Dorsal wrist ganglions: A new procedure to perform excision under ultrasound guidance

Dorsal wrist ganglions are a common pathology, aspiration has been reported as a cost-effective procedure despite a high risk of recurrence. Surgical excision demonstrated less recurrence but is less accessible and more expensive. We developed an ultrasound procedure for percutaneous excision. In this series, we report our results of the first 23 cases. This is a retrospective study, we reviewed 23 dorsal wrist ganglions operated on over a period of 18 months, Clinical and ultrasound examination was performed after 1 and 3 month and telephone interviews at follow-up The WALANT technique was used for local anesthesia. All procedures were performed percutaneously under ultrasound guidance (In-plane control with Out-plane assessment). Surgical blades were proscribed, only a 18 gauge needle was used for skin incision. A single 2 mm portal using a 2 mm shaver blade was used. Bandages were removed by the patient the day after surgery and patients return to activities as usual. The mean follow-up was 8 months (3–18). Procedures were 8 minutes long (3–18). All ganglions were fully excised. The pre-op clinical examination reported a ROM of 110° in F/E° and a mean Quick-DASH score of 18 (8–24); the post-op examination reported a ROM of 130° (at 3 months) and a phone interview Quick-DASH score (at follow-up) of 7 (0–11). After one month, a full finger motion and full wrist extension were observed with tenderness at the point of excision, local swelling between the capsule and extensors was observed on ultrasound. 1 recurrence occurred on ultrasound assessment at one month, it was a second recurrence in this case, the patient was previously operated on 4 years ago. All patients were cured at follow-up with one recurrence. This short retrospective work had limitations and additional studies are needed to confirm these good outcomes and the excellent cost efficiency. The ultrasound-guided excision of dorsal wrist ganglion, using a 2 mm portal, under local anesthesia was reliable and efficient, with a classic rate of recurrence for this pathology.