From the Guidelines
Ganglion cysts should be initially managed with observation, as many resolve spontaneously, and for symptomatic cases, aspiration or surgical excision can be considered based on the severity of symptoms and patient preference. When it comes to the treatment of ganglion cysts, the primary goal is to alleviate symptoms while minimizing morbidity and mortality, and improving quality of life. According to the American College of Radiology 1, ultrasound (US) of the wrist is useful for examining extra-articular soft tissues, such as suspected ganglion cysts, and its accuracy is similar to that of MRI. Some key points to consider in the management of ganglion cysts include:
- Observation is recommended for asymptomatic ganglion cysts, as many resolve spontaneously over time
- Aspiration can provide temporary relief for symptomatic cysts, but has a high recurrence rate of 50-70%
- Surgical excision (ganglionectomy) offers the most definitive treatment with a lower recurrence rate of 5-10%
- Home remedies like immobilization with a wrist brace or applying ice to reduce inflammation may help manage symptoms
- Contrary to folk remedies, hitting the cyst with a heavy object ("Bible therapy") is not recommended as it can damage surrounding tissues. The use of ultrasound to guide therapeutic intra-articular and other soft-tissue injections 1 can also be beneficial in the management of ganglion cysts. It's worth noting that most ganglion cysts form from joint or tendon sheath fluid that herniates through a weak spot in the surrounding tissue, creating a balloon-like structure filled with synovial fluid. In terms of diagnostic approaches, ultrasound is a useful technique for diagnosing ganglion cysts, and can also be used to diagnose abnormalities of the flexor and extensor tendons and tendon sheaths 1. Ultimately, the treatment approach should be individualized based on the patient's symptoms, preferences, and overall health status.
From the Research
Treatment Options for Ganglion Cysts
- Surgical excision and aspiration followed by steroid injection are the two main treatment options for ganglion cysts 2, 3, 4, 5, 6.
- The success rate of surgical excision is higher, with a lower recurrence rate, compared to aspiration and steroid injection 2, 5, 6.
- Aspiration followed by intralesional steroid injection can be an effective treatment option, with a success rate of 64.3% to 86.8% 4, 5.
Comparison of Treatment Outcomes
- A study comparing surgical excision and aspiration followed by steroid injection found that surgical excision had a higher success rate (92.5% vs 64.3%) and lower recurrence rate (7.5% vs 35.7%) 2.
- Another study found that aspiration followed by intralesional steroid injection had a success rate of 86.8%, compared to 83.3% for surgical excision 4.
- A randomized controlled trial found that surgical excision had a higher success rate (94.4% vs 61.1%) compared to aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization 5.
Patient Considerations
- Patients who are not willing to undergo surgery may be offered aspiration and injection treatment, but should be counselled about the chances of failure 6.
- The treatment option should be chosen based on the patient's individual needs and preferences, taking into account the potential risks and benefits of each option 2, 3, 4, 5, 6.