Chapter 5 Arthroscopic Excision of Volar Wrist Ganglia

10.1055/b-0035-121115

Chapter 5 Arthroscopic Excision of Volar Wrist Ganglia

Introduction

Volar wrist ganglia are less common than dorsal ones. They occur mainly in the radiocarpal joint. Although rare, any occurrence in the midcarpal joint is evidence of scaphotrapeziotrapezoid (STT) osteoarthritis. Their exact cause is still debated, but the result is capsule destruction across from the volar insertion of the scapholunate ligament. Like dorsal ganglia, these are benign tumors that can be treated using an open procedure; however, there is a risk of complications due to the proximity of the cyst to the radial artery and nerve. Arthroscopic resection is a simple and reliable procedure as long as the surgical technique is performed correctly, given that the intracapsular origin of the ganglion is far removed from tendons, ligaments, and muscles.

Operative Technique

Patient Preparation and Positioning

Surgery is performed on an outpatient basis under regional anesthesia. The patient is placed supine with the arm resting on an arm board and a tourniquet placed at the base of the upper arm. A traction tower is used to make the procedure easier; 5 to 7 kg of traction is sufficient. The ganglion in the volar wrist crease below the thumb is outlined with a skin marker ( Fig. 5.1 ). This documents the volume of the ganglion prior to the procedure; this information is used at the end of the procedure to ascertain whether all the cyst fluid has been removed.

First Surgical Phase: Intra-articular Assessment

The scope is typically placed in the 3–4 portal. After inspecting the various wrist compartments and making sure there are no other injuries, the position of the volar ganglion is determined from inside the joint. The scope is placed in front of the hiatus between the radioscaphocapitate (RSC) ligament and the long radiolunate ligament (LRL) ( Fig. 5.2a, b ). By gently pressing on the swollen volar structure with a finger, the volar ganglion’s poorly defined, frayed hypertrophic synovial membrane will bulge out between these two ligaments. The volar ganglion will be resected through this opening.