Which specialist, an orthopedic (ortho) surgeon or a general surgeon, should review a ganglion cyst?

From the Guidelines

For a ganglion cyst, it's generally best to refer the patient to an orthopedic surgeon, particularly one who specializes in hand surgery if the cyst is located on the wrist or hand, which is the most common location. Orthopedic surgeons have specific training in musculoskeletal conditions and are typically more experienced with ganglion cyst management and surgical removal when necessary 1. However, if the ganglion cyst is in an unusual location or if there are complicating factors such as infection or uncertainty about the diagnosis, a general surgeon may also be appropriate. The management typically begins with observation as many ganglion cysts resolve spontaneously. If treatment is needed due to pain, interference with function, or cosmetic concerns, options include aspiration with or without steroid injection, or surgical excision. Orthopedic surgeons are particularly skilled at ensuring complete removal of the cyst stalk to prevent recurrence, which occurs in approximately 10-15% of cases even with proper surgical technique 1. They can also better assess any underlying joint or tendon issues that may be contributing to the cyst formation. Some key points to consider when evaluating a patient with a suspected ganglion cyst include:

• The use of imaging studies such as MRI or ultrasound to confirm the diagnosis and rule out other conditions 1
• The location and size of the cyst, as well as any associated symptoms or functional limitations
• The patient's overall health and medical history, including any previous treatments or surgeries for the cyst
• The potential risks and benefits of different treatment options, including observation, aspiration, and surgical excision. In terms of imaging, MRI without IV contrast, MRI with IV contrast, or wrist US are usually appropriate for evaluating a palpable mass or suspected ganglion cyst 1. Ultrasound, in particular, is useful for examining extra-articular soft tissues, such as suspected ganglion cysts, and can also be used to guide therapeutic injections 1. Overall, the decision to refer a patient with a ganglion cyst to an orthopedic surgeon or general surgeon should be based on the individual patient's needs and circumstances, as well as the surgeon's expertise and experience in managing musculoskeletal conditions.

From the Research

Ganglion Cyst Review

To determine who to send a ganglion cyst for review, either an orthopedic surgeon or a general surgeon, we need to consider the treatment options and specialties involved in managing ganglion cysts.

• Ganglion cysts are benign soft tissue tumors that commonly occur in the joints, especially the wrist, and can be treated by surgical excision or non-surgical methods such as aspiration and steroid injection 2.
• The decision between surgical and non-surgical treatment depends on various factors including patient preference, symptoms, and the likelihood of recurrence 3, 4.
• Surgical excision has been shown to have a higher success rate and lower recurrence rate compared to non-surgical methods 2, 5.
• However, surgical intervention may have a higher complication rate and longer recovery period compared to non-surgical treatment 3.
• Orthopedic surgeons specialize in the treatment of musculoskeletal disorders, including ganglion cysts, and are likely to be involved in both surgical and non-surgical management 2, 3, 4, 5, 6.
• General surgeons may also be involved in the treatment of ganglion cysts, especially if the cyst is located in an area that is not typically managed by an orthopedic surgeon, such as the foot or ankle 5.

Specialty Involvement

Considering the treatment options and specialties involved, it is likely that an orthopedic surgeon would be the most appropriate specialist to send a ganglion cyst for review, especially if the cyst is located in the wrist or hand. However, if the cyst is located in the foot or ankle, a general surgeon or a podiatric surgeon may also be involved in the management. Ultimately, the decision of who to send the ganglion cyst for review would depend on the specific location and symptoms of the cyst, as well as the patient's preferences and medical history.