The authors performed a prospective cohort study to assess the long-term outcome of three different treatment alternatives for palmar wrist ganglia; reassurance, aspiration, and surgical excision. One hundred and fifty-five patients agreed to complete an outcome survey 2 and/or 5 years after treatment. Thirty-eight of these patients underwent reassurance alone, 38 patients had the cyst aspirated, and 79 patients had the cyst excised. Forty-two percent of the excised ganglia and 47% of the aspirated ganglia recurred at follow-up, whereas 51% of the untreated ganglia disappeared spontaneously. Significantly more patients in the reassurance group described the persistent ganglion as unsightly, whereas no differences in symptoms were reported between the 3 treatment groups. The authors concluded that the main benefit of either aspiration or surgical excision is improved wrist cosmesis.
There is relatively little information in the English language literature on the expected outcome of untreated palmar wrist ganglia. Different rates of cyst recurrence have been published following both aspiration and surgery. Surgery remains a valuable treatment alternative, particularly when a ganglion is symptomatic and impinging upon local anatomic structures. However, volar ganglion excision is not always a “simple” procedure and there is potential surgical morbidity (radial artery, palmar cutaneous branch of the median nerve, etc.) and a relatively high recurrence rate has been reported. The seemingly higher recurrence rate in this study may be partly attributed to differences in operative technique among the participating surgeons. Additionally, patient self-assessment rather than follow-up examination defined recurrence.
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