Ganglion cysts are painless, fluid-filled cysts that most commonly occur on the back of the wrist. Although they can be painless, some can be unsightly, painful and/or interfere with function. After extensive nonsurgical treatment, surgical ganglion cyst removal may be necessary. Ganglion cyst removal is an outpatient surgical procedure that can be performed arthroscopically, which is minimally invasive. It can be performed under local anaesthesia, during which the patient is awake, or general anaesthesia, depending on the surgeon and patient’s preferences.
During the procedure, an incision is first made over the area with the cyst. Next, the cyst is removed, along with whatever part of the joint capsule or tendon sheath appears to be the root of the ganglion. This may be done arthroscopically, which involves making small incisions through which to insert a camera and instruments to perform the procedure.
Who is a candidate?
Candidates have ganglion cysts that cause symptoms such as tingling, pain, or muscle weakness, and have already exhausted forms of nonsurgical treatment such as aspiration (removal of fluid from the cyst to decrease size and alleviate symptoms), immobilization (using a wrist splint), and physical therapy.
Who is not a candidate?
Patients who have ganglion cysts that are asymptomatic or able to be treated by nonsurgical treatment should not consider a surgical method to remove their cyst(s) as a first line treatment.
Like other surgeries, ganglion cyst removal requires a complete physical examination with your primary care provider before surgery to determine surgery is necessary. You should inform your orthopedic surgeon of any medications or supplements you take, and comply with certain general surgery procedures such as preoperative blood testing and possible cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior. You will likely be asked to stop eating or drinking the night before the surgery.
Immediately after the procedure, you will have a bandage over the area and most likely will have your arm/wrist in a splint for up to 10 days postoperative. You may be given prescription pain relievers for discomfort. As ganglion cyst removal is an outpatient procedure, you will be discharged the day of the procedure. You may experience temporary stiffness, swelling or pain, but these symptoms should subside with time.
A physical therapy regimen might be necessary to help avoid swelling and stiffness of the wrist after the recovery process, which may require a physical therapist or at-home exercises recommended by your surgeon. Full recovery can take up to 6 weeks. Depending on your line of work, you may need to take a few weeks off before resuming normal activity.
As with any surgery, there are risks of complications related to scarring, bleeding, blood clots, infection or adverse reactions to anesthesia. However, ganglion cyst removal is a relatively minor outpatient procedure with a low risk profile. At the same time, ganglion cyst removal does not guarantee that ganglion cysts will not recur; in one of out five patients, ganglion cysts return eventually.
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