Dorsal Ganglion Cyst is the most common tumor found in the back side of the wrist.

Please don’t be alarmed at the word ‘tumor’ because a tumor simply means lump. Ganglion is definitely a benign tumor. It is a cyst, which is a tumor that is filled with liquid. Dorsal ganglion cysts are more common than volar ganglion cyst.

A dorsal ganglion cyst consists of a cyst wall (main body) and a pedicle (stalk). The stalk of a dorsal ganglion cyst is located rather deep, attached to one of the ligaments of the wrist (most frequently the scapholunate ligament). Microscopic studies discovered that the ganglion stalk contained tortuous channels connecting the cyst wall to the joint.

There are some theories of the cause of a ganglion cyst, but none has ever been proven accurate. One theory says that ganglion occurs because of a pre-existing injury in a ligament in the wrist. Another claims that ganglion is a result of degeneration of connective tissue in the wrist.

The liquid in the ganglion cyst somewhat resembles joint fluid in that it contains glucosamine and hyaluronic acid. However, they are different in composition and thickness. Ganglion cyst is definitely thicker (more viscous) than joint fluid. Patients with ganglion cysts in their wrists often complain of discomfort and pain. When the ganglion is quite prominent, it often is impinged when the patient extends his/her wrist. These are the most common reasons for operation.

There are three ways to remove a ganglion : aspiration with syringe (which is NOT a real removal as it only removes the fluid), open surgery, and arthroscopic resection. Interestingly, there are studies that report the recurrence rate of dorsal ganglion cyst. Recurrence rate is highest following aspiration (>50%), and lowest following arthroscopic resection (7%). Open surgery (excision) is the most commonly employed method of ganglion removal. An incision is made on the skin overlying the ganglion cyst. After opening the skin, we can immediately see the the main cyst wall. Further dissection is done to identify the stalk and once the stalk is identified, the ganglion is severed off the stalk and the main cyst is removed.

Ganglion Cyst can be removed by arthroscopy

Ganglion cyst can be removed via arthroscopy. With wrist arthroscopy, we can identify the stalk from within, and then “shave” the stalk / root with a little motorised shaver, and the ganglion fluid will gush out.

Of course, with arthroscopic resection, operation time is slightly longer because one takes more time setting up the arthroscopic tools and apparatus. Arthroscopy, however, allows one to remove ganglion cyst with much smaller incision. To remove a ganglion cyst with arthroscopy, only two stab (key hole) incisions are actually needed. Also, with arthroscopy, finding the stalk is easier because we see the stalk from within, while with open surgery it may be harder to find the stalk because it is hidden beneath the bulk of the cyst. In open surgery, dissecting our way to the cyst stalk automatically creates some degree of soft tissue injury. In fact, more and more centers are leaving open excision and adopting arthroscopic resection as their management of dorsal ganglion cyst.

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Dr. Margareta Arianni Sp. OT-K

Author Dr. Margareta Arianni Sp. OT-K

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