Epidemiology
Most common tumor of hand
- female > male
- 2nd - 4th decade
Etiology
Unknown
Location
Dorsal: 60 - 70%
Volar: 20 - 30%
| Dorsal | Dorsal | Volar |
|---|---|---|
| Scapho-lunate ligament | TFCC | STT joint |
| Radial to EDC | Between FCR and APL |
Retinacular - along flexor sheaths, A1 / A2 pulley
Mucoid cyst - associated with DIPJ OA and osteophyte
Clinical
Most asymptomatic
- fluctuate in size
- 1-3 cm
- transilluminate
Natural history
Dias et al J Hand Surg Eur 2007
- 60% (23/55) of dorsal ganglion resolved spontaneously
Dearden et al J Hand Surg Am 2023
- 157 ganglion in children < 18
- 60% resolved spontaneously
Pathology
Cyst cavity lined by epithelium
Contents - viscous mucin / hyaluronic acid
Ultrasound
Volar ganglion
MRI
Dorsal ganglion
Dorsal ganglion arising from scapholunate joint
Dorsal ganglion arising from scapho-lunate joint
Volar ganglion
Nonoperative management
Aspiration + HCLA injection
- usually needs multiple attempts
Khan J Hand Micosurg 2011
- aspiration plus steroid sucessful in 60%
Operative management
Options
Open resection
Arthroscopic resection
Concept
Excision of ganglion
- find neck and dissect down to capsule
- remove capsular window
Dorsal scapho-lunate ligament ganglion
Open excision
Technique
- radial side EDC
- protect SRN
- follow down
- excise neck and capsule
Arthroscopic excision
Results
Open excision
- 3 surgeons and open excision 628 ganglion
- recurrence rate dorsal: 4%
- recurrence more common in males and less experienced surgeons
Open versus arthroscopic excision
Kang et al J Hand Surg Am 2008
- RCT of 72 patients open v arthroscopic excision of dorsal wrist ganglion
- recurrence arthroscopic: 11%
- recurrence open: 9%
Crawford et al J Hand Surg Eur 2018
- systematic review of open v arthroscopic excision of dorsal wrist ganglion
- recurrence rate arthroscopic: 9%
- recurrence rate open: 20%
Volar STT ganglions
Open excision
Technique
- between FCR and radial artery
- protect palmar branch median nerve
Arthroscopic excision
Results
Open
- 3 surgeons and open excision 628 ganglion
- recurrence rate volar: 4%
- recurrence more common in males and less experienced surgeons
Arthroscopic
Fernandes et al Hand Surg 2014
- systematic review of arthroscopic excision of 232 volar hand ganglions
- recurrence rate 6%
- complication rate 7%
- 3 dorsal radial nerve injuries
- 2 partial median nerve injuries
- 2 radial artery injuries