Treatment of Ganglion Cysts
Surgical excision is the preferred treatment for symptomatic ganglion cysts due to higher success rates and lower recurrence rates compared to aspiration and steroid injection. 1
Initial Management
- Observation is appropriate for asymptomatic ganglion cysts, as approximately 58% will resolve spontaneously over time 2
- For symptomatic cysts, treatment options include:
- Conservative management (observation)
- Aspiration with or without steroid injection
- Surgical excision 3
Treatment Algorithm
For Asymptomatic Cysts:
- Reassurance and observation are recommended 2
- Patient education about the benign nature of the lesion 3
For Symptomatic Cysts:
Option 1: Aspiration with/without Steroid Injection
- Success rate of approximately 64.3% 1
- Recurrence rate of 35.7% after aspiration and steroid injection 1
- Ultrasound guidance does not significantly reduce recurrence rates compared to blind aspiration (69% vs 74% recurrence) 4
- Consider for patients who:
- Decline surgery but want symptomatic relief
- Have medical contraindications to surgery 2
Option 2: Surgical Excision (Preferred Treatment)
- Success rate of 92.5% 1
- Recurrence rate of only 7.5% after surgical excision 1
- Open excision is the standard surgical approach 5
- Arthroscopic excision is an alternative with similar recurrence rates but potentially less effective for pain relief 5
Special Considerations
- For wrist ganglion cysts, 60-70% occur on the dorsal side and 20-30% on the volar side 5
- Dorsal ganglia most commonly originate from the scapholunate joint 5
- Patients whose activities require forceful wrist extension (athletes, military personnel) should be counseled about potential functional limitations and residual pain following surgical excision 5
- Complications of surgery may include:
- Scar formation
- Longer recovery period
- Potential injury to surrounding structures 2
Follow-up
- For patients who undergo aspiration or observation, follow-up is recommended to monitor for recurrence 3
- Patients with recurrent cysts after aspiration typically have worse functional outcomes compared to those without recurrence 4
- Surgical excision should be considered for recurrent cysts after failed aspiration 2
Remember that while surgical excision has the lowest recurrence rate, nonsurgical approaches may be appropriate for patients primarily concerned with symptomatic relief rather than definitive treatment 2.