DOES GANGLIONECTOMY DESTABILIZE THE WRIST OVER THE LONG-TERM

Previous publications have described persistent postganglionectomy sym ptomatology. One report demonstrated scapholunate instability in a sma ll number of patients, We specifically examined our ganglionectomy pat ients for wrist instability. Ninety-one consecutive cases of wrist gan glionectomy performed from 1987 through 1993 by the senior author (FMW ) were studied. Most patients were contacted by telephone and question ed with a standardized interview format. Postoperative course, job cha nges and occupational restrictions, and patient satisfaction were quer ied, Range of motion, grip strength, scaphoid mobility, and radiograph s were studied to characterize scapholunate static and dynamic relatio nships. Seventy-one percent (N = 61) of the operated patients were int erviewed at an average postoperative interval of 44 months. Twenty-fiv e percent (N = 21) had wrist symptoms. There was no late ganglion recu rrence. 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 demonstrate d no scapholunate dissociation or dynamic instability patterns, Wrist ganglionectomy does not destabilize the wrist, particularly the scapho lunate joint. Thorough and meticulous extirpation of the ganglion is w arranted. Additional minor problems, both as consequences of the opera tion and as unrelated concomitants, do occur and deserve attention. Ha nd surgeons assume cure of the problematic wrist because of the patien t's failure to report tolerable problematic sequelae. A late revisit m ay reveal (1) treatable problems emanating from the dynamic forces con tributing to original ganglion formation; (2) additional, unanticipate d, treatable conditions resulting and not resulting from the ganglione ctomy itself; and (3) ganglion recurrence.