made in all cases based on the clinical and imaging findings. Briefly the surgical technique included lateral knee approach, exploration and isolation of CPN, excision of the ganglion cyst, and PTFJ arthrodesis. Patients were followed up in an outpatient clinic at four weeks, three months, and then annually; the routine examination included the assessment of lateral joint stability, knee function, range of motion, and peroneal nerve assessment. The postoperative follow up was at least 24 months. Complete relief of pain was achieved two months following the surgery in all cases. Histological examination con?rmed the diagnosis in all cases. In the routine outpatient visits, no patient was presented with any sign of recurrence, CPN suffering, or any other complication. All patients had return to their normal level of activity three months following the surgery.

CONCLUSION: We believe the cyst excision and the arthrodesis can be a good option in the treatment of PTFJ ganglion cyst; however due to the presence of CPN and postero-lateral compartment adjacent to this zone, it's necessary to know the anatomy and surgical approach of PTFJ to avoid any damage to this structures, which may lead to motor or sensory deficit or lateral knee instability respectively. This video may help young surgeons learn how to approach PTFJ and manage this rare pathology.

HAN050

Ganglions are the most common benign soft-tissue tumors of the hand and wrist. The most common location for these lesions, in 60% to 70% of patients, is the dorsum of the hand and wrist (dorsal wrist ganglions). Mostly, they arise from the wrist joint and extensor tendon sheath, but they may also be intratendinous. Nonsurgical treatment of dorsal wrist ganglions includes observation, splinting of the hand and wrist for comfort, and aspiration of the cyst. Surgical treatment involves open marginal excision of the cyst that includes the body of the cyst and the stalk from which the cyst arises. Open marginal excision is an effective surgical treatment for dorsal wrist ganglions, with a recurrence rate ranging from 5% to 10%. Arthroscopic resection is a relatively new option, and provides a minimally invasive and effective alternative to open ganglionectomy, with comparable outcomes.