Ganglion cysts are sacs containing a gel-like fluid that can form over tendons and joints. They are commonly seen as visible lumps on the hand and back of the wrist. Ganglion cysts are not cancerous, and most are asymptomatic. But if a cyst puts pressure on a nerve, it can cause pain, tingling, and muscle weakness. Initial treatment of a ganglion cyst is not surgical. Observation may be recommended because half of ganglion cysts may disappear over time. Activity often causes the cyst to increase in size, and thus immobilization may be an option. If a ganglion cyst causes pain and limits activities, aspiration of the fluid may decrease pressure and relieve pain. Surgical excision may also be recommended if symptoms are not relieved or if the cyst recurs. Here, we present the case of a 51-year-old female who had a ganglion cyst on her right wrist. Treatment options were presented to the patient, and she opted to undergo aspiration over excision.
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This is a 51-year-old female with a mass on her wrist. Uh, she's had it as mentioned for, for 2-3 months, and it's just grown this size significantly. In this area, in this location, it's most likely what we call a ganglion cyst. It's- what's inside the cyst is normally- it's gel-like. Normally it's inside the sheath. So, for these types of, of lesions, I normally just do an aspiration. There are 3 ways to remove this mass. One is the normal excision. Another is just poking a needle, a big needle and aspirating the fluid inside. And the other one is what they call a... procedure. So, either of the 3 types of surgery. There are significant possibilities of recurrence. So I gave her the option, uh, to lessen the, the surgery. We could do a incision here, and will aspirate. And you can see some gel-like fluid, clear fluid, which will come out. Sometimes, uh, this, this type of procedure would be able to relieve her of the symptoms for, for many months to years. So, of course if you do the excision, it's a smaller chance of recurrence, but I think this should be, um, a simpler procedure for her for the moment.
So right here, um, there are no vessels, big vessels, which are important. Sometimes this ganglion cyst appears here, in front. If it's near the artery, radial artery, or either the other side, then you have to take precaution. So I just do it transversely, not really that angle, just to avoid any, any injuries underneath. So since it's a large one, I just go here. Okay. And then we poke inside. And then, you can aspirate, you can see this gel-like fluid, coming out. Just like the gel that we use for our hair. Then you can see the cyst here, it's almost gone. I tend to press a bit on the sides, avoid touching the needle because the needle will be painful. So I just press on the sides. So we try to get as much fluid inside as we can. Once you're done, just pull it out, and just apply pressure on the area. Okay? You can see here's the fluid, it's fluid filled. And you can see now, it's flat. Even if you ask her to do that, it's flat. Sometimes, the hole- if you still press a bit more, then sometimes some will come out, some fluid come out. So she should feel a little better for the next few months. Again, recurrence could be high, but in some of my patients, uh, it recurs after a couple of years, so I think this would be a simpler procedure- as doing an excision, make an incision here and removing it out, and the recurrence rate of either excision or aspiration are not that far away with regards to percentages.
So we just spray and then put a Band-Aid over it, and give her some medicines for discomfort and pain, if she needs.