From the Research
For a ganglion cyst aspiration on the dorsum of the hand, a 20-gauge needle is the smallest acceptable size, as it allows for effective removal of the viscous cyst contents. The procedure begins with obtaining informed consent, explaining the 50-70% recurrence rate and potential complications including infection, nerve injury, and scarring, as reported in a systematic review and meta-analysis 1. The dorsum of the hand should be cleansed with antiseptic solution and draped in a sterile fashion. Local anesthesia with 1-2 mL of 1% lidocaine without epinephrine is administered into the skin and subcutaneous tissue overlying the cyst. After allowing time for the anesthetic to take effect, the cyst is stabilized between two fingers to prevent movement. The needle is inserted at a 45-degree angle into the center of the cyst, and the thick, clear, jelly-like fluid is aspirated. Complete evacuation of the cyst contents is attempted. Following aspiration, a corticosteroid injection (typically 20-40 mg of methylprednisolone or equivalent) may be administered into the cyst cavity to reduce recurrence rates, as supported by an ultrasound-guided evaluation study 2. A small adhesive bandage is applied, and the patient is advised to limit hand use for 24-48 hours.
Some key points to consider during the procedure include:
- Using a thick enough needle to effectively remove the cyst contents
- Administering local anesthesia to minimize pain and discomfort
- Stabilizing the cyst to prevent movement during aspiration
- Considering the use of corticosteroid injection to reduce recurrence rates
- Counseling patients on the potential for multiple aspiration attempts if the cyst recurs, as recurrence rates can be high, with one study reporting a reduction in cyst volume in 45% of participants, but complete disappearance in only 10% 2.
The recommended approach prioritizes minimizing morbidity, mortality, and improving quality of life, with a focus on effective removal of the cyst contents and reducing recurrence rates. By using a 20-gauge needle and considering the use of corticosteroid injection, patients can experience relief from symptoms with minimal risk of complications. Patient counseling is also crucial to manage expectations and inform patients of the potential need for multiple procedures.