Comparative Study of Aspiration with Intralesional Steroid Injection Versus Surgical Excision in the Management of Wrist Ganglion Cysts: A Prospective Study

Authors

  • Midhun R
  • Selvaraj Ramalingam
  • Arvind Kumar K
  • Manoharan A
  • V.Sasikumar

Keywords:

Wrist ganglion, Triamcinolone acetate, Surgical excision, Recurrence

Abstract

Background: Ganglion cysts are the most common soft tissue tumors of the hand and wrist, accounting for up to 60–70% of such lesions. They are benign, fluid-filled sacs that arise most frequently from the dorsal aspect of the wrist joint, particularly the scapholunate interval. Although their exact cause remains unclear, they are thought to result from mucoid degeneration of connective tissue or herniation of synovial tissue. Ganglion cysts may fluctuate in size and can be asymptomatic or present with pain, weakness, or limited range of motion depending on their location and size. Management options range from observation to aspiration and surgical excision, with varying recurrence rates across treatment,modalities.
Objective: To compare the clinical outcomes of aspiration combined with intralesional steroid injection versus surgical excision in treating wrist ganglion cysts, focusing on pain relief, functional recovery, recurrence, complications, patient satisfaction, and time to return to normal activities.

Methods: A prospective comparative study involved 100 patients with wrist ganglion cysts. Participants were randomly assigned to two groups: Group A (Aspiration + Intralesional Steroid Injection, n=50) and Group B (Surgical Excision, n=50). Outcome measures included visual analog scale (VAS) for pain, wrist range of motion (ROM), recurrence rate, complication rate, patient satisfaction, and time to return to normal activities. Data were recorded pre-treatment and at 6 months post-treatment.

Results: Group A demonstrated significantly better outcomes in terms of post-treatment pain scores (VAS: 1.8 vs. 2.9, p= 0.02), improved ROM (74.2° vs. 68.3°, p = 0.01), lower recurrence rate (12% vs. 24%, p = 0.03), fewer complications (6% vs. 18%, p = 0.02), higher patient satisfaction (8.6 vs. 7.2, p = 0.01), and faster return to activities (2.4 vs. 5.6 weeks, p < 0.001).

Conclusion: Aspiration with intralesional steroid injection is a safe, effective, and minimally invasive treatment modality for wrist ganglion cysts, showing superior clinical outcomes compared to surgical excision. It is recommended as a first-line treatment in uncomplicated cases.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Hassan Y, Rather AA, Peer JA. Comparative study between aspiration followed by intralesional triamcinolone injection, mixture of triamcinolone and hyaluronidase, and surgical excision for the treatment of forearm ganglion in a medical college hospital. Muller J Med Sci Res. 2022;13:64 8.

Comparison of aspiration followed by intralesional steroid injection and surgical excision in the management of dorsal wrist ganglion. Int J Adv Res. 2021;11(12):2249-555X. doi:10.36106/ijar.

Ahmad Shah A, Raina AH, Ganie MA, Kumar IA. Comparison of aspiration followed by intralesional steroid injection and surgical excision in the management of dorsal wrist ganglion. World J Plast Surg. 2019;8(2):181–4. doi:10.29252/wjps.8.2.181.

Uddin MN, Rahman MMM, Rahman MM, Hossain SMS. Management of ganglion: Comparative study between surgical excision and aspiration followed by intralesional steroid injection. J Armed Forces Med Coll. 2021;14(2). doi:10.3329/jafmc.v14i2.45907.

Maaz-ul-Hassan, Ali MT, Nadeem A. Comparison of surgical excision versus aspiration and injection of steroid of wrist ganglion. Pak J Med Health Sci. 2017;11(4):1272–5.

Williams N, O’Connell PR, McCaskie A. Upper limb. In: Bailey & Love’s Short Practice of Surgery. 27th ed. Boca Raton: CRC Press; 2018.

Camasta C. Excision of the Ganglion Cyst. Biol Med. 2012.

Scott WW, William CP, Scott HK, Mark SC, Green I. Green’s Operative Hand Surgery. Philadelphia: Elsevier; 2017.

Plate AM, Lee SJ, Steiner G, Posner MA. Tumorlike lesions and benign tumors of the hand and wrist. J Am Acad Orthop Surg. 2003;11(2):129–41.

Memon F, Abbas R, Khan MA, Quraishy MS. Aspiration combined with seton insertion for treatment of wrist ganglions. J Surg Pak. 2007;3:205–7.

Afridi S, Rahman H, Baig N. Use of seton in ganglions of the wrist. J Surg Pak. 2006;11:121–2.

Mehrabani D, Tabei S, Heydari S, Shamsina S, Shokrpour N, Amini M, et al. Cancer occurrence in Fars province, southern Iran. Iran Red Crescent Med J. 2008;10:314 22.

Edward AA. Bone and soft tissue tumors. In: Green’s Operative Hand Surgery. 2nd ed. Amsterdam: Elsevier; 2011. p. 2150–6.

Gude W, Morelli V. Ganglion cysts of the wrist: pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med. 2008;1:205 11. doi:10.1007/s12178-008-9033-4.

Nelson CL, Sawmiller S, Phalen GS. Ganglions of the wrist and hand. J Bone Joint Surg Am. 1972;54(7):1459–64.

Plate AM, Lee SJ, Steiner G, Posner MA. Tumorlike lesions and benign tumors of the hand and wrist. J Am Acad Orthop Surg. 2003;11(2):129–41.

Gude W, Morelli V. Ganglion cysts of the wrist: Pathophysiology, clinical picture, and management. Curr Rev Musculoskelet Med. 2008;1:205 11.

Nahra ME, Bucchieri JS. Ganglion cysts and other tumor-related conditions of the hand and wrist. Hand Clin. 2004;20(3):249–60.

Humail SM, Abidi AR, Naeem Ul Haq S, et al. Comparative study of two methods for the treatment of dorsal wrist ganglion. J Pak Orthop Assoc. 2010;22(1):53–7.

Limpaphayom N, Wilairatana V. Randomized controlled trial between surgery and aspiration combined with methylprednisolone acetate injection plus wrist immobilization in the treatment of dorsal carpal ganglion. J Med Assoc Thai. 2004;87(12):1513–7.

Khan MS, Rauf A, Ali S, Khan A, Wazir F. Efficacy of corticosteroid injection in inflammatory joint disorders: a meta-analysis. J Orthop Res. 2018;36(3):643–50.

Lee YJ, Park YJ, Kim JH, Park JW. Comparative outcomes of surgical versus nonsurgical treatments for ganglion cysts. Clin Orthop Relat Res. 2020;478(5):1012–9.

Patel H, Sharma S, Gill J. Functional outcomes following soft tissue preservation in joint interventions. Am J Sports Med. 2017;45(8):1856–63.

Sharma R, Mehrotra D, Roy S. Steroid injections reduce recurrence rates in ganglion cyst management. Int J Surg. 2016;28:34 8.

Thomas B, Lewis C, Young A. Postoperative complications in minor orthopedic procedures. J Bone Joint Surg Am. 2015;97(14):1181–6.

Rodriguez L, James L, Chu P, Ramirez K. Patient satisfaction and outcomes after non-invasive orthopedic treatments. Patient Exp J. 2019;6(2):44–52.

Nguyen DT, Martinez R, Wells K. Return-to-work timelines in conservative vs. surgical treatments: A review. Rehabil Med. 2021;53(2):211–8.

Downloads

Published

2025-05-15

How to Cite

1.
Midhun R MR, Ramalingam S, Kumar K A, Manoharan A MA, V.Sasikumar V. Comparative Study of Aspiration with Intralesional Steroid Injection Versus Surgical Excision in the Management of Wrist Ganglion Cysts: A Prospective Study. J Neonatal Surg [Internet]. 2025May15 [cited 2025Nov.14];14(23S):1062-7. Available from: https://jneonatalsurg.com/index.php/jns/article/view/5886

Issue

Vol. 14 No. 23S (2025): Journal of Neonatal Surgery

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

You are free to:

  • Adapt — remix, transform, and build upon the material for any purpose, even commercially.

Terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.