Sonography-Assisted Arthroscopic Resection of Volar Wrist Ganglia: A New Technique  Michiro Yamamoto, M.D., Ph.D., Shigeru Kurimoto, M.D., Nobuyuki Okui, M.D., Ph.D., Masahiro Tatebe, M.D., Ph.D., Takaaki Shinohara, M.D., Ph.D., Hitoshi Hirata, M.D., Ph.D.  Arthroscopy Techniques  Volume 1, Issue 1, Pages e31-e35 (September 2012) DOI: 10.1016/j.eats.2011.12.007 Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 1 (A) Preoperative gross view of hand. This patient underwent aspiration at a previous hospital more than 20 times, but the ganglion cyst (arrows) did not heal, and she complained of wrist pain and an abnormal appearance. (B) Postoperative gross view of hand. After 1 week, the wound had healed and the patient was allowed to perform light work. The ganglion became smaller, but slight swelling at the lesion (arrows) remained because of residual cysts. (C) One month after surgery, there was no swelling (arrows) and no pain. The patient could fully return to work and sporting activities. Arthroscopy Techniques 2012 1, e31-e35DOI: (10.1016/j.eats.2011.12.007) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 2 Under axillary block, the patient is placed in a supine position on the operating table. The upper extremity is placed on an arm board with the shoulder in 90° of abduction, the elbow in 90° of flexion, the forearm in neutral rotation, and the wrist in a neutral position to a position of slight palmar flexion. Traction of the wrist is achieved by use of a sterile wrist tower with digits held by finger traps. A standard small-joint arthroscope (1.9 or 2.3 mm in diameter) with a 30° viewing angle is used. A high-frequency linear-array transducer (curved arrow) at a frequency of 13 MHz (Prosound α10) is covered by a sterile drape (Surgi Transducer Cover) and used simultaneously by an assisting surgeon during wrist arthroscopy. The monitors for the arthroscope and for sonography are placed beyond the patient for easy viewing by the surgeons. Arthroscopy Techniques 2012 1, e31-e35DOI: (10.1016/j.eats.2011.12.007) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions

Figure 3 Color Doppler sonography shows the branches of the radial artery (arrows). The tip of the arthroscopic shaver (star) is clearly visible with an acoustic shadow during shaving. (C, radiocarpal joint capsule; GC, ganglion cyst; Sc, scaphoid.) Arthroscopy Techniques 2012 1, e31-e35DOI: (10.1016/j.eats.2011.12.007) Copyright © 2012 Arthroscopy Association of North America Terms and Conditions