The treatment of dorsal wrist ganglia by radical excision

The dorsal wrist ganglion is the commonest benign soft-tissue tumour of the hand. Its treatment has been the subject of discussion for centuries, many methods being accompanied by an unacceptably high recurrence rate. Surgical extirpation gives the most reliable results and success has been said to depend on the identification of an unvarying deep attachment of the ganglion to the scapholunate ligament. A previous study has suggested that if this is excised, there will be no recurrences and no residual symptoms. Our experience of 62 dorsal ganglia confirms that although a scapholunate origin is usual, ganglia may also arise from a variety of additional sites over the dorsal wrist capsule, particularly in the region of the capitate. Two ganglia have recurred and clinical review of 52 (84%) of the cases has shown that persistent discomfort following excision is not uncommon. One patient appears to have developed scapholunate instability.