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Traitement arthroscopique du kyste dorsal

du carpe :
une pathologie benigne et une technique simple
pour commencer en arthroscopie de poignet!

Jrme Garret, MD
j.garret@cliniqueduparclyon.com

60% benign tumors of the hand


70% dorsal
20% volar
10% other (STT)

firm, smooth, rubbery, rounded, slightly flutuant,


and at times tender, transilluminate.

Evolution capricious
Spontaneous healing
Volar cyst 70%
Dorsal cyst 40%
Unsightly
pain

Dorsal joint impigment

Nerve compression ?

Physiopathologie enigmatique

1- Pas de processus inflammatoire


2- Pas de hernie synoviale
3- Parfois communication intra articulaire
4 Dgnrescence mucode de la capsule

Quoi de neuf dans le complexe


scapho luniare dorsal? DCSS
Dorsal capsulo scapho lunate septum
= ligament intra articulaire & extra synovial

Google: Ligament intra articulaire & extra synovial


& degenerescence mucoide

IL & TNF alpha of the synovial liquid trap the hyaluronic acid of
the matrix and deregule the extra cellular matrix.
Mesenchymal cells of the ligament secrete a abnormal quantity
of proteoglycan agregat = micro cysts of hyaluronic acid.

Origine du kyste = DCSS

Ganglion cyst s origin

3D MRI DPFS SAGITTAL MPR

Kyste occult en squences


classiques DP fat sat et T1

On ne voit presque rien


Trs discrte infiltration du DIC sur le coronal DP FS

Squences 3D DPFS

Reconstructions MPR car acquisition 3D


Sur sag et axial on voit une petite formation ovalaire
en hypersignal correspondant la dgnrescence
dans le DCSS (flche)

Squences 3D T1FS avec gadolinium

Reconstructions MPR car acquisition 3D


Le kyste reste en hyposignal car T1
Trs nette prise de contraste priphrique dans
le DCSS signant la souffrance ractionnelle
lenvahissement protinique

Conservative treatment

Ponction & infiltration & immobilization 3 weeks


Failure in 50 to 70%

Exotic treatment

CYSTECTOMY

CAPSULECTOMY

Courtesy Christophe Mathoulin

Resection of dorsal wrist ganglion arthroscopically


MID CARPAL Arthroscopy
1- MCU

Resection of dorsal wrist ganglion arthroscopically


MID CARPAL Arthroscopy
1- MCU
2- trans ganglion approach

Serie 36 dorsal cysts


- FU 60 months (84 36)
- 24 Females 12 males
- 32 years old.
- one syndrom complex regional pain
2 reccurences 5 %
8 invisibles nodules 27%
80 % pre operative pain (4/10)
30 % post operative pain (2/10)

50% very satisfied 20% satisfied


27% mid satisfied - 3% non satisfied

Surgical treatment
arthroscopic or open?

KANG L, WEISS A-PC, AKELMAN E. 2004. Arthroscopic versus open


dorsal ganglion cyst excision: a prospective comparison of rates of
recurrence. ASSH Meeting, New York, P84.

Reccurence 10 15 %

No Scare no stiffness

Ganglion cyst resection = 21% Of wrist arthroscopy (EWAS)

Simple
Good to start wrist @