Arthroscopic management of painful dorsal wrist ganglion

Mathilde Gras , Christophe Mathoulin - FESSH (Congrès Européen de Chirurgie de la Main)

Copenhague, Danemark

Juin 2018

Objective: The dorsal ganglion of the wrist is a common pathology that has long been neglected. A recent study has proven the value of arthroscopic management. In light of anatomical work, the dorsal capsulo-ligamentous complex septum (DCSS) has been

demonstrated as an anatomical structure. Painful ganglia appear to be related to a lesion of this DCSS, after trauma or not. It therefore seemed legitimate to repair this lesion by arthroscopic dorsal capsuloplasty. This study presents the results of this technique.

Methods: This retrospective study reported the patients operated for painful dorsal wrist ganglion. The ganglion was resected and capsulo-ligamentous suture was performed under arthroscopy. Range of motion, pain, strength and Dash score were reported before and at the last follow up between februrary 2011 and april 2017.

Results: Thirty four patients (10 men, 24 women) had the surgery, one patient on both side, mean age 24,9 years old (15-41). Only 3 were manual worker but most of them had contributing factors, especially sports. All but 5 had RMI before the surgery. A splint was wear on average 6,2 weeks (5,5 to 8) after surgery. The average follow-up was 8,4 months (2,5 to 48,5). Range of motion and strength improved. Pain decreased from 1,4 at rest (0 to 6) and 6,3 on stress (3 to 9) before surgery, to 0,1 at rest (0 to 2) and 0,8 on stress (0 to 6). The average dash went from 27,3 (6,81 to 68,18) to 6,7 (0 to 29,54). There was only one recurrence.

Conclusions: The dorsal capsule-ligamentous repair associated to resection of dorsal wrist ganglion is a simple technique reliable. It allows repairing a lesion of the DCSS causing the pain, associated to the ganglion. Arthroscopic technique avoids stiffness. Our promising results still require a larger serie and longer follow-up to ensure that the results are sustainable.