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DOI: 10.1055/s-0043-1775999
Recurrence, Reoperation, and Patient-Reported Outcomes after Wrist Ganglion Excision
Funding None.![](https://www.thieme-connect.de/media/jws/EFirst/lookinside/thumbnails/10-1055-s-0043-1775999_2300068-1.jpg)
Abstract
Background Ganglion excision is performed for pain, functional impairment, or cosmetic reasons, with recurrence rates ranging between 9 and 20%. The aim of this study was to evaluate the recurrence and reoperation rates after ganglion excision, along with assessing patient-reported outcomes.
Methods Retrospectively, 1,076 patients, with 1,080 wrist ganglia, were identified who underwent open excision (n = 1,055) and arthroscopic excision (n = 25). The ganglia were predominantly dorsal (59%) and volar (37%). Additionally, 149 patients who underwent open excision and all who underwent arthroscopic excision were contacted to complete a questionnaire on recurrence and reoperation, the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and the Patient-Rated Wrist Evaluation (PRWE). Seventy-seven patients responded at a median of 4 years postoperatively. A matched case-control analysis was performed to identify factors associated with reoperation, along with a bivariate analysis to assess what factors influence patient-reported outcomes.
Results The reoperation rate was 3.3%, with no factors statistically associated with reoperation in case-control analysis. Among the contacted patients, 13% reported a recurrence, of which 2.6% reported reoperation. The median QuickDASH score was 2.3 (interquartile range [IQR]: 0–12), the median PRWE score was 0 (IQR: 0–12), and the median pain score was 0 (IQR: 0–3), with female sex being associated with higher scores.
Conclusion The reoperation rate after ganglion excision is low (3.3%) and is mostly performed within 3 years. The self-reported ganglion recurrence is higher (13%), but only one-fifth of these patients reported a repeat excision. After surgery, patients report good functional scores, with little persistent pain.
Statement of Human and Animal Rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
Statement of Informed Consent
Informed consent was waived by the Institutional Review Board given the retrospective nature of this study, along with the large number of patients.
Publication History
Received: 29 May 2023
Accepted: 12 September 2023
Article published online:
09 October 2023
© 2023. Thieme. All rights reserved.
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References
- 1 Tang ZH, Rajaratnam V, Desai V. Incidence and anatomical distribution of hand tumours: a Singapore study. Singapore Med J 2017; 58 (12) 714-716
- 2 Kuliński S, Gutkowska O, Mizia S, Gosk J. Ganglions of the hand and wrist: retrospective statistical analysis of 520 cases. Adv Clin Exp Med 2017; 26 (01) 95-100
- 3 Angelides AC, Wallace PF. The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy, and surgical treatment. J Hand Surg Am 1976; 1 (03) 228-235
- 4 Edwards SG, Johansen JA. Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg Am 2009; 34 (03) 395-400
- 5 Chung S-R, Tay SC. Audit of clinical and functional outcomes of arthroscopic resection of wrist ganglions. Hand Surg 2015; 20 (03) 415-420
- 6 Gude W, Morelli V. Ganglion cysts of the wrist: pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med 2008; 1 (3–4): 205-211
- 7 Balazs GC, Donohue MA, Drake ML, Ipsen D, Nanos III GP, Tintle SM. Outcomes of open dorsal wrist ganglion excision in active-duty military personnel. J Hand Surg Am 2015; 40 (09) 1739-1747
- 8 Dias JJ, Dhukaram V, Kumar P. The natural history of untreated dorsal wrist ganglia and patient reported outcome 6 years after intervention. J Hand Surg Eur Vol 2007; 32 (05) 502-508
- 9 Westbrook AP, Stephen AB, Oni J, Davis TRC. Ganglia: the patient's perception. J Hand Surg [Br] 2000; 25 (06) 566-567
- 10 Dias J, Buch K. Palmar wrist ganglion: does intervention improve outcome? A prospective study of the natural history and patient-reported treatment outcomes. J Hand Surg [Br] 2003; 28 (02) 172-176
- 11 Gallego S, Mathoulin C. Arthroscopic resection of dorsal wrist ganglia: 114 cases with minimum follow-up of 2 years. Arthroscopy 2010; 26 (12) 1675-1682
- 12 Head L, Gencarelli JR, Allen M, Boyd KU. Wrist ganglion treatment: systematic review and meta-analysis. J Hand Surg Am 2015; 40 (03) 546-53.e8
- 13 Cooper C. Fundamentals of Hand Therapy. Philadelphia, PA: Elsevier; 2007
- 14 Kleinlugtenbelt YV, Krol RG, Bhandari M, Goslings JC, Poolman RW, Scholtes VAB. Are the patient-rated wrist evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire used in distal radial fractures truly valid and reliable?. Bone Jt Res 2018; 7 (01) 36-45
- 15 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
- 16 Craik JD, Walsh SP. Patient outcomes following wrist ganglion excision surgery. J Hand Surg Eur Vol 2012; 37 (07) 673-677
- 17 Westenberg RF, Nierich J, Lans J, Garg R, Eberlin KR, Chen NC. What factors are associated with response rates for long-term follow-up questionnaire studies in hand surgery?. Clin Orthop Relat Res 2020; 478 (12) 2889-2898
- 18 Kang L, Akelman E, Weiss APC. Arthroscopic versus open dorsal ganglion excision: a prospective, randomized comparison of rates of recurrence and of residual pain. J Hand Surg Am 2008; 33 (04) 471-475
- 19 Ahsan ZS, Yao J. Arthroscopic dorsal wrist ganglion excision with color-aided visualization of the stalk: minimum 1-year follow-up. Hand (N Y) 2014; 9 (02) 205-208
- 20 Fernandes CH, Meirelles LM, Raduan Neto J, Fernandes M, dos Santos JBG, Faloppa F. Arthroscopic resection of dorsal wrist ganglion: results and rate of recurrence over a minimum follow-up of 4 years. Hand (N Y) 2019; 14 (02) 236-241
- 21 Rizzo M, Berger RA, Steinmann SP, Bishop AT. Arthroscopic resection in the management of dorsal wrist ganglions: results with a minimum 2-year follow-up period. J Hand Surg Am 2004; 29 (01) 59-62
- 22 Kuliński S, Gutkowska O, Mizia S, Martynkiewicz J, Gosk J. Dorsal and volar wrist ganglions: the results of surgical treatment. Adv Clin Exp Med 2019; 28 (01) 95-102
- 23 Gant J, Ruff M, Janz BA. Wrist ganglions. J Hand Surg Am 2011; 36 (03) 510-512
- 24 Crijns TJ, Bernstein DN, Ring D, Gonzalez R, Wilbur D, Hammert WC. Factors associated with a discretionary upper-extremity surgery. J Hand Surg Am 2019; 44 (02) 155.e1-155.e7
- 25 Ahsan ZS, Yao J. Complications of wrist arthroscopy. Arthroscopy 2012; 28 (06) 855-859
- 26 Rocchi L, Canal A, Fanfani F, Catalano F. Articular ganglia of the volar aspect of the wrist: arthroscopic resection compared with open excision. A prospective randomised study. Scand J Plast Reconstr Surg Hand Surg 2008; 42 (05) 253-259
- 27 Jacobs LGH, Govaers KJM. The volar wrist ganglion: just a simple cyst?. J Hand Surg [Br] 1990; 15 (03) 342-346
- 28 Finsen V, Håberg O, Borchgrevink GE. Surgery for wrist Ganglia: one-hundred and twenty-two patients reviewed 8 years after operation. Orthop Rev (Pavia) 2014; 6 (01) 5162
- 29 Kim JP, Seo JB, Park HG, Park YH. Arthroscopic excision of dorsal wrist ganglion: factors related to recurrence and postoperative residual pain. Arthroscopy 2013; 29 (06) 1019-1024
- 30 Rollins KE, Ollivere BJ, Johnston P. Predicting successful outcomes of wrist and finger ganglia. Hand Surg 2013; 18 (01) 41-44
- 31 Korman J, Pearl R, Hentz VR. Efficacy of immobilization following aspiration of carpal and digital ganglions. J Hand Surg Am 1992; 17 (06) 1097-1099
- 32 Chung SR, Tay SC. Audit of clinical and functional outcomes of arthroscopic resection of wrist ganglions. Hand Surg 2015; 20 (03) 415-420
- 33 Kim JY, Lee J. Considerations in performing open surgical excision of dorsal wrist ganglion cysts. Int Orthop 2016; 40 (09) 1935-1940
- 34 Boonstra AM, Stewart RE, Köke AJ. et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front Psychol 2016; 7: 1466
- 35 Oliffe J, Mróz L. Men interviewing men about health and illness: ten lessons learned. J Mens Health Gend 2005; 2 (02) 257-260
- 36 Keogh E, Denford S. Sex differences in perceptions of pain coping strategy usage. Eur J Pain 2009; 13 (06) 629-634
- 37 Boguszewski DV, Cheung EC, Joshi NB, Markolf KL, McAllister DR. Male-female differences in knee laxity and stiffness. Am J Sports Med 2015; 43 (12) 2982-2987