Considerations in performing open surgical excision of dorsal wrist ganglion cysts.

PURPOSE: To investigate which conditions should be considered to make a successful resection of the entire ganglion complex during open excision.

METHODS: We reviewed 52 patients who underwent open surgical excision of dorsal wrist ganglions. The inclusion criterion was a symptomatic ganglion causing pain, weakness and limitation of range of motion. The mean follow-up was 26 (range 12-45) months. We recorded operative details including whether or not the stalk was identified, how the ganglia were resected, and where the stalk originated. Intentional rupture of cyst was performed when the stalk was not easily identified with dissection. Pain score was measured using a visual analog scale system pre-operatively and post-operatively. Recurrence was also described.

RESULTS: A stalk was identified in eight cases using dissection and in 43 cases by rupturing the cyst. The entire ganglion complex was resected in 50 cases. The stalk originated most commonly in the radio-lunate joint. The average pain score improved from 3.9 to 1.8 after ganglion removal. The ganglion recurred in two cases where incomplete resection of the ganglion was made.

CONCLUSIONS: In the majority of ganglions, it is difficult to identify the stalk and its capsular attachment due to a large cyst with severe adhesion to adjacent soft tissues including joint capsule. Rupturing a cyst on purpose helps to identify the stalk and minimize capsular loss. A ganglion over the radiolunate joint was most commonly found and excision of joint capsule over scapholunate joint without identification of the stalk and its capsular attachment might result in recurrence. Recurrence was definitely related to incomplete resection which was more commonly made in ganglions over uncommon sites.

LEVEL OF EVIDENCE: Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.