title: Ganglions of the wrist and associated triangular fibrocartilage lesions: a prospective study in arthroscopically-treated patients.
abstract: OBJECTIVE
  Wrist ganglions are the most common soft tissue tumors of the hand and wrist and can occur at any age. Their etiology remains controversial. A high prevalence of associated intrinsic ligamentous lesions has been described. We hypothesized that painful wrist ganglions are an indicator of an underlying joint abnormality, particularly of lesions of the triangular fibrocartilage complex (TFCC). The aim of our study was to prospectively determine the prevalence of associated TFCC lesions in patients with painful wrist ganglions.
  
  
  METHODS
  Forty-six patients (35 women, 11 men; mean age, 36 ± 11 y; range, 18-57 y) with painful wrist ganglions (20 radiopalmar and 26 dorsal) had surgery from January 2008 to June 2010. There were 18 primary and 28 recurrent ganglions. Clinical examinations, pain score evaluations, disabilities in daily life evaluations, plain radiographs, and magnetic resonance imaging were obtained before arthroscopic resection. Concomitant intrinsic lesions of the wrist were assessed with magnetic resonance imaging and re-evaluated by arthroscopy.
  
  
  RESULTS
  All ganglions were successfully resected. Overall, arthroscopy identified 22 TFCC lesions (48%) and 2 intracarpal ligament lesions. The TFCC perforations were more commonly associated with radiopalmar ganglions with a positive ulnocarpal stress test result and with recurrent radiopalmar ganglions. At 1-year follow-up, all patients were meaningfully improved in terms of pain and disabilities in daily life.
  
  
  CONCLUSIONS
  Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies. Therefore, arthroscopy should be contemplated as the primary treatment option for patients with painful ganglions of the wrist if they are in a radiopalmar location with a positive ulnocarpal stress test and for patients with recurrent radiopalmar ganglions, which are also highly associated with TFCC abnormalities.
  
  
  METHODS
  Therapeutic IV.
authors: Center for Hand Surgery, Department of Trauma and Reconstructive Surgery, Universitymedicine Greifswald, Greifswald, Germany. ilangner@uni-greifswald.de
authors: I
authors: I
authors: Langner
authors: P C
authors: PC
authors: Krueger
authors: H R
authors: HR
authors: Merk
authors: A
authors: A
authors: Ekkernkamp
authors: A
authors: A
authors: Zach
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D045888:Ganglion Cysts / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D051478:Triangular Fibrocartilage / Q000002:abnormalities / Q000601:surgery*; D014953:Wrist / Q000473:pathology / Q000601:surgery*