II. Indications
III. Preparation
- Needle: 18 to 20 gauge (1.5 inch)
-
Anesthetic (in Syringe 1)
- Lidocaine 1%: 1-2 ml or
- Bupivacaine (Marcaine) 0.25% 1-2 ml
-
Corticosteroid (in Syringe 2, optional and questionable efficacy)
- Methylprednisolone: 20-40 mg or
- Celestone Soluspan: 1 ml or
- Triamcinolone 20-40 mg
- Other instruments
- Syringe 10 to 20 ml for cyst aspiration
- Hemostat to hold needle while changing syringes
IV. Efficacy
- Aspiration alone is as effective as aspiration and injection
- Recurrence rate after aspiration: 47%
- Dias (2003) J Hand Surg 28:172-6 [PubMed]
V. Technique
- Joint position
- Hold joint in position that accentuates cyst
- Injection site
- Mark point of maximal cyst fluctuance
- Needle insertion and aspiration
- Apply antiseptic to skin (e.g. Betadine)
- Insert needle into cyst and aspirate fluid (1-2 ml or more)
- May fenestrate the Ganglion Cyst wall in multiple locations
-
Corticosteroid Injection (questionable efficacy)
- Continued from needle insertion aspiration
- Consider not injecting Corticosteroid
- Not found to offer benefit over aspiration alone
- Apply hemostat to hold needle within cyst
- Replace Anesthetic syringe with steroid syringe
- Inject Corticosteroid into cyst
- Needle removal and aspiration site care
- Remove needle and apply Bacitracin and bandage
- Apply ACE wrap over cyst site for 48 to 72 hours
VI. References
- Neustadt in Roberts (1998) Procedures, p. 912-13
- Pfenninger (1994) Procedures, Mosby, p. 1036-54
- Pujalte (2024) Am Fam Physician 110(4): 402-10 [PubMed]
- Tallia (2003) Am Fam Physician 67(4):745-50 [PubMed]