β£What is a ganglion?A ganglion is a mucin-filled synovial cyst with no true epithelial lining that arises from the tendon sheath or joint capsuleIt is NOT a true cyst as it does not have an epithelial liningβ£Most common locations of wrist ganglion?70% dorsal - from SL ligament (can look quite proximal)20% Volar wrist Ganglion - From radio-scaphoid, scapholunate, STT ot Metacarpotrapezial joint. [Higher recurrence rate than dorsal ganglion]10% Flexor sheath ganglion - arises from A1 or A2 pulleys β these do not move with finger flexionβ£Management of wrist ganglion?ObservationAspiration - risk of recurrence is 50%Excision - risk of recurrence is 5% - must remove entire stalk to prevent reaccumulationβ£Any difference in outcomes from various treatment options for VOLAR wrist ganglion cyst?[VOLAR Cysts] Leicester Dias JHS 2007 - prospective cohort study of 182 patientsNo difference in symptoms regardless whether ganglion was excised, aspirated or left alone at 2 - 5 year follow up.At 5 years, no difference in recurrence rate between aspiration or excision (47 vs 42%)At 5 years, 53% of untreated ganglion disappearedhttps://pubmed.ncbi.nlm.nih.gov/12631492/β£How do you excise a dorsal wrist ganglion?Transverse skin incisions preferredIdentify pedicle and excise surrounding joint capsuleDo not close joint capsuleβ£How do you excise a volar wrist ganglion?Check Allens test before surgery - to see involvement of radial artery, need to be careful in excision