Introduction
Wrist joint related injuries are pretty common, and wrist ganglion cysts make up a good portion of them. These cysts are fluid-filled sacs that develop on the back side of the hand causing pain and disruption of motion. When other treatments fail, surgical removal of the wrist ganglion cyst is often recommended. In this surgical report, we present a case of wrist ganglion cyst removal through wrist capsule incision and excision.
Patient History and Diagnosis
A 36-year-old male patient presented with a noticeable lump on the back of his hand. The patient had experienced dull aching pain in the wrist joint for over a year. The physical examination showed a ganglion cyst on the dorsal wrist. The cyst was about 2 cm in diameter, rounded, and firm, and the patient had decreased range of motion in the wrist joint. Magnetic resonance imaging (MRI) confirmed the cyst and tendon involvement. The patient’s medical history was unremarkable.
Procedure
After informed consent, the patient was administered general anesthesia. The surgical area was sterilized, and a tourniquet was placed on the patient’s upper arm. A longitudinal incision of approximately 3cm was made over the wrist joint. By careful dissection, the skin and soft tissues were separated, and the extensor retinaculum was visualized. The cyst had its origin from the capsule, in close proximity to the extensor retinaculum. The wrist capsule was then opened with a scalpel, and the cyst was removed using a sharp dissection. The cyst was found to attach to the scaphotrapezial ligament and was carefully dissected. The remaining capsule was then excised, and the wound was irrigated with saline.
Results
The operation was uneventful, and there was no significant bleeding. The excised tissue was sent to the pathology lab, which confirmed the diagnosis of a ganglion cyst. The wound was closed using 4-0 Vicryl sutures, and a sterile dressing was applied. The tourniquet was released before wound closure. The patient was transferred to the recovery room for monitoring.
Postoperative Care
The patient was put on a splint and was instructed to keep the wrist immobilized for two weeks. The patient was also advised to keep the surgical area elevated for the first three days to minimize swelling. The dressing was changed after three days, and the sutures were removed 10 days later. During that time, the patient was instructed on range-of-motion exercises and was advised to use ice packs for pain relief.
Follow-Up
The patient had an uneventful postoperative course resulting in full range of motion and no reoccurrence of the ganglion cyst. At six months follow-up, the patient continued to experience full range of motion, no pain, and no recurrence of the cyst. The patient was also satisfied with the cosmetic outcome of the procedure.
Conclusion
Wrist ganglion cysts can cause pain and discomfort in the wrist joint, and surgical removal is often necessary. Through this surgical report, we demonstrate that the procedure of wrist ganglion cyst removal through wrist capsule incision and excision is safe and effective. The surgical technique provides excellent cosmetic results and allows patients to resume normal daily activities with minimal downtime.
