Ganglion Cyst Excision

About Ganglion Cyst Excision

Ganglion cyst excision is the surgical removal of a ganglion, the most common soft tissue lump of the hand and wrist. A ganglion is a sac filled with thick, clear, jelly like fluid that arises from a joint capsule or tendon sheath, most often on the back of the wrist over the scapholunate ligament, on the palm side of the wrist near the radial artery, or on the flexor tendon sheath of a finger. Many ganglions cause no symptoms, and a substantial proportion disappear on their own, so observation is common. Aspiration is a simple office procedure in which the fluid is drawn out with a needle under local anesthesia, sometimes combined with a corticosteroid injection. It can relieve symptoms, but recurrence is common because the cyst wall and the stalk connecting it to the joint remain, and aspiration is sometimes repeated. Aspiration of cysts on the palm side of the wrist requires care because of their close relationship to the radial artery. Surgical excision, open or arthroscopic, removes the cyst together with its stalk and a small portion of the joint capsule or tendon sheath at its origin, and is generally associated with a lower recurrence rate than aspiration, although cysts can still return. During dorsal excision the scapholunate ligament is protected, and during volar excision the radial artery and nearby branches of the radial nerve are carefully dissected. Complications include recurrence, nerve or arterial injury, scar sensitivity, stiffness and, rarely, complex regional pain syndrome. Historically, ganglions were sometimes treated by striking them with a heavy book, a practice abandoned in modern medicine.