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Treatment of Dorsal Wrist Ganglions

- Open Resection:
    - short transverse incision directly over the mass;
    - dorsal ganglions are often located between the EPL and EDC tendons;
    - retinaculum is incised between the 2nd and 4th extensor compartments (EPL tendon sheath need not be incised);
    - main cyst and its pedicle are mobilized down to joint capsule;
    - w/ wrist in volar flexion, the joint capsule is opened along border of radius and proximal pole of scaphoid;
    - to ensure complete ganglion excision, a trianglular portion of capsule is removed between the dorsal oblique radiotriquetral
              ligament and the dorsal transverse scaphotriquetral ligament:
    - capsule is retracted distally, exposing capsular attachments of the scapholunate ligament; (see dorsal wrist ligaments);
    - ganglion & its capsular extension are excised off scapholunate ligament;
    - resection of involved portion of dorsal scapholunate ligament will show degenerative changes;
            - this resection should be tangential, and should be proximal to the distal 2-3 mm of dorsal scapholunate interosseous ligament;
    - do not excise scapholunate interosseous ligament, since this could potentially cause SLD;
    - PIN is identified as it runs past 4th dorsal compartment (nerve may be resected proximally over radius);
            - in the study by Loh YC, et al (1999), several patients were identified who had developed a neuroma of the PIN following
                  ganglion excision;
                  - whether or not the nerve is resected, the surgeon should have a clear plan for its management;
                  - ref: Neuroma of the distal posterior interosseous nerve. A cause of iatrogenic wrist pain.  
    - post op care:
            - need active wrist flexion to avoid contractures;
    - outcomes:
            - in the study by Steinberg and Kleinman (1999), 16 out of 21 patiens who underwent excision of an occult ganglion had an
                     excellent outcome; 
            - Occult scapholunate ganglion: a cause of dorsal radial wrist pain.

Outcomes of Open Dorsal Wrist Ganglion Excision in Active-Duty Military Personnel

The treatment of dorsal wrist ganglia by radical excision.

Scapholunate instability following ganglion cyst excision. A case report.

Necessity of Routine Pathological Examination After Surgical Excision of Wrist Ganglions

Color-Aided Visualization of Dorsal Wrist Ganglion Stalks Aids in Complete Arthroscopic Excision

Preliminary Report of the Effectiveness of Tetracycline Sclerotherapy in Treatment of Ganglion