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Methylene Blue-enhanced Arthroscopic Resection of Dorsal Wrist Ganglions

Lee, Byung Joo MD; Sawyer, Gregory A. MD; DaSilva, Manuel F. MD

Techniques in Hand & Upper Extremity Surgery: December 2011 - Volume 15 - Issue 4 - p 243–246
doi: 10.1097/BTH.0b013e3182206c49

The ganglion is the most common soft tissue mass of the hand and wrist. Over the past 10 to 15 years, there has been a growing interest in arthroscopic treatment of dorsal wrist ganglions. Proposed advantages of arthroscopy include greater motion (particularly wrist flexion), improved cosmesis, and potential to identify/treat other intra-articular pathology. Despite the documented clinical success of arthroscopic ganglion excision, limitations include inconsistent identification of the ganglion stalk. Our described technique offers a means by which to improve visualization of the ganglion stalk intra-articularly to produce a more effective and efficient arthroscopic ganglion excision. During the procedure, a small volume of methylene blue solution is injected into the cyst. Its communication with the joint is apparent arthroscopically, thus identifying the location of the stalk. With the ability to precisely identify the ganglion stalk using an injection of methylene blue, the surgeon can direct the arthroscopic debridement toward the appropriate pathologic tissue. Unnecessary debridement of uninvolved tissue can be avoided with the technique. This also allows for optimal portal placement and, in particular, indicates whether a midcarpal portal should be employed. This should result in fewer recurrences, decreased operative time, and less iatrogenic injury.

Department of Orthopedics, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI

Conflicts of Interest: The authors report no conflicts of interest.

Address correspondence and reprint requests to Byung Joo Lee, MD, 593 Eddy St, Providence, RI 02903. e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.