Ganglion cysts are commonly seen on the back of the hand and wrist joints. Usually, they are painless and slowly increase in size. Ganglions may cause pain if they are close to a nerve and put pressure on the nerve. We get patients with ganglion cysts complaining of cosmetic deformity because of the swelling. Sometimes the pain is the primary concern.
Ganglions are outpouchings of synovial sheaths of tendons with jelly-like substance filled in it. It increases over a period if left unchecked.
Treatment depends on patient to patient. Simple ganglions in the elderly may only be observed with the wait and watch strategy.
Aspiration: Small ganglions are sometimes aspirated with a wide bore needle. Though it is very simple and done in minutes, it has high recurrence rates. Cysts tend to fill again over a period. If not done properly cyst may get infected also. I do not prefer this method for my patient. I only do it as a temporary procedure for relief of pain while a definite procedure is planned.
Excision of cyst: Excision of cyst involves surgical removal of the ganglion. This is my preferred mode of treatment. I explore the ganglion so that it is removed completely.
I also make sure that the tendon is not damaged during the process. If needed I use magnification with a microscope to complete the process. If the patient desires, I give a cosmetic closure of the wound for minimal scarring.