Ganglion Cyst Recurrence After Post-Operative Casting Immobilization
Maheen Nadeem, MD1, Peter A Andrawes, MD2 and John D Lubahn, MD3, (1)UPMC Hamot Orthopedic Surgery, Erie, PA, (2)Hand, Microsurgery and Reconstructive Orthopaedics, LLP, Erie, PA, (3)Orthopaedics, UPMC Hamot, Erie, PA
Introduction: Ganglion cysts are the most common soft tissue lesions that upper extremity surgeonsmanage. While about half of patients can expect a wrist ganglion cyst to resolve with expectant management, surgical excision is the gold standard of treatment. However, recurrence after surgical excision can still occur due to inadequate excision of the cystâ€™s pedicle and capsular attachments. Post-surgical recurrence is thought to be more common for volar cysts given the more technically challenging procedure with adjacent important structures such as the radial artery and palmar cutaneous branch of the median nerve. The purpose of this study was to determine whether post-operative casting immobilization after wrist ganglion cyst excision would contribute to reduced recurrence rates.
Materials and Methods: A single surgeonâ€™s operative history was reviewed from February 2018 to February 2022 to identify patients with the diagnosis of wrist ganglion who underwent surgical excision. Initial screening yielded 41 patients of which 18 were then removed from further analysis given a surgical procedure beyond simple cyst excision, or because they could not be contacted via telephone. All included patients had at least one follow up visit and were placed in a short arm cast post-operatively for 4 weeks.
Results: A total of 23 patients were included in analysis. Patients were 44 Â± 17.8 years of age at time of surgery and 71.4% were female. Thirty-eight percent (N=8) of patients had a volar ganglion cyst pathology and follow-up was 2.9 Â± 1.0 years. Overall recurrence rate was 26.1%. Volar ganglion cysts showed a recurrence rate of 25% and dorsal ganglion cysts showed a rate of 26.7% which was not statistically significant (Pearsonâ€™s Chi-Squared test, p=0.07).
Conclusions: Wrist ganglion cyst recurrence is common after non-surgical management such as aspiration or blunt decompression. Surgical excision is the gold standard of ganglion cyst treatment although recurrence is still reported in varying rates, noted to be as high as 42% in volar ganglia studies. This study showed no difference between volar and dorsal wrist ganglia recurrence in setting of casting immobilization after surgical excision.
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