Arthroscopic Needling Technique for the Treatment of Wrist Ganglia

• Published in: Journal of wrist surgery Vol. 12; no. 4; pp. 377 - 382
• Main Authors: Kaempf O, Ricardo, Gómez, Gustavo, Brunelli, João P F, Aita, Marcio A, Carratalà, Vicente, Delgado S, Pedro J
• Format: Journal Article
• Language: English
• Published: United States Thieme Medical Publishers, Inc 01-08-2023
• Subjects: Procedure; dorsal ganglion; wrist ganglion; arthroscopic resection; volar ganglion; surgical excision; wrist arthroscopy
• ISSN: 2163-3916; 2163-3924
• DOI: 10.1055/s-0042-1751015

Synovial cysts (SCs) are the most frequent wrist tumors; the arthroscopic treatment presents good results when surgery is indicated for symptomatic or patients with cosmetic concerns. The tumoral lesion should be arthroscopically decompressed or drained toward the inside of the joint through pedicle opening and resection of a small portion of the capsule. Hence, the cyst pedicle must be found for the success of this technique.
 Some tricks have already been described to facilitate SC location during arthroscopy. We describe an indirect technique that employs an 18-G needle to enhance SC pedicle location and drainage. The technique involves a puncture on the interval of the carpal extrinsic ligaments where the pedicle is suspected to be remain. When found, cyst is drained with a single-puncture motion of the need which promotes cyst content extravasation due to pressure toward the joint.
 This method has been employed in 16 patients, including 9 with dorsal cysts, and seven with volar cysts.
 All patients presented complete recovery and symptom improvement in up to 30 days, with total disappearance of the cyst. There were no relapses or severe complications within the 12-month follow-up.
 This is a safe, useful technique that facilitates location of intra-articular cyst pedicle, thus avoiding unnecessary damage in healthy tissues with no increased costs.