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Arthroscopy for excision of a ganglion Ganglions on the back of the wrist can be treated by an open operation which leaves a scar over the back of the wrist or by arthroscopy leaving a much smaller mark. Only ganglions on the back of the wrist can be treated in this way this is because a ganglion on the back of the wrist generally goes down to a joint between two of the bones in the wrist called the scaphoid and the lunate. The ganglion itself has a root in the ligament which runs between the two bones which is called the scapholunate ligament. Ganglions on the back of the wrist can be associated with wrist pain and one advantage of sorting the ganglion out arthroscopically is that one can have a look inside the wrist and see what the internal architecture of the wrist joint is like. ANAESTHETIC General or regional anaesthetic. OPERATIVE PROCEDURE The wrist joint is entered through 3 tiny stab incisions on the back of the wrist. Two incisions go into the joint between the radius and the carpal bones and one incision goes into the joint between the two carpal rows. A 2mm telescope is passed into the wrist joint through one of the three wounds. The bones of the wrist are examined but concentrated on the ligament between the scaphoid and lunate which is where the ganglion comes from. One cannot actually see the ganglion from inside the wrist joint although its root comes from the back of the ligament on the back of the wrist. Generally a probe is passed through one of the other incisions and one can examine the ligament. Once the ligament has been identified one can determine whether there is any softening of the ligament at the back of the wrist using the wrist. The probe is then replaced with an arthroscopic shaver which is a sheathed blade that rotates with a motor. It has a suction device on it which enables the structures in the wrist to be shaved. The shaver is passed up the dorsal aspect of the wrist in direct vision to identify the most dorsal aspect of the scapholunate ligament which is where the ganglion root comes from. The soft bit of the dorsal ligament is shaved and the shaver is turned round and the dorsal aspect of the wrist joint itself can be shaved. Sometimes during this process the ganglion can be punctured and one can see fat droplets within the wrist joint. The shaver and telescope are then withdrawn and local anaesthetic is infiltrated into the joint and the wounds to reduce pain post operatively. The wounds are closed with steri strips (paper sutures). POST OPERATIVELY Dressings are placed over the back of the wrist and firm bulky bandage is wrapped round the wrist. The patient goes home in a high arm sling which they can remove at 48 hours along with the bulky bandage. The sticky dressing should be kept intact until the patient is reviewed at two weeks. COMPLICATIONS
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