Ganglion cysts are cystic structures which contain a viscous-type of fluid often emanating from a joint and/or tendon sheath area. The most common sites of ganglion cysts in the hand are on the dorsal or top side of the wrist between the scaphoid and lunate bones on the volar, or palm side of the wrist, at the level of the thumb and wrist joint and/or at the Ievel of the flexor tendon sheath. Initial treatment consists of aspiration of the cyst. This means to place a needle into the cyst under local anesthesia and withdraw the viscous fluid emanating from the cyst.
This is often successful treatment. If it is not successful, then consideration for surgical excision is warranted. Excision of the cyst present in the wrist is done under regional anesthesia in which the arm is anesthetized from the shoulder to the hand. In addition, intravenous sedation is also utilized to make the patient feel comfortable. Excision of the cyst is then performed and a bandage is placed for approximately 10 days. After removal of the bandage, therapy is warranted in an effort to regain full range of motion within the wrist. This can often last for several weeks subsequent to the surgical procedure. There is a small recurrence rate with excision of ganglion cysts, but in the vast majority of patients surgery would be definitive treatment for the problem. Cysts at the level of the flexor tendon sheath in the fingers, if not responsive to conservative management, can be excised under local anesthesia. Again, postoperatively immediate mobilization of the fingers is allowed and the patient can utilize the hand immediately for all activities except bathing.