1. Arthroscopic dorsal wrist ganglion excision – The treatment of choice? Kęstutis Bliznikas, Vytautas Mikelevičius

2. Incidence DWG – 80% Volar RC – 12% Volar STT – 8% 2011 IMUKA Presentation, “Practice for Plastic surgery” Dr. Baur, Dr. Fromberg

3. Anatomy

4. Diagnostics Symptoms (pain, functional discomfort, aesthetic discomfort) Lump in the wrist (not visible for occult ganglions)

5. MRI

6. Treatment methods I – Conservative (Observation, crushing, splinting, aspiration, puncture, sclerotherapy) ; II –Surgical:  Open excision;  Arthroscopic excision.

7. Surgery I – Open excision II – Arthrocopic excision

8. Advantages Improved recovery Better joint visualization (magnification) Lower complication rates Lower recurrence rates (8-40% vs 0-10%)* Better cosmetic results *Edwards, S.G. and J.A. Johansen, Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surg Am, 2009. 34(3): p. 395-400

9. Advantages

10. Wrist arthroscopy DWG stalk identification success rate 9-100%* Additional intraarticular pathology may be found up to 75% of patients *Ahsan, Z.S. and J. Yao, Arthroscopic dorsal wrist ganglion excision with color-aided visualization of the stalk: minimum 1-year follow-up. Hand (N Y), 2014. 9(2): p. 205-8

11. Wrist arthroscopy Regional anesthesia Distraction system Tourniquet 2,7mm scope Full radius 2,5-3,5mm shaver No radiofrequency

12. Wrist arthroscopy Start with 6R Diagnostic arthroscopy Identify stalk / sinovitis zone at 3-4portal site 3-4portal introduced Resect ganglion site / stalk, make DW capsule defect Stop when ECRB is clearly visible

13. Wrist arthroscopy

14. Our experience Total 42 patients (16 lost) From 2011-april till now Questioned 26 patients; Follow up from 2 to 38 months. 1 surgeon

15. Our experience

16. Questionnaire Patient outcomes following wrist ganglion excision surgery, J. D. Craik and S. P. Walsh, J Hand Surg Eur Vol 2012 37: 673 originally published online 5 January 2012

17. Results What others say: The reason for consultation: unsightly appearance - 55.2%, the presence of pain 28.9%, both – 15,8%.* Pain (79%) and cosmesis (71%) were the primary pre-operative symptoms. Other symptoms such as paraesthesia, numbness, weakness, and stiffness were experienced by 27–44% of patients.** *Gallego, S. and C. Mathoulin, Arthroscopic resection of dorsal wrist ganglia: 114 cases with minimum follow-up of 2 years. Arthroscopy, 2010. 26(12): p. 1675-82. ** Craik, J.D. and S.P. Walsh, Patient outcomes following wrist ganglion excision surgery. J Hand Surg Eur Vol, 2012. 37(7): p. 673-7.

18. Results

19. Results The ganglion recurred in 3 patients (12%).

20. In conclusion… Etiology and pathogenesis of ganglion is not completely clear Conservative treatment often fails ​ Incision scar may be avoided using arthroscopic technique Arthroscopic technique has definite role in management of DWG with very promising future Our results are similar to other published data ​

21. Thanks for attention