gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Dorsal wrist ganglion in teenager: what else is there?

Meeting Abstract

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  • presenting/speaker Carla Ricardo Nunes - Hospital São Francisco Xavier, Lisbon, Portugal
  • Pedro Xavier Fernandes - Hospital São Francisco Xavier, Lisbon, Portugal
  • Joaquim Rodeia - Hospital São Francisco Xavier, Lisbon, Portugal
  • Raquel Teixeira - Hospital São Francisco Xavier, Lisbon, Portugal

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1523

doi: 10.3205/19ifssh0007, urn:nbn:de:0183-19ifssh00078

Published: February 6, 2020

© 2020 Ricardo Nunes et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Dorsal wrist ganglions may be related to underlying wrist pathology. They are not often described in paediatric population. The purpose of this study was to evaluate their clinical presentation, associated lesions and outcome.

Methods: We evaluated retrospectively the patients operated between April 2012 and June 2018, with a 15,6 months follow up. There were 8 patients, average age 15,6 (10 to 19), 5 female and 3 male. All had a ganglion cyst emerging from the scapho-lunate space and pain during activity. Four practiced sports regularly and 2 competition sports. These 6 reported relevant traumatic events as the origin of the ganglion cyst. Of these 3 had clicking while eliciting the Watson test, but not a clear positive test. There were no other signs of instability or ulnar border pathology. None had range of motion loss. Simple and stress x-rays were normal. Three had MRI which was negative for ligament injuries.

Results and Conclusions: The patients were submitted to wrist arthroscopy, dry technique, observing radio-carpal and mid-carpal compartments. In all cases the cyst was debrided through the mid carpal radial portal with a shaver. Four (50%) had luno-triquetral instability and were submitted to arthroscopic capsule-ligamentous repair though a volar portal, using 3-0 pds suture. One of these had a TFCC type IB distal tear (Atzei classification) repaired with suture. The other 4 had no wrist pathology other than the cyst. None had scapho-lunate instability.

Post operative protocol was for those with instability 6 weeks in a short upper limb cast and physiotherapy and gradual increase in strength for the following 6 weeks. For the simple cysts was 3 weeks in a Robert-Jones bandage and gradual return to usual activity.

There was one recurrence in a simple cyst. There were no other complications. All were pain free and back to their previous activities, including sports, at 3 months time.

Symptomatic ganglion cysts in paediatric population may often have underlying pathology. All those with luno-triquetral instability reported sports practice and relevant trauma. Luno-triquetral tears may have unclear manifestations such as ganglion cyst and clicking while testing wrist stability. These injuries are often missed in dynamic x rays and MRI.