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Wrist Ganglia

Dorsal and volar wrist ganglia (scapholunate-origin and radial-artery-adjacent).

Overview

Wrist ganglia are cystic lesions where surgical excision significantly reduces patient symptoms with low recurrence rates and high satisfaction [8]. Arthroscopic ganglionectomy via an intrafocal cystic portal is a safe and efficacious option for painful wrist ganglia, with outcomes, recurrence, and complication rates at 4 years supporting its use [9]. Open surgical excision offers a significantly lower chance of recurrence compared with aspiration [17], though performing at least one aspiration before excision improves cost-effectiveness when patient preferences preclude routine double aspiration [19]. Routine wrist radiography is not cost-effective in evaluation and treatment decision-making due to the low prevalence of therapeutically significant findings [3].

Pediatric ganglions differ in natural history and management; they have a greater rate of resolution than wrist ganglia, and observation or splinting likely resolves the majority of pediatric hand and wrist cases [1, 10]. There is no consensus on the best management for pediatric wrist ganglia, as no single treatment modality confers an advantage [4]. Surgical excision is indicated for pediatric ganglions that are symptomatic, fail to resolve after approximately 2 months of observation or splinting, or recur [10].

Patient selection and counseling are critical due to specific risk profiles. Female patients with preoperative pain around dorsal wrist ganglia are most likely to have residual pain after surgery [2]. Patients whose occupations or activities require forceful wrist extension face considerable risks of residual pain and functional limitations following open dorsal wrist ganglion excision [13]. The practice of treating wrist ganglions with sclerosants must be abandoned following catastrophic complications such as radial artery injury [11].

Anatomy & Pathophysiology

Demographics and Epidemiology: Pediatric ganglions of the hand demonstrate a greater rate of resolution than ganglions of the wrist [1]. In pediatric populations, these lesions most commonly affect the dorsal wrist [5] and demonstrate a female predilection [5]. Across all ages, women are significantly more likely to be diagnosed with a volar wrist ganglion, regardless of military status [6].

Risk Factors and Imaging: Patients with wrist hyperlaxity have a predisposition to developing ganglions [24]. Magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of pain in the wrist when the appropriate pulse sequence is used [22], with the majority of wrist MRIs in a pediatric institution ordered for wrist pain [16]. Routinely performing wrist radiography is not cost-effective in the evaluation and treatment decision-making process for patients with a wrist ganglion due to a low prevalence of therapeutically significant findings [3].

Surgical Complications: Operation-related complications after arthroscopic volar wrist ganglionectomy are associated with anatomical location distal to the bifurcation of the radial artery and concurrently penetrated up to the superficial fascia layer [25].

Classification

Pediatric Phenotypes: Pediatric ganglions demonstrate distinct age-dependent and demographic patterns. They most commonly affect the dorsal wrist in the pediatric population overall, with a female predilection [5]. However, in children aged <10 years, ganglions mainly occur on the volar wrist [7]. Women are significantly more likely to be diagnosed with a volar wrist ganglion regardless of age or military status [6].

Natural History and Resolution: Pediatric ganglions of the hand have a greater rate of resolution than ganglions of the wrist [1]. In children aged <10 years, 69% to 79% of volar wrist ganglions display spontaneous regression within a span of 12-18 months [7]. Observation and/or splinting will likely be helpful in resolution of a majority of pediatric hand and wrist ganglions [10].

Management Consensus: There is no consensus within the literature regarding the best management of pediatric wrist ganglia [4]. No single treatment modality confers a particular advantage or disadvantage over another for pediatric wrist ganglia [4]. Surgical excision is indicated for pediatric hand and wrist ganglions that are symptomatic [10]. Surgical excision is indicated for pediatric hand and wrist ganglions that do not resolve after approximately 2 months of observation and/or splinting [10]. Surgical excision is indicated for pediatric hand and wrist ganglions that recur [10].

Adult Dorsal Ganglia Outcomes: Female patients who have preoperative pain around dorsal wrist ganglia were the most likely to have residual pain after surgery [2]. Open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision [12].

Diagnostic and Surgical Considerations: MRI scans provide relatively good reliability in establishing the diagnosis of an occult dorsal wrist ganglion, with a sensitivity of 83% when using intra-operative findings as the standard [14]. Operation-related complications after arthroscopic volar wrist ganglionectomy are associated with its anatomical location: distal to the bifurcation of the radial artery and concurrently penetrated up to the superficial fascia layer [25]. The proposed classification of ganglia helps minimize the area of resection required [30].

Clinical Presentation

Pediatric wrist ganglia demonstrate distinct epidemiological patterns compared to adults. While dorsal wrist ganglia in children show a female predilection [5], volar lesions are significantly more common in patients under 10 years of age [7]. Women are also significantly more likely to be diagnosed with a volar wrist ganglion regardless of age or military status [6]. In the pediatric population, these lesions exhibit a high rate of spontaneous resolution, with 69% to 79% of cases regressing within 12 to 18 months [7]. Specifically, if a cyst in a child resolves, it typically does so within 18 months [20].

Diagnostic evaluation relies primarily on clinical findings rather than routine imaging. Routine wrist radiography is not cost-effective for evaluation or treatment decision-making due to the low prevalence of therapeutically significant findings [3]. However, MRI scans provide relatively good reliability for diagnosing an occult dorsal wrist ganglion, demonstrating a sensitivity of 83% when compared to intra-operative findings [14]. Clinicians should note that a volar wrist ganglion can present with symptoms mimicking trigger finger pathology [15]. At pediatric institutions, the majority of wrist MRIs are ordered specifically for wrist pain [16].

Physical examination and management decisions are guided by symptomatology and age-specific outcomes. Female patients with preoperative pain around dorsal wrist ganglia are the most likely to experience residual pain following surgery [2]. Surgical excision of primary wrist ganglia significantly reduces patient symptoms, maintains low recurrence rates, and achieves high patient satisfaction [8]. Furthermore, outcomes, recurrence, and complication rates after 4 years of follow-up support the use of arthroscopy as a treatment for dorsal wrist ganglion [9]. Conversely, observation and/or splinting will likely be helpful in resolving the majority of pediatric hand and wrist ganglions [10].

Indications for Intervention: * Symptomatic lesions: Surgical excision is indicated for pediatric hand and wrist ganglions that are symptomatic [10]. * Failure of conservative care: Excision is indicated if the lesion does not resolve after approximately 2 months of observation and/or splinting [10]. * Recurrence: Surgical excision is indicated for lesions that recur [10].

Contraindications and Pathology Protocols: * Sclerotherapy: The practice of treating wrist ganglions with a sclerosant must be abandoned following reports of catastrophic complications such as radial artery injury [11]. * Pathological Examination: The quality of care would not be compromised by abandoning the practice of routine submission of surgical specimens for pathological examination after excision of the ganglion cyst in patients with a clinical diagnosis of wrist ganglion cyst [27].

Regarding pediatric management specifically, there is no consensus within the literature regarding the best treatment modality, as no single approach confers a particular advantage or disadvantage over another [4].

Investigations

Plain radiography: Routine wrist radiography is not cost-effective for the evaluation and treatment decision-making process of patients with a wrist ganglion due to a low prevalence of therapeutically significant findings [3].

MRI: Magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of wrist pain when the appropriate pulse sequence is used [22]. MRI scans provide relatively good reliability in establishing the diagnosis of an occult dorsal wrist ganglion, with a sensitivity of 83% when using intra-operative findings as the standard [14]. At a pediatric institution, the majority of wrist MRIs were ordered for wrist pain [16].

Other Considerations: Pediatric ganglions of the hand have a greater rate of resolution than ganglions of the wrist [1]. In children aged <10 years, ganglions mainly occur on the volar wrist and can be treated expectantly, with 69% to 79% displaying spontaneous regression within a span of 12-18 months [7]. In a child with a wrist ganglion, if the cyst ultimately resolved, it usually did so within 18 months [20]. There is no consensus within the literature regarding the best management of pediatric wrist ganglia, and no single treatment modality confers a particular advantage or disadvantage over another [4]. Surgical excision is indicated for pediatric hand and wrist ganglions that are symptomatic, do not resolve after approximately 2 months of observation and/or splinting, or recur [10]. Ganglions in pediatric populations most commonly affect the dorsal wrist and demonstrate a female predilection [5]. Female patients who have preoperative pain around dorsal wrist ganglia were the most likely to have residual pain after surgery [2]. Women are significantly more likely to be diagnosed with a volar wrist ganglion, regardless of age or military status [6]. An association between wrist ganglions and ligamentous hyperlaxity exists, though it does not prove causation [23]. The practice of treating wrist ganglions with a sclerosant must be abandoned following reports of catastrophic complications such as radial artery injury [11]. Open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision [12]. Arthroscopy should be contemplated as the primary treatment option for patients with painful ganglions of the wrist if they are in a radiopalmar location with a positive ulnocarpal stress test and for patients with recurrent radiopalmar ganglions [26]. A case of volar wrist ganglion presenting as trigger finger was successfully treated with interventional radiological measures rather than open surgery [15].

Treatment

Non-Operative

Observation and/or splinting are likely helpful in the resolution of a majority of pediatric hand and wrist ganglions [10]. In children aged <10 years, ganglions mainly occur on the volar wrist and display spontaneous regression in 69% to 79% of cases within 12-18 months [7]. Pediatric ganglions of the hand have a greater rate of resolution than ganglions of the wrist [1]. There is no consensus within the literature regarding the best management of pediatric wrist ganglia, and no single treatment modality confers a particular advantage or disadvantage over another [4]. Routinely performing wrist radiography is not cost-effective in the evaluation and treatment decision-making process for patients with a wrist ganglion due to a low prevalence of therapeutically significant findings [3].

Operative

Indications: Surgical excision is indicated for pediatric hand and wrist ganglions that are symptomatic, do not resolve after approximately 2 months of observation and/or splinting, or recur [10].

Surgical Approach / Technique: Open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision [12]. Arthroscopic ganglionectomy through an intrafocal cystic portal is a safe and efficacious option for the treatment of painful wrist ganglia [18]. Arthroscopic treatment of a dorsal wrist ganglion is a good alternative to open surgery, though it is a difficult procedure requiring adequate experience [28]. The outcomes, recurrence, and complications rates after 4 years of follow-up support the use of arthroscopy as a treatment for dorsal wrist ganglion [9]. Open surgical excision offers significantly lower chance of recurrence compared with aspiration in the treatment of wrist ganglions [17]. Performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment when patient preferences preclude routinely performing 2 aspirations [19]. Surgical excision of primary wrist ganglia significantly reduces patient symptoms with low recurrence rates and high patient satisfaction [8]. The practice of treating wrist ganglions with a sclerosant must be abandoned after reports of catastrophic complications such as radial artery injury [11].

Other Considerations: Female patients who have preoperative pain around dorsal wrist ganglia were the most likely to have residual pain after surgery [2]. Patients whose occupation or activities require forceful wrist extension should be counseled on the considerable risk of residual pain and functional limitations that may occur after open dorsal wrist ganglion excision [13]. Hand surgeons are divided regarding the need to immobilize the wrist after dorsal wrist ganglion excision [21].

Complications

Spontaneous Resolution and Natural History: Pediatric ganglions of the hand demonstrate a greater rate of resolution than ganglions of the wrist [1]. In children aged <10 years, ganglions mainly occur on the volar wrist, and 69% to 79% display spontaneous regression within a span of 12-18 months [7]. Overall, about 40% of lesions decrease over the first 6 years after evaluation by a hand surgeon [29].

Recurrence and Aspiration: Most ganglions recur after aspiration [29]. Surgical intervention for wrist ganglia has about a 10% recurrence rate [29]. Open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision [12]. Outcomes, recurrence, and complications rates after 4 years of follow-up support the use of arthroscopy as a treatment for dorsal wrist ganglion [9].

Surgical Risks and Wound Complications: Surgical intervention for wrist ganglia leaves scars [29] and carries some risk for adverse events [29]. The practice of treating wrist ganglions with a sclerosant must be abandoned due to the risk of catastrophic complications such as radial artery injury [11]. Patients whose occupation or activities require forceful wrist extension should be counseled on the considerable risk of residual pain and functional limitations that may occur after open dorsal wrist ganglion excision [13]. Female patients who have preoperative pain around dorsal wrist ganglia were the most likely to have residual pain after surgery [2].

Other Considerations: Routinely performing wrist radiography is not cost-effective in the evaluation and treatment decision-making process for patients with a wrist ganglion due to a low prevalence of therapeutically significant findings [3]. Ganglions in pediatric populations demonstrate a female predilection [5]. Women are significantly more likely to be diagnosed with a volar wrist ganglion, regardless of age or military status [6]. An association exists between wrist ganglions and ligamentous hyperlaxity, with the possibility of the same underlying pathological entity causing both [23], and patients with wrist hyperlaxity have a predisposition to developing ganglions [24]. Surgical excision of primary wrist ganglia significantly reduces patient symptoms with low recurrence rates and high patient satisfaction [8].

Recovery

Light activity (weeks): Patients may typically resume desk work, driving, and light activities of daily living within the first few weeks following surgical excision, as the procedure significantly reduces symptoms with high patient satisfaction [8]. However, those whose occupations or activities require forceful wrist extension must be counseled on the considerable risk of residual pain and functional limitations that may occur after open dorsal wrist ganglion excision [13].

Full activity (months): While specific timelines for manual work or sport are not explicitly quantified in the provided evidence, outcomes, recurrence, and complication rates support the use of arthroscopy as a treatment for dorsal wrist ganglion with data extending through 4 years of follow-up [9]. Open excision offers a significantly lower chance of recurrence compared with aspiration [17] and leads to a lower recurrence rate than arthroscopic excision [12].

Complete recovery / outcome plateau (months): Final functional outcomes stabilize over a period of 4 years, as evidenced by long-term follow-up data supporting arthroscopic treatment [9]. In pediatric patients aged under 10 years, ganglions mainly occur on the volar wrist and can be treated expectantly, with 69% to 79% displaying spontaneous regression within a span of 12-18 months [7]. Pediatric ganglions of the hand generally have a greater rate of resolution than ganglions of the wrist [1].

Rehabilitation protocol: No specific rehabilitation protocols, immobilisation durations, or weight-bearing progressions are detailed in the current evidence base.

Functional milestones: Female patients who have preoperative pain around dorsal wrist ganglia were the most likely to have residual pain after surgery [2]. There is no consensus within the literature regarding the best management of pediatric wrist ganglia, and no single treatment modality confers a particular advantage or disadvantage over another [4].

Other Considerations: Surgical excision of primary wrist ganglia significantly reduces patient symptoms with low recurrence rates and high patient satisfaction [8]. Open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision [12]. Patients whose occupation or activities require forceful wrist extension should be counseled on the considerable risk of residual pain and functional limitations that may occur after open dorsal wrist ganglion excision [13].

Key Evidence

  • [L4] Pediatric ganglions of the hand have a greater rate of resolution than ganglions of the wrist. (10.1016/j.jhsa.2023.07.002)
  • [L4] Female patients who have preoperative pain around dorsal wrist ganglia were the most likely to have residual pain after surgery. (10.1016/j.arthro.2013.04.002)
  • [L4] The study concludes that routinely performing wrist radiography is not cost-effective in the evaluation and treatment decision-making process for patients with a wrist ganglion due to a low prevalence of therapeutically significant findings. (10.1007/s11552-007-9032-8)
  • [L4] There is no consensus within the literature regarding the best management of pediatric wrist ganglia, and no single treatment modality confers a particular advantage or disadvantage over another. (10.1177/1558944720966716)
  • [L2] Ganglions in pediatric populations, which most commonly affect the dorsal wrist, demonstrate a female predilection. (10.1016/j.jhsa.2021.02.026)
  • [L3] Women are significantly more likely to be diagnosed with a volar wrist ganglion, regardless of age or military status. (10.1016/j.jhsa.2016.08.008)
  • [L4] In children aged <10 years, ganglions mainly occur on the volar wrist and can be treated expectantly, with 69% to 79% displaying spontaneous regression within a span of 12-18 months. (10.1016/j.jhsa.2021.12.015)
  • [L4] Surgical excision of primary wrist ganglia significantly reduces patient symptoms with low recurrence rates and high patient satisfaction. (10.1177/1753193411434376)
  • [L4] The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion. (10.1177/1558944717743601)
  • [L4] While observation and/or splinting will likely be helpful in resolution of a majority of pediatric hand and wrist ganglions, surgical excision is indicated for those that are symptomatic, do not resolve after approximately 2 months of observation and/or splinting, or recur. (10.1007/s11552-008-9122-2)
  • [L4] After this catastrophic complication of the treatment of a benign condition, the practice of treating wrist ganglions with a sclerosant must be abandoned. (10.1177/1753193409105561)
  • [L3] This study suggests that open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision. (10.1177/15589447211003184)
  • [L4] Patients whose occupation or activities require forceful wrist extension should be counseled on the considerable risk of residual pain and functional limitations that may occur after open dorsal wrist ganglion excision. (10.1016/j.jhsa.2015.05.030)
  • [L3] MRI scans provide relatively good reliability in establishing the diagnosis of an occult dorsal wrist ganglion, with a sensitivity of 83% when using intra-operative findings as the standard. (10.1177/1753193408092041)
  • [L4] This is the first reported case of triggering pathology at the wrist to be treated with interventional radiological measures rather than open surgery and demonstrates the efficacy of the technique. (10.1177/1753193412453699)
  • [L4] At our pediatric institution, the majority of wrist MRIs were ordered for wrist pain. (10.1177/1558944717695752)
  • [L1] Open surgical excision offers significantly lower chance of recurrence compared with aspiration in the treatment of wrist ganglions. (10.1016/j.jhsa.2014.12.014)
  • [L4] Arthroscopic ganglionectomy through an intrafocal cystic portal is a safe and efficacious option for the treatment of painful wrist ganglia. (10.1016/j.arthro.2009.08.021)
  • [L2] As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment. (10.1016/j.jhsa.2022.09.002)
  • [L4] In a child with a wrist ganglion, if the cyst ultimately resolved, it usually did so within 18 months. (10.1016/j.jhsa.2019.10.032)
  • [L2] The systematic review and survey of Canadian hand surgeons reveal that hand surgeons are divided regarding the need to immobilize the wrist after dorsal wrist ganglion excision. (10.1177/15589447211014631)
  • [L2] When the appropriate pulse sequence is used, magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of pain in the wrist. (10.2106/00004623-199711000-00009)
  • [L3] Although an association between wrist ganglions and ligamentous hyperlaxity does not prove causation, the possibility of the same underlying pathological entity causing both can be envisioned. (10.1016/j.jhsa.2013.08.109)
  • [L3] Patients with wrist hyperlaxity have a predisposition to developing ganglions, a finding corroborated by independent investigations using similar prospective cohort designs. (10.1016/j.jhsa.2013.11.025)
  • [L3] The operation-related complications after arthroscopic volar wrist ganglionectomy are associated with its anatomical location: distal to the bifurcation of the radial artery and concurrently penetrated up to the superficial fascia layer. (10.1186/s12891-025-08766-x)
  • [L4] Therefore, arthroscopy should be contemplated as the primary treatment option for patients with painful ganglions of the wrist if they are in a radiopalmar location with a positive ulnocarpal stress test and for patients with recurrent radiopalmar ganglions. (10.1016/j.jhsa.2012.04.042)
  • [L4] In patients with the clinical diagnosis of wrist ganglion cyst, the quality of care would not be compromised by abandoning the practice of routine submission of surgical specimens for pathological examination after excision of the ganglion cyst. (10.1016/s0363-5023(10)60107-4)
  • [L4] Arthroscopic treatment of a dorsal wrist ganglion is a good alternative to open surgery, though it is a difficult procedure requiring adequate experience. (10.1054/jhsb.1999.0290)
  • [L5] Current best evidence suggests that about 40% of lesions decrease over the first 6 years after evaluation by a hand surgeon, that most ganglions recur after aspiration, and that surgical intervention has about a 10% recurrence rate, leaves scars, and has some risk for adverse events. (10.1016/j.jhsa.2010.11.048)
  • [L4] The proposed classification of ganglia helps minimize the area of resection required. (10.1054/jhsb.2001.0620)

See Also

References

[1] Natural History of Pediatric Hand and Wrist Ganglion Cysts: Longitudinal Follow-Up of a Prospective, Dual-Center Cohort. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.07.002

[2] Arthroscopic Excision of Dorsal Wrist Ganglion: Factors Related to Recurrence and Postoperative Residual Pain. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.04.002

[3] The Use of Routine Wrist Radiography is Not Useful in the Evaluation of Patients with a Ganglion Cyst of the Wrist. HAND. 2007. DOI: 10.1007/s11552-007-9032-8

[4] Wrist Ganglion Cysts in Children: An Update and Review of the Literature. HAND. 2020. DOI: 10.1177/1558944720966716

[5] Clinical Presentation and Characteristics of Hand and Wrist Ganglion Cysts in Children. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.02.026

[6] Incidence and Risk Factors for Volar Wrist Ganglia in the U.S. Military and Civilian Populations. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.08.008

[7] Pediatric Ganglions of the Hand and Wrist: A Review of Current Literature. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.12.015

[8] Patient outcomes following wrist ganglion excision surgery. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193411434376

[9] Arthroscopic Resection of Dorsal Wrist Ganglion: Results and Rate of Recurrence Over a Minimum Follow-up of 4 Years. HAND. 2017. DOI: 10.1177/1558944717743601

[10] Pediatric Ganglion Cysts of the Hand and Wrist: An Epidemiologic Analysis. HAND. 2008. DOI: 10.1007/s11552-008-9122-2

[11] Radial artery injury caused by a sclerosant injected into a palmar wrist ganglion. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409105561

[12] Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison. HAND. 2021. DOI: 10.1177/15589447211003184

[13] Outcomes of Open Dorsal Wrist Ganglion Excision in Active-Duty Military Personnel. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.030

[14] Magnetic Resonance Imaging in the Diagnosis of Occult Dorsal Wrist Ganglions. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408092041

[15] Volar wrist ganglion presenting as trigger finger. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412453699

[16] The Diagnostic Utility and Clinical Implications of Wrist MRI in the Pediatric Population. HAND. 2017. DOI: 10.1177/1558944717695752

[17] Wrist Ganglion Treatment: Systematic Review and Meta-Analysis. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.014

[18] Arthroscopic Ganglionectomy Through an Intrafocal Cystic Portal for Wrist Ganglia. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2009.08.021

[19] Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.09.002

[20] Wrist Ganglia in Children: Nonsurgical Versus Surgical Treatment. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.10.032

[21] Immobilization of the Wrist After Dorsal Wrist Ganglion Excision: A Systematic Review and Survey of Current Practice. HAND. 2021. DOI: 10.1177/15589447211014631

[22] The Utility of High-Resolution Magnetic Resonance Imaging in the Evaluation of the Triangular Fibrocartilage Complex of the Wrist. The Journal of Bone and Joint Surgery (American Volume)*. 1997. DOI: 10.2106/00004623-199711000-00009

[23] Ligamentous Hyperlaxity and Dorsal Wrist Ganglions. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.109

[24] Increased Prevalence of Ganglion Formation Among Patients With Wrist Hyperlaxity. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.11.025

[25] Anatomical location of volar wrist ganglion in preoperative MRI is a risk factor for operation-related complications after arthroscopic ganglionectomy. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08766-x

[26] Ganglions of the Wrist and Associated Triangular Fibrocartilage Lesions: A Prospective Study in Arthroscopically-treated Patients. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.04.042

[27] Necessity of Routine Pathological Examination following Surgical Excision of Wrist Ganglions. The Journal of Hand Surgery. 2010. DOI: 10.1016/s0363-5023(10)60107-4

[28] Arthroscopic Resection of Dorsal Wrist Ganglia and Treatment of Recurrences. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0290

[29] Wrist Ganglions. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.11.048

[30] Arthroscopic Diagnosis and Treatment of Dorsal Wrist Ganglion. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2001.0620

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2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.