The authors review the operative results of 59 surgically treated ganglions over a 10-year period with a mean follow-up of 65 months. Sixty percent of the ganglions were dorsal and 40% volar. The mean age of the patients was 38 years with nearly 80% female. Indications for surgery included pain (68%) and cosmesis (32%). At follow-up, there was a 10% recurrence rate noted, four dorsal and two volar. Twenty eight percent of patients complained of one or more of the following: persistent pain (14%), loss of function, dissatisfaction with the result or a recurrence. Seven follow-up ultrasound examinations on symptomatic patients revealed 2 occult recurrences, yielding a known overall recurrence rate of 14%. Two patients had dysethesias in the distribution of the dorsal sensory radial nerve.
Ganglions of the wrist are common benign lesions treated by hand surgeons. This review highlights the potential morbidity that may be associated with their surgical treatment. In addition to the problems identified, dorsal resections can be complicated by loss of wrist flexion and volar resections by sensory disturbance to the palmar cutaneous branch of the median nerve. A previous review of anterior ganglions alone revealed a 20% recurrence rate with a surprisingly high rate of persistent symptoms and even RSD (3%) (JHS 19A: 954-8, 1994). These potential complications should be emphasized during preoperative patient teaching, especially when surgery is performed for cosmetic purposes. The study also emphasizes the need for careful technique when surgical intervention is chosen. It is unclear if newer arthroscopic techniques for dorsal ganglion resection will lessen the morbidity.
Link: www.jhandsurg.org