gms | German Medical Science

Objectives/Interrogation: Synovial ganglion is a benign soft tissue tumor most commonly found in the dorsal region of the wrist. There are numerous forms of treatment described in the literature, among them, observational, aspiration of ganglion fluid and infiltration of corticosteroids or sclerosing agents and surgical resection. Conservative treatment with aspiration with or without infiltration has a low resolution rate (20-30%) compared to surgical treatment (up to 100%), however the surgery is more invasive and has a higher rate of complications. Few sclerosing agents have been studied for this purpose. There are reports of polydocanol and hypertonic serum, however no work using 75% hypertonic glucose.

Hypertonic glucose is considered one of the safest sclerosing agents. Our study was performed with dorsal synovial ganglion aspiration and hypertonic glucose infiltration 75%

Methods: Case series, prospective interventional with 45 patients, totaling 47 dorsal synovial ganglion of the wrist, confirmed by ultrasound examination, without previous treatment.

Local anesthesia was performed with 1% lidocaine subcutaneous injection; puncture of the cyst with needle and aspiration of synovial fluid; infiltration of solution containing 3 ml of 75% hypertonic glucose and associated with 0.5 ml of 1% Lidocaine; band Aid. If there was no complete cure or permanence of the cyst within 4 weeks, another puncture and infiltration was performed.

The cure index, the pain intensity by the visual analog pain scale (VAS), the scores of the Quick DASH and Brief Michigan functional questionnaires, the presence of the side effects, range of motion of the wrist and grip strength were evaluated.

Results and Conclusions: Of the 45 patients, 30 were female and 15 were male. The mean age was 36.4 years. Of the 47 evaluated ganglion, 24 were on the left side and 23 on the right side, 57.4% evolved to cure, 12.8% presented ganglion without elevation but present palpation and 29.8% were present.

The functional questionnaires and the applied EVA show significant improvement. Side effects were edema and hyperemia for 2 days and skin necrosis in 1 patient treated with dressings. There were no differences in grip strength and range of motion.

It is concluded that the treatment of dorsal synovial ganglion of the wrist with aspiration and infiltration of Hypertonic Glucose 75%, is another new tool for conservative treatment of the ganglion, with a cure rate of 57.4% at 6 months after the procedure.