From the Research
Flexor retinaculum cysts of the hands, commonly known as ganglion cysts, may resolve on their own without treatment in some cases, but many persist and require intervention, with the most recent and highest quality study suggesting that surgical excision offers the lowest recurrence rate of 5-10% 1.
Overview of Flexor Retinaculum Cysts
Flexor retinaculum cysts, or ganglion cysts, are fluid-filled sacs that form on the flexor tendon sheaths in the hands, often causing pain, discomfort, or functional limitations. The exact cause of these cysts is not fully understood, but they are thought to form when joint fluid leaks from the joint capsule or tendon sheath, creating a fluid-filled sac connected to the joint or tendon by a stalk.
Treatment Options
For persistent cysts causing symptoms, treatment options include:
- Aspiration with a needle, which has a high recurrence rate of 50-70%
- Steroid injection following aspiration, which may reduce recurrence
- Surgical excision, which offers the lowest recurrence rate of 5-10% 1 The traditional "bible therapy" (striking the cyst with a heavy object) is not recommended due to the risk of injury.
Management and Prognosis
While waiting for potential spontaneous resolution, patients can use over-the-counter pain relievers like ibuprofen (400-600mg three times daily) or acetaminophen (500-1000mg every 6 hours) for discomfort, and avoid activities that worsen symptoms. A study published in 2022 found that intra-flexor retinaculum corticosteroid injection can provide better functional recovery and symptom reduction for elderly patients with carpal tunnel syndrome, compared to within-carpal tunnel corticosteroid injection 2. However, this study is not directly related to the treatment of flexor retinaculum cysts, and the most recent and highest quality study on this topic is the 2018 study on the results of surgical treatment of volar retinacular ganglions 1.
Key Points
- Spontaneous resolution of flexor retinaculum cysts occurs in approximately 30-50% of cases over time, typically within 1-2 years
- Surgical excision offers the lowest recurrence rate of 5-10% 1
- Patients can use over-the-counter pain relievers and avoid activities that worsen symptoms while waiting for potential spontaneous resolution
- The most recent and highest quality study on this topic is the 2018 study on the results of surgical treatment of volar retinacular ganglions 1