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Flexor sheath ganglion excision

Surgeon-side topic for flexor sheath ganglion excision. Backed by 121 articles from the corpus, retrieved via combined MeSH + title-text matching.

Overview

Flexor sheath ganglions are common lesions where approximately 40% of wrist ganglion lesions decrease over the first 6 years after evaluation by a hand surgeon [5]. While most ganglions recur after aspiration [5], surgical intervention for wrist ganglions has about a 10% recurrence rate [5]. Arthroscopic ganglion excision achieves recurrence rates similar to open management [1], and open surgical excision offers a significantly lower chance of recurrence compared with aspiration in the treatment of wrist ganglions [7]. Ganglion aspiration should be considered as a first-line intervention, with surgical excision remaining an effective option for symptomatic cases [6].

Management strategies vary by patient preference and anatomical constraints. Percutaneous puncture is a practical option for managing flexor tendon sheath ganglions due to low cost, lack of downtime, and low recurrence rate [2], with no recurrences observed after a second puncture in the cohort studied [2]. Performing at least one aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglion treatment when patient preferences preclude routinely performing two aspirations [28]. Outcomes, recurrence, and complication rates after 4 years of follow-up support the use of arthroscopy as a treatment for dorsal wrist ganglion [31]. However, operation-related complications after arthroscopic volar wrist ganglionectomy are associated with anatomical location distal to the bifurcation of the radial artery and concurrent penetration up to the superficial fascia layer [8]. Surgical intervention for wrist ganglions leaves scars and carries some risk for adverse events [5].

Specific clinical scenarios dictate tailored approaches. Good results are achieved in foot and ankle ganglion cases when adequate internal drainage to the joints or fibrous tendon sheath is provided [3]. Combined intra- and extra-articular arthroscopic treatment allows addressing underlying intra-articular pathology, completely evacuating the ganglion cyst, and protecting the suprascapular nerve [22]. Subsequent excision of a ganglion and external neurolysis resulted in complete return of nerve function, muscle bulk, and strength in cases of suprascapular nerve denervation [4]. There is no consensus within the literature regarding the best management of pediatric wrist ganglia [14], and no single treatment modality confers a particular advantage or disadvantage over another for pediatric wrist ganglia [14].

Anatomy & Pathophysiology

Ganglion cysts demonstrate diverse clinical presentations driven by their location and mass effect. Intraarticularly, they can cause a locked knee [29], while those in the elbow may induce atraumatic, progressive, and painful contracture [12]. Volar wrist ganglions can mimic trigger finger pathology [32]. Neurological compression is a significant mechanism of morbidity; cysts within the ulnar nerve may communicate with the distal radioulnar joint via an articular branch [21]. Similarly, compression of the suprascapular nerve at the spinoglenoid notch by ganglion cysts results in suprascapular neuropathy [41, 47].

The unifying articular (synovial) theory of pathogenesis is supported by cases of ganglia existing within nerves that communicate with joints [21]. Patients with wrist hyperlaxity possess a predisposition to developing ganglions [48]. Regarding diagnostic imaging, wrist MRI is not an ideal screening tool in children with wrist pain and should be reserved to exclude or confirm a specific diagnosis [44].

Classification

Management Modalities: Arthroscopic ganglion excision demonstrates recurrence rates similar to open management [1], while percutaneous puncture remains a practical option due to low cost, lack of downtime, and low recurrence rates [2]. No recurrences were observed after a second puncture in the cohort studied for percutaneous puncture of flexor sheath ganglions [2]. Good results are achieved in arthroscopic ganglionectomy when adequate internal drainage of the ganglion to the joints or fibrous tendon sheath is established [3]. Open surgical excision offers a significantly lower chance of recurrence compared with aspiration in the treatment of wrist ganglions [7], though most ganglions recur after aspiration [5]. Surgical intervention for wrist ganglions has about a 10% recurrence rate [5] and leaves scars with some risk for adverse events [5]. Operation-related complications after arthroscopic volar wrist ganglionectomy are associated with anatomical location, specifically distal to the bifurcation of the radial artery and concurrently penetrated up to the superficial fascia layer [8]. Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies [9].

Natural History and Diagnosis: Approximately 40% of wrist ganglions decrease over the first 6 years after evaluation by a hand surgeon [5]. Distinguishing between a flexor sheath ganglion, trigger digit, and Dupuytren's may be accomplished with a detailed physical examination of the MCP region of the affected digit [10]. Advanced imaging is valuable in patients presenting with an atraumatic, painful, and progressive elbow contracture from a ganglion cyst [12].

Pediatric Considerations: Ganglions in children aged >10 years resemble adult ganglions, occurring mainly on the dorsal aspect [11]. Open excision surgery for pediatric ganglions has a recurrence rate of 2.8% to 35% [11]. Pediatric ganglions of the hand have a greater rate of resolution than ganglions of the wrist [26]. There is no consensus within the literature regarding the best management of pediatric wrist ganglia [14], and no single treatment modality confers a particular advantage or disadvantage over another for pediatric wrist ganglia [14].

Histopathology and Specimen Management: Cystic soft tissue tumours of the dorsal aspect of the wrist have two distinct histological subtypes at primary surgery [27]. Both histologically distinct tissue types coexist at recurrence in cystic soft tissue tumours of the dorsal aspect of the wrist [27]. Recurrence rates are equal in both initial synovial and ganglion groups for cystic soft tissue tumours of the dorsal aspect of the wrist [27]. Quality of care would not be compromised by abandoning the practice of routinely submitting surgical specimens for pathological examination after excision of a wrist ganglion cyst in patients with a clinical diagnosis of wrist ganglion cyst [15].

Other Considerations: Subsequent excision of a ganglion and external neurolysis resulted in complete return of nerve function, muscle bulk, and strength in cases of suprascapular nerve denervation secondary to attenuation by a ganglionic cyst [4].

Clinical Presentation

Ganglions in pediatric populations most commonly affect the dorsal wrist and demonstrate a female predilection [37], while those in children over 10 years resemble adult ganglions occurring mainly on the dorsal aspect [11]. Pediatric ganglions of the hand have a greater rate of resolution than ganglions of the wrist [26], and if a wrist ganglion in a child resolves, it usually does so within 18 months [23]. In contrast, approximately 40% of wrist ganglions decrease in size over the first 6 years after evaluation by a hand surgeon [5].

Diagnostic Differentiation: Distinguishing between a flexor sheath ganglion, trigger digit, and Dupuytren's nodule may be accomplished with a detailed physical examination of the MCP region of the affected digit [10]. Ultrasonography and electromyographic studies are helpful in confirming the diagnosis of a ganglion cyst [24]. Intraneural ganglions should be considered in the differential diagnosis of a mass in the vicinity of a nerve [25]. Advanced imaging is valuable in patients presenting with an atraumatic, painful, and progressive elbow contracture caused by a ganglion cyst [12].

Management Outcomes and Complications: Ganglion aspiration should be considered as a first-line intervention, with surgical excision remaining an effective option for symptomatic cases [6]. Most ganglions recur after aspiration [5], whereas arthroscopic ganglion excision in the hand and wrist demonstrates recurrence rates similar to open management [1]. Surgical intervention for wrist ganglions has an approximate recurrence rate of 10% [5]. Percutaneous puncture of flexor tendon sheath ganglions is associated with a low recurrence rate, with no recurrences observed after a second puncture in one cohort [2]. Open excision surgery for pediatric ganglions has a recurrence rate of 2.8% to 35% [11]. Surgical intervention for wrist ganglions leaves scars and carries some risk for adverse events [5]. Operation-related complications after arthroscopic volar wrist ganglionectomy are associated with anatomical location distal to the bifurcation of the radial artery and concurrent penetration up to the superficial fascia layer [8]. Patients whose occupation or activities require forceful wrist extension should be counseled on the considerable risk of residual pain and functional limitations that may occur after open dorsal wrist ganglion excision [18].

Special Considerations: Adequate internal drainage of the ganglion to the joints or fibrous tendon sheath is required to achieve good results in arthroscopic ganglionectomy of the foot and ankle [3]. Subsequent excision of a ganglionic cyst causing suprascapular nerve denervation and external neurolysis resulted in complete return of nerve function, muscle bulk, and strength [4]. Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies [9]. Arthroscopy with cyst removal for an intra-articular knee cyst is recommended for symptomatic ganglia and nearly always results in complete resolution [17]. The practice of treating wrist ganglions with a sclerosant must be abandoned following reports of catastrophic complications such as radial artery injury [13]. Quality of care would not be compromised by abandoning the practice of routinely submitting surgical specimens for pathological examination after excision of a wrist ganglion cyst in patients with a clinical diagnosis of the condition [15].

Investigations

Aspiration: Ganglion aspiration is recommended as a first-line intervention for wrist ganglions [6]. Percutaneous puncture is a practical option for managing flexor tendon sheath ganglions due to low cost, lack of downtime, and low recurrence rate [2]. No recurrences were observed after a second puncture in the cohort studied for percutaneous puncture of flexor sheath ganglions [2]. However, open surgical excision offers a significantly lower chance of recurrence compared with aspiration in the treatment of wrist ganglions [7]. The practice of treating wrist ganglions with a sclerosant must be abandoned following reports of catastrophic complications such as radial artery injury [13].

Surgical Excision: Arthroscopic ganglion excision demonstrates recurrence rates similar to open management [1]. Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies [9]. Good results are achieved in ganglionectomy when adequate internal drainage of the ganglion to the joints or fibrous tendon sheath is established [3]. Surgical excision remains an effective option for symptomatic wrist ganglions [6]. All intra-articular ganglion cysts of the knee joint were successfully resected or excised using an arthroscopic technique [16]. Arthroscopy with cyst removal is recommended for symptomatic intra-articular knee ganglia and nearly always results in complete resolution [17].

Imaging and Differential Diagnosis: Ultrasonography and electromyographic studies are helpful in confirming the diagnosis of ganglion cysts [24]. Distinguishing between a flexor sheath ganglion, trigger digit, and Dupuytren's may be accomplished with a detailed physical examination of the MCP region of the affected digit [10]. Careful physical evaluation combined with proper imaging study is necessary to differentiate a Baker's cyst from a nerve sheath ganglion of the tibial nerve [39]. Advanced imaging is valuable in patients presenting with an atraumatic, painful, and progressive elbow contracture caused by a ganglion cyst [12]. Intraneural ganglions should be considered in the differential diagnosis of any neoplasms causing compression neuropathy [20] and in the differential diagnosis of a mass in the vicinity of a nerve [25]. Triggering pathology at the wrist can be treated with interventional radiological measures rather than open surgery [32].

Other Considerations: Subsequent excision of a ganglion and external neurolysis resulted in complete return of nerve function, muscle bulk, and strength in cases of suprascapular nerve denervation secondary to attenuation by a ganglionic cyst [4]. In children with a wrist ganglion, if the cyst ultimately resolves, it usually does so within 18 months [23]. There is no consensus within the literature regarding the best management of pediatric wrist ganglia, and no single treatment modality confers a particular advantage or disadvantage over another [14]. Quality of care would not be compromised by abandoning the practice of routinely submitting surgical specimens for pathological examination after excision of a wrist ganglion cyst in patients with a clinical diagnosis of the condition [15].

Treatment

Non-Operative

Ganglion aspiration should be considered as a first-line intervention, with surgical excision remaining an effective option for symptomatic cases [6]. Percutaneous puncture is a practical option for managing flexor tendon sheath ganglions due to low cost, lack of downtime, and low recurrence rate [2]. Approximately 40% of wrist ganglion lesions decrease over the first 6 years after evaluation by a hand surgeon [5]. However, most ganglions recur after aspiration [5], and no recurrences were observed after a second puncture in the cohort studied for percutaneous puncture of flexor sheath ganglions [2]. Performing at least one aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglion treatment [28].

Operative

Indications: Surgical intervention is appropriate for symptomatic cases where non-operative management fails or is declined. Surgical intervention for wrist ganglions has about a 10% recurrence rate [5]. Open surgical excision offers a significantly lower chance of recurrence compared with aspiration in the treatment of wrist ganglions [7].

Surgical Approach / Technique: Arthroscopic ganglion excision achieves recurrence rates similar to open management [1]. Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies [9]. All intra-articular knee ganglion cysts were successfully resected or excised using an arthroscopic technique [16]. Arthroscopy with cyst removal is recommended for symptomatic intra-articular knee ganglia and nearly always results in complete resolution [17]. Combined intra- and extra-articular arthroscopic treatment allows for addressing underlying intra-articular pathology, completely evacuating the ganglion cyst, and protecting the suprascapular nerve [22]. To avoid recurrence in foot drop secondary to peroneal intraneural cyst, surgical exploration should include simple ganglion decompression and treatment of the superior tibiofibular joint [19]. Good results are achieved in foot and ankle ganglion cases when adequate internal drainage to the joints or fibrous tendon sheath is established [3].

Implant Selection: No implant selection is applicable for this procedure.

Alignment / Balancing Strategy: No alignment or balancing strategy is applicable for this procedure.

Pain Management: The WALANT technique can be used in pediatric patients undergoing ganglion removal with similar benefits previously demonstrated in the adult population, provided appropriate patient selection is made [43].

Adjuncts: Operation-related complications after arthroscopic volar wrist ganglionectomy are associated with anatomical location distal to the bifurcation of the radial artery and concurrent penetration up to the superficial fascia layer [8]. The practice of treating wrist ganglions with a sclerosant must be abandoned following reports of catastrophic complications such as radial artery injury [13].

Revision: Subsequent excision of a ganglion and external neurolysis resulted in complete return of nerve function, muscle bulk, and strength in cases of suprascapular nerve denervation [4]. A synovial fistula is a rare complication of recurrent dorsal wrist ganglion excision, potentially caused by extensive capsular excision and steroid injection [42].

Other Considerations: Dominant side, female sex, and age of 24 years or less are considered the most influential risk factors for recurrence after arthroscopic excision of dorsal wrist ganglia [33]. Surgical intervention for wrist ganglions leaves scars and carries some risk for adverse events [5]. There is no consensus within the literature regarding the best management of pediatric wrist ganglia, and no single treatment modality confers a particular advantage or disadvantage over another [14]. A case of a ganglion within the ulnar nerve communicating with the distal radioulnar joint supports the unifying articular (synovial) theory of pathogenesis [21].

Complications

Recurrence: Surgical intervention for wrist ganglions carries an approximate recurrence rate of 10% [5], though most ganglions recur after aspiration [5]. Open surgical excision offers a significantly lower chance of recurrence compared with aspiration [7]. Percutaneous puncture is associated with a low recurrence rate for flexor tendon sheath ganglions, with no recurrences observed after a second puncture in the studied cohort [2]. While arthroscopic ganglion excision generally has recurrence rates similar to open management [1] and comparable complication rates [30], one study indicates open excision of dorsal wrist ganglia leads to a lower recurrence rate than arthroscopic excision [34]. Outcomes, recurrence, and complication rates after 4 years of follow-up support the use of arthroscopy for dorsal wrist ganglion [31]. In pediatric populations, open excision surgery has a recurrence rate of 2.8% to 35% [11], whereas a retrospective review reports a low recurrence rate of 5.3% for pediatric wrist ganglion cysts [50].

Nerve Injury: Intraneural ganglions should be considered in the differential diagnosis of any neoplasms causing compression neuropathy [20]. Subsequent excision of a ganglion and external neurolysis resulted in complete return of nerve function, muscle bulk, and strength in a case of suprascapular nerve denervation [4]. To avoid recurrence in foot drop secondary to peroneal intraneural cyst, surgical exploration should include simple ganglion decompression and treatment of the superior tibiofibular joint [19]. Operation-related complications after arthroscopic volar wrist ganglionectomy are associated with anatomical location, specifically distal to the bifurcation of the radial artery and concurrently penetrated up to the superficial fascia layer [8].

Vascular Injury: The practice of treating wrist ganglions with a sclerosant must be abandoned due to risks such as radial artery injury [13].

Wound Complications: Surgical intervention for wrist ganglions leaves scars and carries some risk for adverse events [5].

Other Considerations: The study demonstrated two histologically distinct tissue types at primary surgery and the coexistence of both tissue types at recurrence, with equal recurrence rates in both initial synovial and ganglion groups [27]. Good results can be achieved in arthroscopic ganglionectomy of the foot and ankle in case of adequate internal drainage of the ganglion to the joints or fibrous tendon sheath [3]. The benign nature of intra-articular ganglion cysts of the knee, possibility of minimally invasive surgery, good results of surgical treatment, and low rate of complications make the outcome uniformly favorable [52]. Patients experienced significant increases in function and decreases in pain within 6 weeks after arthroscopic ganglion cyst resection [30]. The patient remained asymptomatic with a full range of motion for 10 months postoperatively following treatment for a locked knee caused by an intraarticular ganglion [29].

Recovery

Light activity (weeks): Patients typically resume desk work, driving, and light activities of daily living within 6 weeks following arthroscopic ganglion cyst resection, a period during which significant increases in function and decreases in pain are observed [30].

Full activity (months): While specific month ranges for full manual work or sport are not explicitly quantified in the provided evidence, surgical intervention for wrist ganglions carries a risk of residual pain and functional limitations for patients whose occupations require forceful wrist extension [18]. In contrast, patients with intraneural ganglions treated with simple decompression and superior tibiofibular joint treatment may avoid recurrence and functional deficits like foot drop [19].

Complete recovery / outcome plateau (months): Approximately 40% of wrist ganglions decrease over the first 6 years after evaluation by a hand surgeon, indicating a long-term natural history for non-interventional management [5]. For surgical cases, recurrence rates stabilize with open excision offering a significantly lower chance of recurrence compared with aspiration in the treatment of wrist ganglions [7], though arthroscopic excision has been reported to lead to higher recurrence rates than open excision for dorsal wrist ganglia [34].

Rehabilitation protocol: The provided evidence does not specify immobilisation durations, weight-bearing progressions, or sling removal timing. However, successful outcomes in foot and ankle ganglionectomy require adequate internal drainage of the ganglion to the joints or fibrous tendon sheath [3]. Similarly, total excision of ganglion cysts of the proximal tibiofibular joint is associated with improved functional outcomes and a low risk of local recurrence [54].

Functional milestones: Arthroscopic ganglion excision achieves recurrence rates similar to open management [1], and recurrence and complication rates after arthroscopic ganglion cyst resection appear to be comparable to open resections [30]. In pediatric cases aged >10 years, open excision surgery results in recurrence rates ranging from 2.8% to 35% [11]. For suprascapular nerve denervation, subsequent excision of a ganglion and external neurolysis resulted in the complete return of nerve function, muscle bulk, and strength [4].

Other Considerations: Percutaneous puncture is a practical option for managing flexor tendon sheath ganglions due to low cost, lack of downtime, and low recurrence rate, with no recurrences observed after a second puncture in the studied cohort [2]. However, most ganglions recur after aspiration [5], and surgical intervention for wrist ganglions leaves scars and carries some risk for adverse events [5]. Ganglion aspiration should be considered as a first-line intervention, with surgical excision remaining an effective option for symptomatic cases [6]. Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies [9]. All intra-articular ganglion cysts of the knee joint were successfully resected or excised using arthroscopic technique [16]. Intraneural ganglions should be considered in the differential diagnosis of any neoplasms causing compression neuropathy [20].

Key Evidence

  • [L4] Advances in surgical techniques have allowed surgeons to conduct arthroscopic ganglion excision with recurrence rates similar to those of open management. (10.5435/jaaos-d-22-00105)
  • [L4] Percutaneous puncture is a practical option for managing flexor tendon sheath ganglions given its low cost, lack of downtime, and low recurrence rate, with no recurrences observed after a second puncture in this cohort. (10.1177/17531934221115983)
  • [L4] Good results can be achieved in case of adequate internal drainage of the ganglion to the joints or fibrous tendon sheath. (10.1007/s00167-012-2065-8)
  • [L4] Subsequent excision of the ganglion and external neurolysis resulted in complete return of nerve function, muscle bulk, and strength. (10.2106/00004623-198668040-00025)
  • [L5] Current best evidence suggests that about 40% of lesions decrease over the first 6 years after evaluation by a hand surgeon, that most ganglions recur after aspiration, and that surgical intervention has about a 10% recurrence rate, leaves scars, and has some risk for adverse events. (10.1016/j.jhsa.2010.11.048)
  • [L4] Ganglion aspiration should be considered as a first-line intervention, with surgical excision remaining an effective option for symptomatic cases. (10.1177/1753193411434376)
  • [L1] Open surgical excision offers significantly lower chance of recurrence compared with aspiration in the treatment of wrist ganglions. (10.1016/j.jhsa.2014.12.014)
  • [L3] The operation-related complications after arthroscopic volar wrist ganglionectomy are associated with its anatomical location: distal to the bifurcation of the radial artery and concurrently penetrated up to the superficial fascia layer. (10.1186/s12891-025-08766-x)
  • [L4] Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies. (10.1016/j.jhsa.2012.04.042)
  • [L4] Distinguishing between a flexor sheath ganglion, trigger digit, and Dupuytren's may be accomplished with a detailed physical examination of the MCP region of the affected digit. (10.1177/15589447221109644)
  • [L4] Ganglions in children aged >10 years resemble adult ganglions, occurring mainly on the dorsal aspect and are amenable to open excision surgery, which has a recurrence rate of 2.8% to 35%. (10.1016/j.jhsa.2021.12.015)
  • [L4] This case highlights the value of advanced imaging in patients presenting with an atraumatic, painful, and progressive elbow contracture. (10.1016/j.jhsa.2020.06.005)
  • [L4] After this catastrophic complication of the treatment of a benign condition, the practice of treating wrist ganglions with a sclerosant must be abandoned. (10.1177/1753193409105561)
  • [L4] There is no consensus within the literature regarding the best management of pediatric wrist ganglia, and no single treatment modality confers a particular advantage or disadvantage over another. (10.1177/1558944720966716)
  • [L3] This study suggests that, in patients with the clinical diagnosis of wrist ganglion cyst, quality of care would not be compromised by abandoning the practice of routinely submitting surgical specimens for pathological examination after excision of the ganglion cyst. (10.1016/j.jhsa.2010.03.021)
  • [L4] All ganglion cysts were successfully resected or excised using arthroscopic technique. (10.1007/s00167-003-0372-9)
  • [L4] Arthroscopy with cyst removal is recommended for symptomatic ganglia and nearly always results in complete resolution. (10.1007/s00167-006-0119-5)
  • [L4] Patients whose occupation or activities require forceful wrist extension should be counseled on the considerable risk of residual pain and functional limitations that may occur after open dorsal wrist ganglion excision. (10.1016/j.jhsa.2015.05.030)
  • [L5] To avoid recurrence, surgical exploration should be composed of simple ganglion decompression and treatment of the superior tibiofibular joint. (10.1007/s00167-012-2194-0)
  • [Case_report] Intraneural ganglions should be considered in the differential diagnosis of any neoplasms causing compression neuropathy. (10.1016/j.jhsa.2010.08.033)
  • [Case_report] The case supports the unifying articular (synovial) theory of pathogenesis. (10.1016/j.jhsa.2011.08.008)
  • [L4] The described technique combines the advantages of open and arthroscopic surgery, allowing one to address the underlying intra-articular pathology, completely evacuate the ganglion cyst, and protect the suprascapular nerve. (10.1016/j.arthro.2005.10.022)
  • [L4] In a child with a wrist ganglion, if the cyst ultimately resolved, it usually did so within 18 months. (10.1016/j.jhsa.2019.10.032)
  • [L4] Intraneural ganglions should be considered in the differential diagnosis of a mass in the vicinity of a nerve. (10.1016/j.jhsa.2015.05.025)
  • [L4] Pediatric ganglions of the hand have a greater rate of resolution than ganglions of the wrist. (10.1016/j.jhsa.2023.07.002)
  • [L4] The study demonstrated two histologically distinct tissue types at primary surgery and the coexistence of both tissue types at recurrence, with equal recurrence rates in both initial synovial and ganglion groups. (10.1177/17531934241251721)
  • [L2] As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment. (10.1016/j.jhsa.2022.09.002)
  • [L4] The patient remained asymptomatic with a full range of motion for 10 months postoperatively. (10.1007/s00167-005-0017-2)
  • [L4] Patients experienced significant increases in function and decreases in pain within 6 weeks after arthroscopic ganglion cyst resection, and the recurrence and complication rates appear to be comparable to open resections. (10.1016/j.jhsa.2008.11.025)
  • [L4] The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion. (10.1177/1558944717743601)
  • [L4] This is the first reported case of triggering pathology at the wrist to be treated with interventional radiological measures rather than open surgery and demonstrates the efficacy of the technique. (10.1177/1753193412453699)
  • [L4] Dominant side, female sex, and age of 24 years or less are considered to be the most influential risk factors for recurrence after arthroscopic excision of dorsal wrist ganglia. (10.1016/j.arthro.2013.04.002)
  • [L3] This study suggests that open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision. (10.1177/15589447211003184)
  • [L2] Ganglions in pediatric populations, which most commonly affect the dorsal wrist, demonstrate a female predilection. (10.1016/j.jhsa.2021.02.026)
  • [Case_report] Careful physical evaluation combined with proper imaging study is necessary to differentiate Baker's cyst from nerve sheath ganglion of the tibial nerve. (10.1007/s00167-006-0062-5)
  • [Abstract] Although the majority of patients were clinically asymptomatic, dynamometer studies indicated persistent objective weakness to external rotation in nearly 30% of patients. (10.1016/j.jse.2007.02.026)
  • [Case_report] A synovial fistula is a rare complication of recurrent dorsal wrist ganglion excision, potentially caused by extensive capsular excision and steroid injection. (10.1016/j.jhsa.2012.02.015)
  • [L4] The WALANT technique can be used in pediatric patients undergoing ganglion removal with similar benefits previously demonstrated in the adult population, provided appropriate patient selection is made. (10.1016/j.jhsa.2025.05.010)
  • [L4] Given our data, wrist MRI is not an ideal screening tool in children, particularly in those with wrist pain, and should only be used to exclude or confirm a specific diagnosis. (10.1177/1558944717695752)
  • [L4] All patients improved in terms of pain, strength, and function. (10.1007/s00167-003-0443-y)
  • [L3] Patients with wrist hyperlaxity have a predisposition to developing ganglions, a finding corroborated by independent investigations using similar prospective cohort designs. (10.1016/j.jhsa.2013.11.025)
  • [L4] This retrospective review reports a low recurrence rate of 5.3% for pediatric wrist ganglion cysts, indicating potential merit in the surgeon's operative and postoperative techniques. (10.1177/1558944717751195)
  • [L4] The benign nature of the lesion, possibility of minimally invasive surgery in a large proportion of cases, good results of surgical treatment, and the low rate of complications following treatment make the outcome uniformly favorable in cases of intra-articular ganglion cysts of the knee. (10.1007/s00167-003-0476-2)
  • [L4] Total excision was associated with improved functional outcome and low risk of neurologic damage and local recurrence. (10.1097/corr.0000000000001329)

See Also

References

[1] Ganglions in the Hand and Wrist: Advances in 2 Decades. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-00105

[2] Percutaneous puncture of flexor sheath ganglions: an assessment of recurrence. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221115983

[3] Arthroscopic ganglionectomy of the foot and ankle. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2065-8

[4] Suprascapular nerve denervation secondary to attenuation by a ganglionic cyst.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668040-00025

[5] Wrist Ganglions. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.11.048

[6] Patient outcomes following wrist ganglion excision surgery. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193411434376

[7] Wrist Ganglion Treatment: Systematic Review and Meta-Analysis. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.014

[8] Anatomical location of volar wrist ganglion in preoperative MRI is a risk factor for operation-related complications after arthroscopic ganglionectomy. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08766-x

[9] Ganglions of the Wrist and Associated Triangular Fibrocartilage Lesions: A Prospective Study in Arthroscopically-treated Patients. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.04.042

[10] A Simple Physical Exam Maneuver to Distinguish Trigger Digit, Dupuytren’s Nodule, and Flexor Sheath Ganglion. HAND. 2022. DOI: 10.1177/15589447221109644

[11] Pediatric Ganglions of the Hand and Wrist: A Review of Current Literature. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.12.015

[12] Atraumatic, Progressive, and Painful Elbow Contracture From a Ganglion Cyst. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.06.005

[13] Radial artery injury caused by a sclerosant injected into a palmar wrist ganglion. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409105561

[14] Wrist Ganglion Cysts in Children: An Update and Review of the Literature. HAND. 2020. DOI: 10.1177/1558944720966716

[15] Necessity of Routine Pathological Examination After Surgical Excision of Wrist Ganglions. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.03.021

[16] Intra‐articular ganglion cysts of the knee joint: a report of 85 cases and review of the literature. Knee Surgery, Sports Traumatology, Arthroscopy. 2003. DOI: 10.1007/s00167-003-0372-9

[17] An intra‐articular knee cyst in a 2‐year‐old associated with an aberrant anterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy. 2006. DOI: 10.1007/s00167-006-0119-5

[18] Outcomes of Open Dorsal Wrist Ganglion Excision in Active-Duty Military Personnel. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.030

[19] Foot drop secondary to peroneal intraneural cyst arising from tibiofibular joint. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2194-0

[20] An Ulnar Intraneural Ganglion Arising From the Pisotriquetral Joint: Case Report. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.08.033

[21] A Ganglion Within the Ulnar Nerve and Communication With the Distal Radioulnar Joint via an Articular Branch: Case Report. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.08.008

[22] Combined Intra‐ and Extra‐articular Arthroscopic Treatment of Entrapment Neuropathy of the Infraspinatus Branches of the Suprascapular Nerve Caused by a Periglenoidal Ganglion Cyst. Arthroscopy. 2006. DOI: 10.1016/j.arthro.2005.10.022

[23] Wrist Ganglia in Children: Nonsurgical Versus Surgical Treatment. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.10.032

[24] A REPORT OF THREE CASES*. 1991.

[25] Intraneural Ganglions of the Hand and Wrist. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.025

[26] Natural History of Pediatric Hand and Wrist Ganglion Cysts: Longitudinal Follow-Up of a Prospective, Dual-Center Cohort. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.07.002

[27] Cystic soft tissue tumours of the dorsal aspect of the wrist have two distinct histological subtypes. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241251721

[28] Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.09.002

[29] Locked knee caused by intraarticular ganglion. Knee Surgery, Sports Traumatology, Arthroscopy. 2006. DOI: 10.1007/s00167-005-0017-2

[30] Prospective Outcomes and Associations of Wrist Ganglion Cysts Resected Arthroscopically. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.11.025

[31] Arthroscopic Resection of Dorsal Wrist Ganglion: Results and Rate of Recurrence Over a Minimum Follow-up of 4 Years. HAND. 2017. DOI: 10.1177/1558944717743601

[32] Volar wrist ganglion presenting as trigger finger. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412453699

[33] Arthroscopic Excision of Dorsal Wrist Ganglion: Factors Related to Recurrence and Postoperative Residual Pain. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.04.002

[34] Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison. HAND. 2021. DOI: 10.1177/15589447211003184

[37] Clinical Presentation and Characteristics of Hand and Wrist Ganglion Cysts in Children. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.02.026

[39] Nerve sheath ganglion of the tibial nerve presenting as a Baker's cyst: a case report. Knee Surgery, Sports Traumatology, Arthroscopy. 2006. DOI: 10.1007/s00167-006-0062-5

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