Surgical excision of wrist ganglia; literature review and nine-year retrospective study of recurrence and patient satisfaction

The main options for the treatment of wrist ganglia are reassurance, aspiration, arthroscopic resection and open excision. Variations within each option have been described and the literature is clouded by widespread variability in the results reported. We present the results of our own long-term retrospective study, review the literature and question the surgical risks and demands placed on healthcare resources. A retrospective review of the surgical results of dorsal and volar wrist ganglia excision between January 1998 and March 2005 was undertaken at a single institution. Of the 152 patients in this consecutive series, 117 (77%) patients responded to a telephone questionnaire. The mean length of follow-up in this series of 117 patients was 4.2 years (range 1.5-8.7 years). The overall recurrence rate following excision of all wrist ganglia in this series was 41.8 %. When looking just at volar ganglia, the risk of recurrence is higher at 46.8%. Should the ganglion recur, the risk of developing a moderate to severely tender scar is 34.6% and the risk of developing an unsightly scar is 8.2%. This study questions the effectiveness of surgical excision in the treatment of wrist ganglia when performed by a mixture of surgeons in that the recurrence rates are very similar to the rates seen in studies that merely observe or aspirate wrist ganglia. We propose that for symptomatic ganglia, specialists in hand surgery may be more appropriate at treating such a pathology.