Outcomes of Open Excision of Occult Dorsal Carpal Ganglions
Elizabeth A Harkin, MD; Tomas Liskutin, BS; Michael Bednar, MD
Loyola University Medical Center, Maywood, IL
Introduction/Background: Ganglion cysts are the most common soft tissue tumor of the hand and are a frequent cause of chronic dorsal wrist pain. Patients typically present with swelling, a palpable mass, and normal x-rays. In general treatment includes aspiration and arthroscopic or open resection. To date outcome studies have focused on outcomes of all wrist ganglions, open excision of palpable dorsal wrist ganglions, and arthroscopic excision of occult dorsal carpal ganglions. However, a gap in knowledge remains regarding the outcomes of open excision for occult dorsal carpal ganglions. The goal of our study is to retrospectively review the outcomes of open excision of occult dorsal carpal ganglions.
Methods: After receiving IRB approval, a retrospective analysis was performed. Eighteen adult patients, 17 women and 1 male, that underwent excision of an occult dorsal carpal ganglion from January 1st 2006 and January 1st 2016 by one of six practicing orthopaedic hand surgeons.
Results: All clinical notes for the were reviewed confirming all patients had tenderness to palpation over the dorsal aspect of the wrist and lack of palpable mass on presentation. All 18 patients had an occult dorsal carpal ganglion confirmed on preoperative MRI. Mean age at presentation was 25.2 years. Mean follow-up was 15.5 weeks (range 0 to 103 weeks). All patients underwent open excision of an occult dorsal carpal ganglion, additionally 7 underwent arthroscopy following excision without any other identifiable pathology and 6 underwent simultaneous posterior interosseous nerve transection. Cyst location was confirmed intraoperatively with 9 (50%) originating from SL ligament, 5 (27.8%) isolated to wrist capsule, 3 (16.7%) originating from mid carpal joint, and 1 (5.6%) from the radiocarpal joint. Seventeen specimens (94.4%) were confirmed to be ganglion cysts on pathology. No complications were experienced. Recurrence occurred in 1/18 (5.6%) cases. Seventeen patients (94.4%) achieved a satisfactory result with improved pain and were without complication or recurrence at post-op follow-up.
Discussion/Conclusions: Open excision of occult dorsal carpal ganglions is an effective treatment with results comparable to arthroscopic excision. Patients demonstrated satisfactory results, no complications, and a recurrence rate of 1/18 (5.6%).
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