Ganglion da bainha dos tendões flexores Folheto

O que você está sentindo

Você pode notar um caroço mole no pulso ou na mão. Ele geralmente parece um pequeno balão de água sob a pele. O caroço pode aparecer subitamente ou crescer lentamente ao longo do tempo. Muitas pessoas sentem que a área está tensa ou dolorida. A dor costuma ser leve, mas pode se tornar aguda ao mover o pulso de certas maneiras. Você pode sentir desconforto ao flexionar o pulso para trás ou ao segurar objetos com firmeza.

As tarefas diárias podem se tornar difíceis devido ao caroço ou à dor. Alcançar as costas para fechar o fecho de um sutiã pode parecer desconfortável. Enfiar a camisa pode puxar a pele sobre o cisto. Levantar sacos pesados ou abrir potes pode irritar a área. Algumas pessoas sentem uma sensação de formigamento se o caroço comprimir os nervos próximos. Isso pode fazer com que a mão pareça fraca ou adormecida. Os sintomas frequentemente pioram após períodos de movimento repetitivo do pulso ou atividade intensa.

A dor pode aumentar à noite, dificultando o sono confortável. Você pode ter dificuldade em apoiar o pulso em um travesseiro. Ao acordar, a rigidez pode ser mais acentuada. No entanto, o caroço nem sempre causa dor. Em alguns casos, é apenas um inchaço visível que incomoda esteticamente. Cerca de 40% dos cistos ganglionares do pulso diminuem de tamanho nos primeiros 6 anos sem qualquer tratamento. Isso significa que seus sintomas podem melhorar espontaneamente com o passar do tempo.

Se o caroço crescer, pode limitar sua amplitude de movimento. Você pode notar que o pulso não se flexiona com a mesma suavidade de antes. O desconforto pode interferir no trabalho ou nos hobbies que exigem habilidades motoras finas. Você pode evitar usar a mão por medo de causar mais dor. É importante ouvir o seu corpo e descansar quando a área estiver dolorida. Seu cirurgião ajudará você a entender se os sintomas são causados pelo cisto ganglionar ou por outro problema.

O que está realmente acontecendo

Um cisto de gânglio é uma bolsa preenchida por líquido que se forma perto das suas articulações ou tendões. Pense nele como um pequeno balão de água que se desenvolve a partir do revestimento articular. Esse revestimento, chamado sinóvia, produz líquido lubrificante para ajudar suas articulações a se moverem suavemente. Às vezes, esse líquido vaza ou atravessa um ponto fraco na cápsula articular. A cápsula é a bainha resistente que envolve sua articulação.

O líquido se acumula em uma bolsa, criando um caroço que você pode ver ou sentir. Esse caroço pode pressionar estruturas próximas. Por exemplo, pode pressionar um nervo, causando dor ou fraqueza. Também pode interferir no movimento dos seus tendões, que são os cordões resistentes que conectam o músculo ao osso. Essa pressão é a razão pela qual você pode sentir desconforto ou notar movimento limitado.

Em alguns casos, o cisto se conecta diretamente ao espaço articular. Isso significa que o líquido pode fluir para frente e para trás entre a articulação e o cisto. Essa conexão explica por que o caroço pode mudar de tamanho ou desaparecer temporariamente. O corpo às vezes reabsorve esse líquido por conta própria. Cerca de 40% das lesões de gânglio no punho diminuem de tamanho nos primeiros 6 anos após a avaliação por um cirurgião de mão.

No entanto, se o cisto persistir, pode causar problemas contínuos. Pode levar à dedo em gatilho, onde um tendão fica preso durante o movimento. Ou pode comprimir nervos, levando a dormência ou formigamento. Seu cirurgião examinará a área para confirmar o diagnóstico. Ele pode usar imagens para ver a localização e o tamanho do cisto.

O tratamento depende dos seus sintomas. Algumas pessoas escolhem esperar para ver se melhora. Outras preferem tratamento ativo. A punção percutânea é uma opção prática para o manejo de gânglios da bainha do tendão flexor devido ao baixo custo, à ausência de tempo de recuperação e à baixa taxa de recorrência. Isso envolve drenar o líquido com uma agulha. Se o cisto retornar, a excisão cirúrgica remove a bolsa completamente. A excisão cirúrgica aberta oferece uma chance significativamente menor de recorrência em comparação com a aspiração no tratamento de gânglios do punho.

Nosso objetivo é aliviar seus sintomas e restaurar a função normal. Seu cirurgião discutirá a melhor abordagem para o seu caso específico. O objetivo é reduzir a dor e melhorar sua capacidade de usar a mão e o punho.

O que podemos fazer a respeito

A abordagem adotada para o seu ganglion da bainha do tendão flexor geralmente depende do quanto ele o incomoda e há quanto tempo está presente. O Dr. Kieran Hirpara, cirurgião do membro superior do Mater Private Hospital Rockhampton, orienta essa decisão em nossa clínica com base nos seus sintomas específicos e estilo de vida. Começamos por compreender o que você consegue fazer sem dor. Muitos ganglions diminuem espontaneamente. Cerca de 40% das lesões de ganglion do punho reduzem de tamanho nos primeiros 6 anos após avaliação por um cirurgião da mão. Em crianças, se o cisto se resolver, geralmente isso ocorre dentro de 18 meses.

Você pode tentar cuidados simples em casa primeiro. Isso inclui alterar as atividades para evitar esforço repetitivo no tendão. Seu fisioterapeuta ou terapeuta da mão pode ensinar exercícios suaves para manter a articulação movendo-se suavemente. O uso de talas pode ajudar a repousar a área e reduzir a irritação. Frequentemente, sugerimos dar uma tentativa razoável a esse cuidado não cirúrgico antes de considerar medidas mais invasivas. Se o ganglion não estiver causando dor ou limitando seu movimento, a vigilância ativa é uma opção segura e válida.

Se os sintomas persistirem, avançamos para o manejo médico. Isso geralmente envolve analgésicos e medicamentos anti-inflamatórios para controlar o desconforto. Também podemos oferecer uma injeção. Injeções de cortisona podem reduzir o inchaço e a dor, embora o efeito seja temporário. Injeções de ácido hialurônico ou plasma rico em plaquetas (PRP) são às vezes usadas para apoiar a saúde dos tecidos, mas seu benefício a longo prazo varia. A aspiração, na qual drenamos o fluido com uma agulha, é uma opção prática para ganglions da bainha do tendão flexor. Tem baixo custo, nenhum tempo de recuperação e uma baixa taxa de recorrência. Nenhuma recorrência foi observada após uma segunda punção em alguns estudos. No entanto, a maioria dos ganglions recorre após uma única aspiração. Consideramos a aspiração como uma intervenção de primeira linha para casos sintomáticos.

A cirurgia é considerada quando o tratamento conservador não proporcionou melhora suficiente ou se o ganglion está causando compressão nervosa significativa. A excisão cirúrgica permanece como uma opção eficaz para esses casos sintomáticos. A excisão cirúrgica aberta oferece uma chance significativamente menor de recorrência em comparação com a aspiração. Para ganglions do punho, a intervenção cirúrgica tem uma taxa de recorrência de cerca de 10%. Discutimos os riscos, como cicatrizes ou eventos adversos, e os ponderamos contra o benefício de remover o cisto. Em alguns casos, a artroscopia nos permite tratar o ganglion e quaisquer outras questões subjacentes da articulação ao mesmo tempo. Tomamos essa decisão juntos, garantindo que você compreenda o provável desfecho e o processo de recuperação.

O que esperar

Seu cisto de ganglione é uma protuberância preenchida por fluido que frequentemente tem um comportamento imprevisível. Cerca de 40% dos ganglionares do punho diminuem de tamanho nos primeiros 6 anos após você consultar um cirurgião de mão. Muitas pessoas percebem que a protuberância aparece e desaparece ou permanece do mesmo tamanho por anos. Se você a deixar em paz, ela pode encolher espontaneamente, mas também pode persistir ou crescer.

Se você optar por não tratá-la, pode conviver com a protuberância indefinidamente. Algumas pessoas não sentem dor alguma. Outras sentem rigidez ou desconforto leve. Se a protuberância comprimir estruturas próximas, você pode notar fraqueza ou alterações na sensibilidade. Em muitos casos, o corpo reabsorve o fluido naturalmente, mas isso não é garantido.

Se você decidir removê-la, seu cirurgião discutirá a melhor abordagem para o seu caso específico. A aspiração, na qual o fluido é drenado com uma agulha, é uma primeira etapa comum. No entanto, a maioria dos ganglionares recorre após a aspiração. A remoção cirúrgica oferece uma chance significativamente menor de recorrência em comparação com a aspiração. Para ganglionares do punho, a intervenção cirúrgica tem uma taxa de recorrência de cerca de 10%. Isso significa que, em aproximadamente 9 dos 10 casos, a protuberância não retorna.

A recuperação da cirurgia envolve o controle do inchaço e da dor. A maioria dos pacientes experimenta aumentos significativos na função e diminuições na dor dentro de 6 semanas após a ressecção artroscópica do cisto de ganglione. A excisão aberta deixa uma cicatriz e carrega algum risco de eventos adversos. As técnicas artroscópicas permitem o tratamento simultâneo de outras questões e frequentemente resultam em taxas de recorrência comparáveis às da cirurgia aberta.

Seu cirurgião ajudará você a ponderar os riscos e os benefícios. Ele considerará sua idade, nível de atividade e o quanto a protuberância o incomoda. Não existe um único melhor tratamento para todos. Algumas pessoas preferem esperar e observar. Outras preferem a remoção definitiva para evitar incertezas futuras. Seu cirurgião o guiará para a opção que se encaixa na sua vida e nos seus objetivos.

Quando procurar ajuda médica

Consulte o seu médico de família se notar um nódulo no pulso ou na mão que cause dor persistente, fraqueza ou instabilidade. Procure uma avaliação especializada se o inchaço bloquear a articulação, causar sensação de fraqueza súbita ou interferir no sono ou no trabalho. A piora súbita dos sintomas também justifica uma avaliação. Embora muitos cistos ganglionares diminuam ao longo de seis anos, alguns requerem intervenção. A punção percutânea oferece uma baixa taxa de recorrência para cistos ganglionares da bainha do tendão flexor, sem recorrências observadas após uma segunda punção num estudo. No entanto, a maioria dos cistos ganglionares recorre após simples aspiração. O seu cirurgião pode ajudá-lo a decidir se é necessário um tratamento adicional para restaurar a função e o conforto.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath [1].
Percutaneous puncture is a practical option for managing flexor tendon sheath ganglions due to its low cost, lack of downtime, and low recurrence rate [2].
No recurrences were observed after a second percutaneous puncture in the assessed cohort [2].
Pediatric ganglions are more commonly found on the volar surface of the hand and wrist compared to adults [3].
Pediatric ganglions more commonly have a tendon sheath origin compared to adult ganglions [3].
There is no consensus within the literature regarding the best management of pediatric wrist ganglia [5].
No single treatment modality confers a particular advantage or disadvantage over another for pediatric wrist ganglia [5].
Endoscopic ganglionectomy via flexor carpi radialis tendoscopy is a minimally invasive approach that offers better cosmesis [4].
Endoscopic ganglionectomy via flexor carpi radialis tendoscopy results in less soft tissue trauma [4].
Endoscopic ganglionectomy via flexor carpi radialis tendoscopy allows for the management of concomitant FCR tendon pathology [4].
Endoscopic ganglionectomy via flexor carpi radialis tendoscopy carries risks of recurrence and nerve or vessel injury [4].
Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies [8].
Outcomes, recurrence, and complications rates after 4 years of follow-up support the use of arthroscopy as a treatment for dorsal wrist ganglion [9].
The quality of care would not be compromised by abandoning the practice of routine submission of surgical specimens for pathological examination after excision of a wrist ganglion cyst [10].
Routinely performing wrist radiography is not cost-effective in the evaluation and treatment decision-making process for patients with a wrist ganglion [12].
Routine wrist radiography is not useful in the evaluation of patients with a ganglion cyst of the wrist due to a low prevalence of therapeutically significant findings [12].
At 12 months follow-up, the rates of recurrence with arthroscopic dorsal ganglion excision are comparable with those of open excision [13].
At 12 months follow-up, the rates of recurrence with arthroscopic dorsal ganglion excision are not superior to those of open excision [13].
About 40% of wrist ganglion lesions decrease over the first 6 years after evaluation by a hand surgeon [14].
Most ganglions recur after aspiration [14].
Surgical intervention for wrist ganglions has about a 10% recurrence rate [14].
Surgical intervention for wrist ganglions leaves scars [14].
Surgical intervention for wrist ganglions has some risk for adverse events [14].
Operation-related complications after arthroscopic volar wrist ganglionectomy are associated with the anatomical location of the ganglion [18].
Operation-related complications after arthroscopic volar wrist ganglionectomy are associated with the ganglion being distal to the bifurcation of the radial artery [18].
Operation-related complications after arthroscopic volar wrist ganglionectomy are associated with the ganglion concurrently penetrating up to the superficial fascia layer [18].

Anatomy & Pathophysiology

Patients with wrist hyperlaxity have a predisposition to developing ganglions [53].
The incidence of dorsal wrist ganglia is higher in the military population compared with the civilian population [28].
Surgical recurrence rates for ganglion cysts range from 4% to 40% [27].
Complications of ganglion cyst surgery include infection, nerve injury, and wrist stiffness [27].
Dominant side, female sex, and age of 24 years or less are influential risk factors for recurrence after arthroscopic excision of dorsal wrist ganglia [55].
Worse hand function is associated with recurrence following prior surgery [31].
Worse hand function is associated with worse baseline hand function [31].
Worse hand function is associated with lower treatment credibility [31].
Intraneural ganglions require identification and excision of the articular branch of the involved nerve [30].
Arthroscopic treatment of intraosseous ganglion cysts of the lunate bone results in cyst resorption with fewer complications such as joint stiffness and vascular disturbances [45].

Classification

Pediatric ganglions more commonly have a tendon sheath origin compared to adults [3].
Ganglions in pediatric populations most commonly affect the dorsal wrist [20].
Ganglions in pediatric populations demonstrate a female predilection [20].
Women are significantly more likely to be diagnosed with a volar wrist ganglion, regardless of age or military status [7].
The incidence of dorsal wrist ganglia is higher in the military compared with the civilian population [28].
Tendon-associated ganglion cysts are not usual, although flexor hallucis longus tendinopathy is common in athletes [6].
Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve [50].

Clinical Presentation

Pediatric ganglions more commonly have a tendon sheath origin compared to those in adults [3].
In children aged <10 years, ganglions mainly occur on the volar wrist [17].
Pediatric ganglions of the hand have a greater rate of resolution than ganglions of the wrist [15].
In a child with a wrist ganglion, if the cyst ultimately resolved, it usually did so within 18 months [11].
In children aged <10 years, 69% to 79% of volar wrist ganglions display spontaneous regression within a span of 12-18 months [17].
MRI is an excellent diagnostic modality to evaluate rapidly growing upper extremity masses and distinguish ganglions from malignant processes [16].
MRI scans provide relatively good reliability in establishing the diagnosis of an occult dorsal wrist ganglion, with a sensitivity of 83% when using intra-operative findings as the standard [21].
Advanced imaging has value in patients presenting with an atraumatic, painful, and progressive elbow contracture [24].
Intraneural ganglions should be considered in the differential diagnosis of a mass in the vicinity of a nerve [22].
Uncommon aetiologies should be considered in patients with atypical symptoms of carpal tunnel syndrome [32].

Investigations

Routine submission of surgical specimens for pathological examination after excision of a clinically diagnosed wrist ganglion cyst does not compromise quality of care [10].
Routinely performing wrist radiography is not cost-effective in the evaluation and treatment decision-making process for patients with a wrist ganglion due to a low prevalence of therapeutically significant findings [12].
Radiologists are less likely to identify occult dorsal ganglion cysts on MRI if the cyst is smaller or if the requisition form does not mention a cyst [41].
Preoperative MRI is essential for the diagnosis of intra-articular ganglion cysts of the cruciate ligaments [42].
Ganglion cysts of the cruciate ligaments can easily be detected by MRI [43].
Sonography-guided wrist arthroscopy provides visualization of the ganglions and ganglion stalk, as well as of the arthroscopic shaver and adjacent structures such as nerves, vessels, and tendons to perform surgery safely [36].
Sonography-assisted arthroscopic resection is a safer and more reliable method for treating volar wrist ganglia [23].

Treatment

Non-Operative Management

Nonsurgical treatment is largely ineffective in treating ganglion cysts [37].
Nonsurgical treatment may be considered for symptomatic relief in patients who do not want surgery [37].
Ganglion aspiration should be considered as a first-line intervention [40].
Percutaneous puncture is a practical option for managing flexor tendon sheath ganglions given its low cost, lack of downtime, and low recurrence rate [2].
No recurrences were observed after a second puncture in the cohort studied for percutaneous puncture of flexor sheath ganglions [2].

Operative Management: General Outcomes

Surgical intervention has about a 10% recurrence rate [14].
Surgical intervention leaves scars and has some risk for adverse events [14].
Surgical recurrence rates range from 4% to 40% [27].
Complications of surgical treatment include infection, nerve injury, and wrist stiffness [27].
Open surgical excision offers a significantly lower chance of recurrence compared with aspiration in the treatment of wrist ganglions [39].
Surgical excision remains an effective option for symptomatic cases where aspiration is not suitable or has failed [40].

Operative Management: Arthroscopic Techniques

Arthroscopic resection is an effective treatment strategy for intra-articular synovial ganglions refractory to conservative measures, providing complete resolution of symptoms and functional recovery with minimal soft tissue damage [34].
Arthroscopic ganglionectomy through an intrafocal cystic portal is a safe and efficacious option for the treatment of painful wrist ganglia [35].
Arthroscopic debridement of ganglion cysts offers excellent outcomes without recurrence [38].
Ganglion cysts have a high association with certain interosseous laxities [19].
Recurrent ganglion cysts originating from the midcarpal joint are not contraindications for arthroscopic resection [19].
The outcomes, recurrence, and complications rates after 4 years of follow-up support the use of arthroscopy as a treatment for dorsal wrist ganglion [9].
At 12 months follow-up, the rates of recurrence with arthroscopic dorsal ganglion excision are comparable with and not superior to those of open excision [13].

Operative Management: Endoscopic Techniques

Endoscopic ganglionectomy via flexor carpi radialis tendoscopy offers less soft tissue trauma [4].
Endoscopic ganglionectomy via flexor carpi radialis tendoscopy allows for the ability to manage concomitant FCR tendon pathology [4].

Pathological Examination

In patients with the clinical diagnosis of wrist ganglion cyst, the quality of care would not be compromised by abandoning the practice of routine submission of surgical specimens for pathological examination after excision of the ganglion cyst [10].
In patients with the clinical diagnosis of wrist ganglion cyst, the quality of care would not be compromised by abandoning the practice of routinely submitting surgical specimens for pathological examination after excision of the ganglion cyst [25].

Complications

Surgical excision of digital flexor tendon sheath ganglions is considered a safe method [1].
Percutaneous puncture of flexor tendon sheath ganglions is associated with a low recurrence rate [2].
Surgical intervention for wrist ganglions has approximately a 10% recurrence rate [14].
Surgical intervention for wrist ganglions carries some risk for adverse events [14].
Operation-related complications after arthroscopic volar wrist ganglionectomy are associated with the cyst's anatomical location distal to the bifurcation of the radial artery and penetration up to the superficial fascia layer [18].
Patients whose occupation or activities require forceful wrist extension face a considerable risk of residual pain and functional limitations after open dorsal wrist ganglion excision [29].

Recovery

Endoscopic ganglionectomy via flexor carpi radialis tendoscopy is a minimally invasive approach that offers better cosmesis and less soft tissue trauma [4].
Arthroscopy is supported as a treatment for dorsal wrist ganglion based on outcomes, recurrence, and complication rates after 4 years of follow-up [9].
In children with wrist ganglions, spontaneous resolution usually occurs within 18 months [11].
In children aged <10 years, ganglions mainly occur on the volar wrist and can be treated expectantly [17].
69% to 79% of ganglions in children aged <10 years display spontaneous regression within a span of 12-18 months [17].
Surgical intervention for wrist ganglions leaves scars and has some risk for adverse events [14].
Routine midcarpal joint exploration during arthroscopic excision of dorsal wrist ganglions appeared to reduce recurrence at 1 year without negatively impacting patient outcomes [26].
Complete resection of the ganglion stem and complete closure of the joint capsule is the most important step to avoid recurrences [46].

Key Evidence

[L4] Surgical excision is a simple, safe, and effective method for treating a painful ganglion of the digital flexor tendon sheath. [1] (10.1007/s11552-007-9028-4)
[L4] Percutaneous puncture is a practical option for managing flexor tendon sheath ganglions given its low cost, lack of downtime, and low recurrence rate, with no recurrences observed after a second puncture in this cohort. [2] (10.1177/17531934221115983)
[L4] Pediatric ganglions are more commonly found on the volar surface of the hand and wrist and more commonly have tendon sheath origin compared to adults. [3] (10.1007/s11552-008-9122-2)
[Paper] Endoscopic ganglionectomy via flexor carpi radialis tendoscopy is a minimally invasive approach that offers better cosmesis, less soft tissue trauma, and the ability to manage concomitant FCR tendon pathology, though it carries risks of recurrence and nerve or vessel injury. [4] (10.1016/j.eats.2017.06.002)
[L4] There is no consensus within the literature regarding the best management of pediatric wrist ganglia, and no single treatment modality confers a particular advantage or disadvantage over another. [5] (10.1177/1558944720966716)
[L4] Tendon associated ganglion cyst is not usual although flexor hallucis longus tendinopathy is common in athletes. [6] (10.1177/2325967114s00211)
[L3] Women are significantly more likely to be diagnosed with a volar wrist ganglion, regardless of age or military status. [7] (10.1016/j.jhsa.2016.08.008)
[L4] Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies. [8] (10.1016/j.jhsa.2012.04.042)
[L4] The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion. [9] (10.1177/1558944717743601)
[L4] In patients with the clinical diagnosis of wrist ganglion cyst, the quality of care would not be compromised by abandoning the practice of routine submission of surgical specimens for pathological examination after excision of the ganglion cyst. [10] (10.1016/s0363-5023(10)60107-4)
[L4] In a child with a wrist ganglion, if the cyst ultimately resolved, it usually did so within 18 months. [11] (10.1016/j.jhsa.2019.10.032)
[L4] The study concludes that routinely performing wrist radiography is not cost-effective in the evaluation and treatment decision-making process for patients with a wrist ganglion due to a low prevalence of therapeutically significant findings. [12] (10.1007/s11552-007-9032-8)
[L1] At 12 months follow-up, the rates of recurrence with arthroscopic dorsal ganglion excision are comparable with and not superior to those of open excision. [13] (10.1016/j.jhsa.2008.01.009)
[L5] Current best evidence suggests that about 40% of lesions decrease over the first 6 years after evaluation by a hand surgeon, that most ganglions recur after aspiration, and that surgical intervention has about a 10% recurrence rate, leaves scars, and has some risk for adverse events. [14] (10.1016/j.jhsa.2010.11.048)
[L4] Pediatric ganglions of the hand have a greater rate of resolution than ganglions of the wrist. [15] (10.1016/j.jhsa.2023.07.002)
[L4] MRI is an excellent diagnostic modality to evaluate rapidly growing upper extremity masses and distinguish ganglions from malignant processes. [16] (10.1007/s11552-007-9083-x)
[L4] In children aged <10 years, ganglions mainly occur on the volar wrist and can be treated expectantly, with 69% to 79% displaying spontaneous regression within a span of 12-18 months. [17] (10.1016/j.jhsa.2021.12.015)
[L3] The operation-related complications after arthroscopic volar wrist ganglionectomy are associated with its anatomical location: distal to the bifurcation of the radial artery and concurrently penetrated up to the superficial fascia layer. [18] (10.1186/s12891-025-08766-x)
[L4] Ganglion cysts also have a high association with certain interosseous laxities, and recurrent ganglion cysts originating from the midcarpal joint are not contraindications for arthroscopic resection. [19] (10.1016/j.jhsa.2008.11.025)
[L2] Ganglions in pediatric populations, which most commonly affect the dorsal wrist, demonstrate a female predilection. [20] (10.1016/j.jhsa.2021.02.026)
[L3] MRI scans provide relatively good reliability in establishing the diagnosis of an occult dorsal wrist ganglion, with a sensitivity of 83% when using intra-operative findings as the standard. [21] (10.1177/1753193408092041)
[L4] Intraneural ganglions should be considered in the differential diagnosis of a mass in the vicinity of a nerve. [22] (10.1016/j.jhsa.2015.05.025)
[Paper] This method is safer and more reliable for treating volar wrist ganglia. [23] (10.1016/j.eats.2011.12.007)
[L4] This case highlights the value of advanced imaging in patients presenting with an atraumatic, painful, and progressive elbow contracture. [24] (10.1016/j.jhsa.2020.06.005)
[L3] This study suggests that, in patients with the clinical diagnosis of wrist ganglion cyst, quality of care would not be compromised by abandoning the practice of routinely submitting surgical specimens for pathological examination after excision of the ganglion cyst. [25] (10.1016/j.jhsa.2010.03.021)
[L3] Routine midcarpal joint exploration during arthroscopic excision of dorsal wrist ganglions appeared to reduce recurrence at 1 year without negatively impacting patient outcomes. [26] (10.1177/17531934251405730)
[L5] Surgical recurrence rates range from 4% to 40%, and complications include infection, nerve injury, and wrist stiffness. [27] (10.1016/j.hcl.2004.03.015)
[L3] The incidence of dorsal wrist ganglia was higher in the military compared with the civilian population. [28] (10.1016/j.jhsg.2020.08.001)
[L4] Patients whose occupation or activities require forceful wrist extension should be counseled on the considerable risk of residual pain and functional limitations that may occur after open dorsal wrist ganglion excision. [29] (10.1016/j.jhsa.2015.05.030)
[L4] Every attempt should be made to identify and excise the articular branch of the involved nerve. [30] (10.1016/j.jhsa.2014.06.095)
[L2] Worse hand function was associated with recurrence following prior surgery, worse baseline hand function and lower treatment credibility. [31] (10.1177/17531934231153029)
[L4] This case highlights the importance of considering uncommon aetiologies in patients with atypical symptoms of carpal tunnel syndrome. [32] (10.1177/17531934241227809)
[L4] Arthroscopic resection is an effective treatment strategy for intra-articular synovial ganglions refractory to conservative measures, providing complete resolution of symptoms and functional recovery with minimal soft tissue damage. [34] (10.1016/j.jhsg.2024.05.007)
[L4] Arthroscopic ganglionectomy through an intrafocal cystic portal is a safe and efficacious option for the treatment of painful wrist ganglia. [35] (10.1016/j.arthro.2009.08.021)
[L4] Sonography-guided wrist arthroscopy provides several advantages for surgeons, including visualization of the ganglions and ganglion stalk, as well as of the arthroscopic shaver and adjacent structures such as nerves, vessels, and tendons to perform surgery safely. [36] (10.1016/j.jhsa.2012.04.012)
[L4] Nonsurgical treatment is largely ineffective in treating ganglion cysts, though it may be considered for symptomatic relief in patients who do not want surgery. [37] (10.1155/2013/940615)
[L4] Arthroscopic debridement of ganglion cyst offers excellent outcome without recurrence. [38] (10.1186/1471-2474-13-137)
[L1] Open surgical excision offers significantly lower chance of recurrence compared with aspiration in the treatment of wrist ganglions. [39] (10.1016/j.jhsa.2014.12.014)
[L4] Ganglion aspiration should be considered as a first-line intervention, with surgical excision remaining an effective option for symptomatic cases. [40] (10.1177/1753193411434376)
[L3] Radiologists are less likely to identify occult dorsal ganglion cysts on MRI if the cyst is smaller or if the requisition form does not mention a cyst. [41] (10.1055/s-0039-1683847)
[Case_report] Intra-articular ganglion cysts of the cruciate ligaments are difficult to diagnose and do not necessarily require specific clinical symptoms or previous trauma; preoperative MRI is essential for diagnosis, and the condition can be successfully treated by arthroscopy. [42] (10.1007/s00402-003-0494-z)
[L4] Ganglion cysts of the cruciate ligaments can easily be detected by MRI and should be arthroscopically resected. [43] (10.1007/s00402-011-1286-5)
[Paper] The technique provides good results regarding cyst resorption with fewer complications such as joint stiffness and vascular disturbances. [45] (10.1016/j.eats.2015.05.011)
[L4] Complete resection of the ganglion stem and complete closure of the joint capsule is the most important step to avoid recurrences. [46] (10.1007/s001670050073)
[L4] Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve. [50] (10.1016/j.otsr.2016.05.014)
[L3] Patients with wrist hyperlaxity have a predisposition to developing ganglions, a finding corroborated by independent investigations using similar prospective cohort designs. [53] (10.1016/j.jhsa.2013.11.025)
[L4] Dominant side, female sex, and age of 24 years or less are considered to be the most influential risk factors for recurrence after arthroscopic excision of dorsal wrist ganglia. [55] (10.1016/j.arthro.2013.04.002)

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