Internal decompression of dorsal wrist ganglions

A technique is described for internal decompression of dorsal wrist ganglions without first rupturing the cyst, including documentation of the ganglion's relation to the scapholunate interosseous ligament. Critical evaluation of the stalk's true origin indicates that dorsal wrist ganglions originate primarily at the synovial-capsular interface between the dorsal scaphoid ridge and the overlying extensor carpi radialis brevis tendon. Although the ultimate etiology of dorsal wrist ganglions still remains unproven, arthroscopic techniques allow a thorough evaluation of the carpal intrinsic and extrinsic ligaments for any associated carpal instability. Despite differences between various arthroscopic methods, the clinical advantages over open techniques remain minimal scarring, avoidance of stiffness after surgery, and a comprehensive joint evaluation.