Arthroscopic Ganglion Cyst Resection Showing Good Results

Ganglion cysts, swellings at the top of a joint or on a tendon, can cause pain and affect your movement. For example, if one is on the joint at the base of your finger, you may have trouble moving that finger. The cyst may feel firm or spongy when you touch it. Generally, these cysts are removed arthroscopically, a surgery technique in which the surgeon makes tiny incisions and uses long, narrow instruments to reach inside.

Arthroscopic surgery has been a boon for many types of surgeries because the smaller incisions and minimal invasiveness usually mean fast recovery and fewer complications than traditional surgeries. In arthroscopic ganglion cyst surgery, surgeons have also noticed that the cysts have a lower chance of coming back as well. That being said, there are no studies to back this up. The authors of this study wanted to evaluate the outcomes and identify certain characteristics of the cysts through arthroscopic surgery.

Researchers found 55 patients who had ganglion cysts on the back of their hand (the dorsal part) and they had all tried nonsurgical methods to remove them. The average age of the patients was 42 years. Some of the patients had had trauma to the wrist, but many didn't. Ten of the patients had had open surgeries before, but the cysts recurred, came back. Twelve of the patients were treated by having the fluid removed from the cyst with a needle and syringe (aspirated). Among the patients who had never tried surgery, 34 had tried medications, splinting, aspiration or steroid injections, while the others didn't try any other treatment and opted to go straight to surgery.

The researchers evaluated the patients by measuring their grip strength, pinch strength, and wrist motion. The patients were asked to complete two questionnaires: the preoperative visual analog pain scale, which gave the researchers an idea of how much pain the patients were feeling, on a scale of one to 10, and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH). Because 10 patients had had surgery before, the patients were divided into two groups: those who had had surgery (10) and those who hadn't (45). The tests and questionnaires were repeated six weeks, six months, and two years after surgery. The patients were also asked about any problems such as infection, pain, scarring and other issues that may have come up.

During the surgery, the surgeons looked to see if they could identify the properties of the ganglion cysts. Using the camera inserted through the small incisions, the surgeons examined the cyst's tissue (thicker than the tissue around it) and in 11 of the cases where the surgery was the first one, the cyst came off the radiocarpal joint, the section of the wrist where several small carpal bones line up in two short rows. In 29 cases, the cyst extended from the midcarpal joint, between two of the rows of carpal bones. For 29 patients, the cyst went from the radiocarpal joint to the midcarpal joint, other joints were involved in the rest of the cases.

The results of the study showed that at six weeks, the patients had an average improvement of by 5.9 kilograms in grip strength and 2.3 kilograms in pinch strength. Their wrist movement improved and their pain decreased. In fact, after reporting an average of 4 on the pain scale before surgery, all patients reported 0 at six weeks after surgery. The DASH scores improved significantly as well.

At six months after surgery, strength continued to improve and this continued up to two years. The researchers didn't find any noticeable differences between the two groups. Complications were painless tenosynovitis, inflammation of the sheath that covers the tendon and this only affected three patients. Two of the patients had surgery to improve how it looked.

It appears that this type of surgery is successful for many patients with ganglion cysts, and examination of the cysts didn't find a connection between findings and outcome. However, being able to see and assess the midcarpal joint is important in order to be able to remove the entire cyst.

Reference: 

Scott G. Edwards, MD, and John A. Johansen, MD. Prospective Outcomes and Associations of Wrist Ganglion Cysts Resected Arthroscopically. In The Journal of Hand Surgery. March 2009. Vol. 34. No 3. Pp. 395-400.

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