Does ganglionectomy destabilize the wrist over the long-term?

Previous publications have described persistent postganglionectomy symptomatology. One report demonstrated scapholunate instability in a small number of patients. We specifically examined our ganglionectomy patients for wrist instability. Ninety-one consecutive cases of wrist ganglionectomy performed from 1987 through 1993 by the senior author (FMW) were studied. Most patients were contacted by telephone and questioned with a standardized interview format. Postoperative course, job changes and occupational restrictions, and patient satisfaction were queried. Range of motion, grip strength, scaphoid mobility, and radiographs were studied to characterize scapholunate static and dynamic relationships. Seventy-one percent (N = 61) of the operated patients were interviewed at an average postoperative interval of 44 months. Twenty-five percent (N = 21) had wrist symptoms. There was no late ganglion recurrence. Twenty of the 21 symptomatic patients (95%) had normal ranges of motion and no carpal instability. Grip strengths averaged 12% below normal in 45% of the dominant operated hands. Radiographs demonstrated no scapholunate dissociation or dynamic instability patterns. Wrist ganglionectomy does not destabilize the wrist, particularly the scapholunate joint. Thorough and meticulous extirpation of the ganglion is warranted. Additional minor problems, both as consequences of the operation and as unrelated concomitants, do occur and deserve attention. Hand surgeons assume cure of the problematic wrist because of the patient's failure to report tolerable problematic sequelae. A late revisit may reveal (1) treatable problems emanating from the dynamic forces contributing to original ganglion formation; (2) additional, unanticipated, treatable conditions resulting and not resulting from the ganglionectomy itself; and (3) ganglion recurrence.