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The purpose of this study was to examine the behavior of ganglia of the hand and wrist in young children treated without surgery. Fourteen consecutive children, less than 10 years of age, who presented with cysts of the hand and wrist were followed up by a single surgeon. The average age of the patient at the time of diagnosis was 38 months (range, 2 months to 9 years 3 months). The masses included 7 retinacular cysts, 5 volar wrist ganglia, and 2 dorsal wrist ganglia. These cysts had been present for an average of 3.3 months (range, 1-12 months) before medical advice was sought. None of the cysts were painful. Follow-up averaged 33 months (range, 9-112 months), with 79% of all cysts spontaneously resolving, the majority within a year. We believe that a child presenting with a benign hand lesion characteristic of a ganglion cyst should initially be treated by observation.

This study examined the treatment of anterior wrist ganglions by aspiration and injection or surgical excision. Eighty-four patients treated for an anterior wrist ganglion were studied, with an average followup period of 5 years. Initial treatment by aspiration and injection with corticosteroid was performed in 24 patients, with recurrence in 20. A second aspiration and injection was associated with recurrence in all. Of the 72 patients who underwent surgical excision 14 experienced a recurrence of the ganglion. Four patients with a recurrence underwent a second surgical procedure with successful excision in two patients. The origin of the majority of surgically treated ganglions was on the scaphotrapeziotrapezoid joint and radiocarpal joint. Because of a large number of recurrences after nonoperative treatment, surgical excision is recommended as the primary definitive treatment for anterior wrist ganglions Aspiration and injection may provide palliative relief of symptoms.

In a prospective study 69 carpal and digital ganglions were aspirated, multiply punctured, and digitally ruptured. Fifty percent of the wrists and digits were immobilized for 3 weeks and 50% were mobilized early. Follow-up was 1 year. Immobilization in our study did not significantly improve the results of treatment. During the course of the study, 51% of all ganglions did not recur. The outcome was successful in 52% of the wrists and digits that were immobilized and in 50% of those that were not. Forty-six percent of the dorsal carpal ganglions did not recur. Treatment was successful in 48% of dorsal carpal ganglions in which the wrists were immobilized and in 45% of those that were not. Similar percentages were found for palmar and digital ganglions. From our results, we conclude that immobilization does not significantly improve the successful treatment of ganglions over perforation and aspiration alone.

A prospective study has shown that aspiration treatment of ganglion cysts of the wrist and hand can safely remove 85% of these tumors if one, two or three separate treatments are administered. There is a decided cost savings when this treatment is compared with surgical excision, even when the expense of surgical excision for aspiration treatment failures is added to the equation.