Does orthopedics manage ganglion cysts of the elbow?

Management of Ganglion Cysts of the Elbow

Orthopedic surgeons are the appropriate specialists to manage ganglion cysts of the elbow, particularly when surgical intervention is required. 1, 2, 3

Diagnostic Approach for Elbow Ganglion Cysts

• Ganglion cysts can develop in tendon sheaths, joints, and ligaments throughout the upper extremity, including the elbow 4, 5
• Diagnosis primarily relies on history and physical examination, with imaging used for confirmation 6
• Ultrasound is recommended as the initial imaging modality to confirm the fluid-filled nature of ganglion cysts and distinguish them from solid masses 4, 7, 6
• MRI is typically reserved for suspected occult ganglion cysts or when there's concern about solid tumors 4, 7, 6

Clinical Presentation and Complications

• Elbow ganglion cysts may present with:
  • Visible or palpable swelling at the elbow 1, 2
  • Pain and dysesthesia at the lateral aspect of the elbow 2
  • Potential nerve compression symptoms, particularly of the superficial radial nerve 2, 8
  • Progressive and painful elbow contracture in some cases 3
• Type A ganglion cysts (located proximal to the arcade of Frohse) may compress the superficial radial nerve, causing pain and dysesthesia that can be misdiagnosed as lateral epicondylitis 2
• Type B ganglion cysts are located distal to the arcade of Frohse 2

Treatment Options

• Approximately 58% of ganglion cysts may resolve spontaneously over time 9
• Treatment approaches include:
  • Conservative management for asymptomatic cysts or patients who prefer non-surgical options 9
  • Surgical excision when:
    • Conservative treatment fails 1
    • The cyst causes nerve compression symptoms 2, 8
    • The cyst leads to progressive elbow contracture 3
    • The patient desires definitive treatment with lower recurrence risk 9

Surgical Approaches

• Orthopedic surgeons may perform:
  • Open surgical excision - traditional approach with lower recurrence rates but higher complication rates 9
  • Arthroscopic excision - a safe and viable alternative to open excision with successful outcomes documented by follow-up MRI 1
  • Combined procedures when indicated (e.g., cyst excision with anterior capsular release and ulnar nerve decompression for cases with elbow contracture) 3

Important Considerations

• Elbow ganglion cysts compressing the superficial radial nerve may be misdiagnosed as lateral epicondylitis, leading to delayed appropriate treatment 2
• Advanced imaging (MRI) is valuable in patients presenting with atraumatic, painful, and progressive elbow contracture to identify underlying ganglion cysts 3
• Surgical excision typically provides good outcomes with resolution of symptoms 1, 2, 3, 8
• Patients should be counseled about the benefits and risks of each approach:
  • Conservative: Lower complication rate but higher recurrence rate 9
  • Surgical: Lower recurrence rate but higher complication rate and longer recovery period 9