Surgical Excision Versus Aspiration Combined with Intralesional Triamcinolone Acetonide Injection Plus Wrist Immobilization Therapy in the Treatment of Dorsal Wrist Ganglion; A Randomized Controlled Trial

Abstract

Ganglion is the most common benign soft tissue tumour of hand and represents about 60–70% of all such soft tissue tumours. Treatment options include observation, aspiration, intralesional steroids and surgical and arthroscopic excision. Aspiration with intralesional steroid, with its many advantages, may be an alternative choice for its treatment but the operative treatment is the best method when considering the recurrence rate. Objective: To compare the result of surgical excision versus aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization therapy in the treatment of dorsal wrist ganglion. Study period: November 2007 to October 2009. Participants: 36 patients above 15 years of age, having the disease for first time, having no history of wrist injury and with no history of use of steroid or any allergy to it, were selected for the study. Setting: The study was undertaken at SKIMS Medical College Hospital, Bemina Srinagar Kashmir. Patients were randomly allocated to undergo either surgical excision (group A, n=18) or aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization (group B, n=18) using table of random numbers. All the patients were operated under local anaesthesia. Fisher-exact-test, Chi-square test were used for statistics. The success rate of surgery was 94.4% and that of aspiration with triamcinolone acetonide injection plus wrist immobilization was 61.1%. The difference in success rate was statistically significant(p=0.041). Surgery is the most successful form of treatment when considering the cure rate of dorsal wrist ganglion.

Keywords

Dorsal wrist ganglion - Surgical excision - Aspiration

• References

• 1 Thornburg LE. Ganglions of the hand and wrist. J Am Acad Orthop Surg 1999; 7 ((4)) 231-238
• 2 Angelides AC. Ganglions of the hand and wrist. 1999. In: Green DP, Hotchkiss RN, Pederson WC. (eds) Green’s operative hand surgery. Churchill Livingstone; Philadelphia: pp 2171-2183
• 3 Limpaphayom N, Wilairatana V. Randomized controlled trial between surgery and aspiration combined with methylprednis-olone acetate injection plus wrist immobilization in the treatment of dorsal carpal ganglion. J Med Assoc Thai 2004; 87 ((12)) 1513-1517
• 4 Paramhans D, Nayak D, Mathur RK, Kushwah K. Double dart technique of instillation of triamcinolone in ganglion over the wrist. J Cutan Aesthet Surg 2010; 3 ((1)) 29-31
• 5 Clay NR, Clement DA. The treatment of dorsal wrist ganglia by radical excision. J Hand Surg Br 1988; 13: 187-191
• 6 Varley GW, Needoff M, Davis TR. Conservative management of wrist ganglia. J Hand Surg Br 1997; 22: 636-637
• 7 Humail SM, Abidi AR, Naeem Ul Haq S, Ghulam Mustafa KK. Comparative study of two methods for treatment of dorsal wrist ganglion. J Pak Orthop Assoc 2010; 22 ((1)) 53-57
• 8 Janson L, Niechajev IA. Wrist ganglion. Scand. J Plast Reconstr Surg 1981; 15: 53-56