What is the best treatment for wrist ganglion cysts?
EVIDENCE-BASED ANSWER:
Open surgical excision of wrist ganglion cysts is associated with a lower recurrence rate than aspiration with or without corticosteroid injection (strength of recommendation [SOR]: B, systematic review of randomized clinical trials [RCTs] and observational trials and RCT).
Even though the recurrence rate with aspiration is about 50%, most patients are satisfied with aspiration and report a decrease in symptoms involving pain, function, and range of motion (SOR: B, individual cohort and case series).
Overall, 52.4% of patients experienced recurrence of their ganglia. However, 95% expressed satisfaction with treatment independent of recurrence. Mean symptom scores improved from baseline for pain (4.1 points), function (3.9 points), range of motion (3.8 points), and appearance (4.1 points). Improvements in all symptoms were independent of recurrence.
Aspiration plus steroids results in 43% recurrence rate
A 2015 prospective study examined the recurrence rate at 1 year after therapy in 30 patients, ages 15 to 55 years, with a wrist ganglion treated by aspiration and steroid injection.4 Patients chose aspiration and steroid injection with 40 mg/mL methyl-prednisolone acetate over reassurance or surgical intervention. The recurrence rate at 1-year follow-up was 43.3% (13 patients).
Editor’s takeaway
Surgical excision of ganglion cysts results in fewer recurrences than aspiration. However, moderately high-quality evidence shows that both methods help most patients.
