Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series

Abstract

Objectives To describe the technique and results of the arthroscopic surgical treatment of volar ganglion cyst of the wrist. Materials and Methods The present study comprised 21 patients submitted to the arthroscopic treatment of volar ganglion cysts of the wrist from January 2015 to May 2017, with a full evaluation for at least 6 months. The technique was indicated for patients presenting pain and functional impairment for more than four months, with no improvement with the conservative treatment, or for those with cosmetic complaints and cyst present for more than three months. Results The mean age of the patients was 43.6 years; 16 (76%) patients were female, and 5 (24%) were male. The mean follow-up time from surgery to the final assessment was of 10.9 months. A total of 2 (9.6%) patients complained of mild pain after the procedure, and another patient presented slight motion restrictions. The 18 (90.4%) remaining patients reported cosmetic improvement, complete functional recovery, and pain improvement. There were no recurrences or infections. No patient required further surgery. Conclusions The arthroscopic resection of volar ganglion cysts is a useful and safe technique. It is a minimally-invasive procedure, with low morbidity and very few complications, representing a good alternative to the open technique.

Keywords: arthroscopy/use; ganglion cyst; musculoskeletal diseases/surgery; wrist joint.

Fig. 1

Clinical aspect of the volar synovial cyst observed under the skin, proximal to the wrist flexion fold, between the flexor carpi radialis (FCR) and flexor pollicis longus (FPL) muscle tendons ( A ). Magnetic resonance imaging scan of the lesion ( B ).

Fig. 2

Positioning for wrist arthroscopy. The long fingers are encased in surgical finger traps, making it easy to position and place continuous 5-kg traction to the zenith ( A ). Volar cyst marked with a dermographic pen to show its size and location ( B ).

Fig. 3

Portals most commonly used for wrist (radiocarpal) arthroscopy.

Fig. 4

Schematic drawing of the endoscope positioned at the 3/4 portal, facing the gap between the radioscaphocapitate ligament (RSCL) and the long radiolunate ligament (LRLL).

Fig. 5

Endoscope positioned at the 3/4 portal, facing the gap between the RSCL and the LRLL), and instrumentation with the soft-tissue shaver positioned at the 1/2 portal ( A ). The location of the pedicle is facilitated by the external manual pressure applied on the cyst ( B ).

Fig. 6

Soft-tissue shaver between the RSCL and the (LRLL) ( A ). The capsule was perforated, and the cyst mucous content leaks to the joint ( B ). New external pressure on the cyst helps complete the drainage of the contents ( C ). Resection of a 4- to 6-mm portion of the volar capsule, forming a window-shaped defect ( D ).

Fig. 1

Aspecto clínico do cisto sinovial volar, observado sob a pele, proximal à prega de flexão do punho, entre os tendões do flexor radial do carpo (FRC) e do flexor longo do polegar (FLP) ( A ). Comprovação da lesão por meio de ressonância magnética ( B ).

Fig. 2

Paciente posicionado para a realização da artroscopia do punho. Os dedos longos são envoltos por malha de tração, facilitando o posicionamento e a colocação de tração contínua ao zênite com 5 kg ( A ). Cisto volar marcado com uma caneta dermográfica para demonstrar o seu tamanho e localização ( B ).

Fig. 3

Portais mais utilizados para a artroscopia de punho (radiocárpica).

Fig. 4

Desenho esquemático do endoscópio posicionado no portal 3/4, em frente ao intervalo entre o ligamento rádio-escafo-capitato (LREC) e o ligamento rádiossemilunar longo (LRSL).

Fig. 5

Endoscópio posicionado no portal 3/4, em frente ao intervalo entre o LREC e o LRSL, e instrumentação com shaver de partes moles no portal 1/2 ( A ). Para facilitar a localização do pedículo, realiza-se pressão manual externa sobre o cisto ( B ).

Fig. 6

Shaver de partes moles no intervalo entre o LREC e o LRSL ( A ). Cápsula perfurada extravasando o conteúdo mucoso do cisto dentro da articulação ( B ). Nova pressão externa sobre o cisto ajuda na drenagem completa do seu conteúdo ( C ). Ressecção de uma porção de 4 a 6 mm da cápsula volar, formando um defeito em forma de janela ( D ).