A ganglion cyst is a non-cancerous, fluid-filled lump that commonly forms near the joints or tendon sheaths of the wrist and hand, though they can also appear in the ankle or foot. The cyst is filled with a thick, jelly-like substance known as synovial fluid. While these lumps are benign and often painless, treatment is typically sought if the cyst causes discomfort, interferes with joint function, or is bothersome due to its appearance. The decision to treat a ganglion cyst usually involves either draining the fluid through a procedure called aspiration or surgically removing the entire mass.
The Aspiration Procedure: What Draining Involves
Draining a ganglion cyst is a straightforward, minimally invasive procedure known as aspiration, often performed in an outpatient setting. The process begins with the medical professional sterilizing the skin over the cyst with an antiseptic solution and then injecting a local anesthetic to numb the area. Once the area is numb, a fine needle is inserted directly into the cyst to withdraw the thick, gelatinous fluid. The entire aspiration procedure is usually completed within a few minutes, and patients generally feel only a sensation of pressure rather than pain. Following the fluid removal, a doctor may inject a corticosteroid medication into the now-empty cyst cavity to help reduce inflammation and discourage the cyst from refilling. A significant drawback to aspiration is the high rate of recurrence, with studies showing that the cyst returns in about half of the cases because the root connecting the cyst to the joint is not removed.
Medical Specialists Qualified to Perform Aspiration
The medical professional who performs a ganglion cyst aspiration depends on the cyst’s location, size, and proximity to sensitive structures. For small, superficial, and uncomplicated cysts, a Primary Care Physician or a specialist like a Dermatologist may be able to perform the aspiration. However, the procedure is most often performed by specialists who have more extensive experience with musculoskeletal issues and joint anatomy. These specialists frequently use ultrasound guidance to ensure the needle is accurately placed, especially for cysts that are not easily felt or are near nerves and blood vessels.
Orthopedic Surgeons, particularly those specializing in the hand and wrist, are the most common and definitive specialists who perform both aspiration and surgical removal. Hand Surgeons are highly specialized in the intricate anatomy of the upper extremity, which is where the majority of ganglion cysts occur. Their expertise is particularly important for cysts located on the palm side of the wrist, which are often close to the radial artery and require careful precision.
Rheumatologists, who specialize in joint and soft tissue diseases, may also be involved in the treatment, especially if the cyst is suspected to be related to an underlying inflammatory joint condition. Seeking out a specialist is generally recommended because proper diagnosis is important to rule out other potential masses, and a specialist minimizes the risk of complications during the aspiration.
When Surgical Removal is Necessary
While aspiration is the first-line, less invasive treatment, surgical removal, known as excision or ganglionectomy, becomes necessary in specific circumstances. Surgery is typically advised when the cyst causes severe or chronic pain, weakness, or nerve compression resulting in numbness or tingling, which aspiration cannot relieve. The procedure involves making an incision to carefully remove the entire cyst, including the stalk or root that connects it to the joint capsule or tendon sheath.
Surgical removal is also the preferred option when the cyst recurs repeatedly after one or more failed aspirations. By removing the entire sac and its origin, the recurrence rate is significantly lower than with aspiration alone, dropping to a range of 5% to 15% in most cases. Although surgery is a more invasive outpatient procedure with a longer recovery period of two to six weeks, it offers a more permanent solution for symptomatic and persistent cysts. Surgical excision is almost always performed by an Orthopedic Surgeon or a Hand Surgeon.