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Arthroscopic dorsal wrist ganglion excision – The treatment of choice? Kęstutis Bliznikas, Vytautas Mikelevičius.

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Presentation on theme: "Arthroscopic dorsal wrist ganglion excision – The treatment of choice? Kęstutis Bliznikas, Vytautas Mikelevičius."— Presentation transcript:

1 Arthroscopic dorsal wrist ganglion excision – The treatment of choice? Kęstutis Bliznikas, Vytautas Mikelevičius

2 Incidence DWG – 80% Volar RC – 12% Volar STT – 8% 2011 IMUKA Presentation, “Practice for Plastic surgery” Dr. Baur, Dr. Fromberg

3 Anatomy

4 Diagnostics Symptoms (pain, functional discomfort, aesthetic discomfort) Lump in the wrist (not visible for occult ganglions)

5 MRI

6 Treatment methods I – Conservative (Observation, crushing, splinting, aspiration, puncture, sclerotherapy) ; II –Surgical:  Open excision;  Arthroscopic excision.

7 Surgery I – Open excision II – Arthrocopic excision

8 Advantages Improved recovery Better joint visualization (magnification) Lower complication rates Lower recurrence rates (8-40% vs 0-10%)* Better cosmetic results *Edwards, S.G. and J.A. Johansen, Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg Am, (3): p

9 Advantages

10 Wrist arthroscopy DWG stalk identification success rate 9-100%* Additional intraarticular pathology may be found up to 75% of patients *Ahsan, Z.S. and J. Yao, Arthroscopic dorsal wrist ganglion excision with color-aided visualization of the stalk: minimum 1-year follow-up. Hand (N Y), (2): p

11 Wrist arthroscopy Regional anesthesia Distraction system Tourniquet 2,7mm scope Full radius 2,5-3,5mm shaver No radiofrequency

12 Wrist arthroscopy Start with 6R Diagnostic arthroscopy Identify stalk / sinovitis zone at 3-4portal site 3-4portal introduced Resect ganglion site / stalk, make DW capsule defect Stop when ECRB is clearly visible

13 Wrist arthroscopy

14 Our experience Total 42 patients (16 lost) From 2011-april till now Questioned 26 patients; Follow up from 2 to 38 months. 1 surgeon

15 Our experience

16 Questionnaire Patient outcomes following wrist ganglion excision surgery, J. D. Craik and S. P. Walsh, J Hand Surg Eur Vol : 673 originally published online 5 January 2012

17 Results What others say: The reason for consultation: unsightly appearance %, the presence of pain 28.9%, both – 15,8%.* Pain (79%) and cosmesis (71%) were the primary pre-operative symptoms. Other symptoms such as paraesthesia, numbness, weakness, and stiffness were experienced by 27–44% of patients.** *Gallego, S. and C. Mathoulin, Arthroscopic resection of dorsal wrist ganglia: 114 cases with minimum follow-up of 2 years. Arthroscopy, (12): p ** Craik, J.D. and S.P. Walsh, Patient outcomes following wrist ganglion excision surgery. J Hand Surg Eur Vol, (7): p

18 Results

19 Results The ganglion recurred in 3 patients (12%).

20 In conclusion… Etiology and pathogenesis of ganglion is not completely clear Conservative treatment often fails ​ Incision scar may be avoided using arthroscopic technique Arthroscopic technique has definite role in management of DWG with very promising future Our results are similar to other published data ​

21 Thanks for attention


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