Treatment of ganglia: is it conservative or only surgical?

Patients with no symptoms, no pain and no sensory disturbances can be followed up on an outpatient basis. In some cases, the ganglion cyst may spontaneously disappear.

Massage and physiotherapy of the joint area may help in conservative treatment.

Some non-expert sources list a forceful blow to the ganglion area, such as a book blow, as one treatment method.

However, such a procedure is not recommended. The cyst may be close to blood vessels, nerves and small joints and such a strong blow could cause injury.

If the cyst bursts, further treatment may be very difficult.

Ganglion cysts occurring on the back of the wrist can be removed by aspirating their contents. This procedure is called aspiration.

Aspiration of cysts on the inner side of the wrist is not routinely performed because of the risk of puncturing the radial artery, which is often close to the ganglion or even bypassed by the ganglion.

Surgical removal of the cyst is indicated in patients who have persistent symptoms such as pain or limited joint mobility and in whom conservative treatment has failed.

Surgical excision is a simple outpatient procedure performed under local anaesthesia.

The skin over the cyst is incised transversely and the cyst is carefully removed through this incision. Care is taken not to rupture the cyst pedicle when removing the cyst. Spilled fluid into the surgical field would make excision difficult, which could lead to recurrence, i.e. regrowth of the cyst.

If the ganglion cyst is located on the inner side of the wrist, it is likely to be in close proximity to a radial artery. Alternatively, the cyst may have outgrown the artery. In this case, the cyst is first separated from the artery with a blunt instrument to rule out any injury to the artery.

In this position of the ganglion, there is also a risk of injury to the median nerve, which extends 5 cm from the wrist joint and innervates the palm and fingers.

The most common complication of surgery is recurrence of the ganglion cyst. Ganglions on the inner side of the wrist recur more frequently. Re-growth of ganglion cysts after surgery occurs in approximately 15 to 20% of cases.