Gangliones volares de muñeca – señal externa de patología intraarticular

Resumen

Introducción La etiología y el manejo de los gangliones sigue en controversia pese a su elevada frecuencia. Concretamente el tratamiento del ganglión volar de muñeca se ha asociado a un mayor índice de recidiva y complicaciones comparado con el ganglión dorsal. En los últimos años, se ha desarrollado el tratamiento artroscópico con el fin de realizar un tratamiento menos invasivo y poder identificar una relación causal. El objetivo del estudio es determinar la presencia de lesiones intraarticulares asociadas al ganglión volar y si el tratamiento de ambas patologías puede ser una opción válida.

Material y Método Estudio longitudinal en el que se intervinieron de forma consecutiva 21 pacientes de ganglión volar de muñeca por vía artroscópica. Se recogieron los datos sociodemográficos, exploración física, pruebas complementarias, región predominante de dolor (EVA) y cuestionario DASH pre y postoperatorio. Se asoció el tratamiento de las lesiones intraarticulares en el mismo acto quirúrgico si existía correlación clínica con la exploración física inicial.

Resultados Todos los casos fueron intervenidos por vía artroscópica sin complicaciones intraoperatorias. Se observaron hallazgos artroscópicos en todos los casos siendo la mayoría lesiones del Fibrocartilago Triangular del Carpo (57,12%). Se obtuvo una mejoría en los parámetros de dolor y DASH postoperatorios siendo este último significativo en los casos de dolor cubital y dorsal asociado al ganglión (p < 0.02). Hubo 2 casos de recidiva 9,52% que requirieron reintervención.

Conclusiones Existe un gran número y variabilidad de lesiones intraarticulares asociadas al ganglión volar de muñeca. El tratamiento artroscópico es una herramienta versátil y útil ya que permite un tratamiento combinado. Se ha observado una mejora en los resultados postoperatorios con un escaso índice de complicaciones.

Abstract

Introduction The etiology and management of wrist ganglions remains controversial despite its high frequency. Specifically, the treatment of volar wrist ganglion has been associated with a higher rate of recurrence and complications compared with the dorsal ganglion. In the last years, arthroscopic treatment has been developed to perform a less invasive treatment and identify a causal relationship. The objective of the study was to evaluate the type of intraarticular lesions associated with the volar ganglion and if the treatment of both pathologies could improve the published clinical results.

Material and Methods Longitudinal study in which 21 patients were operated consecutively of volar ganglion by wrist arthroscopy. Sociodemographic data, physical examination, complementary tests, pain (VAS) and DASH questionnaire before and after surgery were collected. The treatment of intra-articular lesions was performed in the same surgical procedure if there was a clinical correlation between the initial physical examination and the arthroscopic finding.

Results All the cases were operated without intraoperative complications. Intra-articular lesions were observed in all cases. The triangular fibrocartilage complex was the structure with more lesions found (57.12%). An improvement in postoperative pain scale and postoperative DASH score was observed. A statistically significant improvement of the DASH score was observed in the arthroscopic treatment of the cases with ulnar and dorsal pain associated to the ganglion (p < 0.02). There were 2 cases of recurrence that required reoperation (9.52%).

Conclusions There is a large number and variability of intraarticular lesions associated with the volar ganglion. Arthroscopic treatment is a versatile and useful tool because it allows a combined treatment. An improvement in postoperative results has been observed with a low rate of complications.

Palabras clave

ganglion volar - artroscopia de muñeca - tratamiento - etiología

Keywords

volar ganglion - wrist arthroscopy - treatment - etiology

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