Evidence - Ganglionectomy for palmar wrist ganglion

With up to 60%, wrist ganglia are the most common soft tissue tumors of the wrist. Their average size is 1-2 cm, and they can occur uni- and multilocular. The overall incidence for males is 25/100,000, and for females, it is 43/100,000. Women are affected about 2 to 3 times more often than men [1-5]. 70% of ganglia occur between the ages of 20-40 years, 10% between 10-20 years, and 1-2% below the age of 10 years. In adults, the ganglion is found dorsally in 80% of cases and volarly in 20% of cases. In children under 10 years of age, the volar location is significantly more common at 60-77% [5, 6].

The ganglion usually originates from the radiocarpal joint, occasionally from the midcarpal joint, particularly from the trapezionavicular joint. A mucoid degeneration of the joint capsule with simultaneous capsule weakening is causal [2, 4]. The clear, highly viscous ganglion content has a high concentration of hyaluronic acid and other mucopolysaccharides [2].

Spontaneous remissions occur and are reported to be 10-63% [4, 7].

The conservative treatment includes waiting as well as puncture and aspiration of the ganglion content, possibly multiple times. The instillation of a corticosteroid, ethanol, or hyaluronidase is also possible [3, 4]. The combination of aspiration and electrocauterization is described as well as the provision with an orthosis [3-5]. For aspiration alone, the recurrence rate is over 50%, but can be reduced to 13% by the instillation of a corticosteroid [8].

The indication for surgical treatment arises in cases of persistent symptoms, recurrences, and unsuccessful conservative treatment [9-11]. The resection of the ganglion can be performed both open-surgically and arthroscopically, and the ganglion stalk should be removed [4, 11].

A meta-analysis showed that open ganglion resection reduces the recurrence rate by 76% compared to puncture alone [3]. For open-surgical resection, the recurrence rate is 4-40%, and for the arthroscopic technique, it is 0-11% [4, 11-13]. Risk factors for recurrence include handedness, dominant arm, female gender, and age < 24 years [11, 13].

Medical Imaging in the Diagnosis of Ganglion Cysts of the Hand

Outcomes of Surgical Excision of Dorsal Wrist Ganglia With or Without Partial Wrist Denervation

1. Breindl G. Ganglions of hand and wrist. Harmless—but often bothersome. MMW FortschrMed. 2008 Oct 2;150(40):35-7.

2. de Oliveira RK, Brunelli JPF, Carratalá V, Aita M, Mantovani G, Delgado PJ. Arthroscopic Resection of Wrist Volar Synovial Cyst: Technique Description and Case Series. J Wrist Surg. 2021 Aug;10(4):350-358.

3. Head L, Gencarelli JR, Allen M, Boyd KU. Wrist ganglion treatment: systematic review and meta-analysis. J Hand Surg Am. 2015 Mar;40(3):546-53

4. Mathoulin C, Gras M. Arthroscopic Management of Dorsal and Volar Wrist Ganglion. Hand Clin. 2017 Nov;33(4):769-777.

5. Shanks C, Schaeffer T, Falk DP, Nunziato C, Hogarth DA, Bauer AS, Shah AS, Gottschalk H, Abzug JM, Ho CA. The Efficacy of Nonsurgical and Surgical Interventions in the Treatment of Pediatric Wrist Ganglion Cysts. J Hand Surg Am. 2022 Apr;47(4):341-347.

6. Krishnan P, Wolf JM. Pediatric Ganglions of the Hand and Wrist: A Review of Current Literature. J Hand Surg Am. 2022 Feb 22:S0363-5023(22)00004-1.

7. Schicke S, Hoigne D, Zwipp H, Grünert J. Ganglions of the hand and wrist—a retrospective study on recurrence formation. Handchir Mikrochir Plast Chir. 2011 Oct;43(5):298-301.

8. Suen M, Fung B, Lung CP. Treatment of ganglion cysts. ISRN Orthop. 2013 May 28;2013:940615

9. Arshad Z, Iqbal AM, Al Shdefat S, Bhatia M. The management of foot and ankle ganglia: A scoping review. Foot (Edinb). 2022 May;51:101899.

10. Borisch N. The arthroscopic removal of dorsal wrist ganglion. Oper Orthop Traumatol. 2016 Aug;28(4):270-8.

11. Graham JG, McAlpine L, Medina J, Jawahier PA, Beredjiklian PK, Rivlin M. Recurrence of Ganglion Cysts Following Re-excision. Arch Bone Jt Surg. 2021 Jul;9(4):387-390.

12. Cluts LM, Fowler JR. Factors Impacting Recurrence Rate After Open Ganglion Cyst Excision. Hand (N Y). 2022 Mar;17(2):261-265.

13. Kim JP, Seo JB, Park HG, Park YH. Arthroscopic excision of dorsal wrist ganglion: factors related to recurrence and postoperative residual pain. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2013; 29(6):1019-24.

Tottas S, Kougioumtzis I, Titsi Z, Ververidis A, Tilkeridis K, Drosos GI. Ulnar nerve entrapment in Guyon's canal caused by a ganglion cyst: two case reports and review of the literature. Eur J Orthop Surg Traumatol. 2019 Oct;29(7):1565-1574.

Stacy GS, Bonham J, Chang A, Thomas S. Soft-Tissue Tumors of the Hand-Imaging Features. Can Assoc Radiol J. 2020 May;71(2):161-173

Strike SA, Puhaindran ME. Tumors of the Hand and the Wrist. JBJS Rev. 2020 Jun;8(6):e0141.

Tomori Y, Motoda N, Nanno M, Majima T. Intratendinous Ganglion of the Extensor Pollicis Longus: Case Report and Literature Review. J Nippon Med Sch. 2021 Nov 17;88(5):500-505.

Arshad Z, Iqbal AM, Al Shdefat S, Bhatia M. The management of foot and ankle ganglia: A scoping review. Foot (Edinb). 2022 May;51:101899.

Muramatsu K, Tani Y, Kobayashi M, Sugimoto H, Iwanaga R, Mihara A, Sakai K. Refractory satellite ganglion cyst in the hallux and finger. Mod Rheumatol Case Rep. 2023 Jan 3;7(1):257-260

Eriksen JH, Kønig MJ, Balslev E, Søe NH. Ganglion cysts on wrists and hands. Ugeskr Laeger. 2022 Jun 20;184(25).

Koehl P, Rueth MJ, Sesselmann S, Necula R, Mada L, Schuh A. Wrist ganglion. MMW Fortschr Med. 2023 Feb;165(2):56-57.

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