Aim: The authors analyze the anatomical, etiopathogenetic and clinical characteristics of ganglia of the hand and especially the radio-carpus, which represent the most frequent cause of wrist swelling in pediatric age. They underline the importance of an adequate period of clinical observation and splint treatment, as the first methodical choice, rather than aspiration or surgical immediate resection.
Methods: The experience of the authors is based on splinting and/or surgical treatment on a series of 15 patients with wrist ganglion, with a follow-up of 4 years. The period of clinical observation had never been less than 6 months and the static splint had been recommended during nocturnal hours only, on a 3-4 month basis at least.
Results: Two thirds of the cases showed spontaneous re-absorption of the ganglion, while in the remaining third part a surgical indication of removal had been suggested, due to absence of spontaneous remission and the presence of trouble or pain in movements. The authors never practice the aspiration of the content of the ganglion, since recent literature advises against it due to the high percentage of recurrence observed.
Conclusions: The clinical observation and the dedicated nocturnal splinting of the wrist ganglia in pediatric age represent the first treatment advocated. Surgery is suggested in cases unsolved with a conservative therapy. Aspiration is strongly discouraged.