Clinical Question: What is the natural history of ganglion cysts of the wrist?

Setting: Outpatient (specialty)

Study Design: Cohort (prospective)

Synopsis: Although ganglion cysts of the palmar wrist are quite common, the evidence base with which to guide treatment decisions is limited. The results from aspiration plus steroid infiltration are no better than those from aspiration alone. The authors wondered about the natural history of ganglion cysts. In this study, 155 of 233 patients referred to a hand surgeon for treatment of a palmar wrist ganglion cyst responded at two or five years to a mailed survey. Of the respondents, 38 patients were treated with aspiration, 79 patients were treated with surgical excision, and 38 patients were given reassurance alone. Outcomes were similar: 42 percent of excised cysts and 47 percent of aspirated cysts had recurred at the time of follow-up, while 53 percent of cysts that were not treated spontaneously disappeared.

Bottom Line: Although not a randomized trial, the results of this simple observational study show that approximately one half of ganglion cysts spontaneously resolve, and that approximately one half of surgically treated cysts recur. Thus, the net long-term benefit is similar whether the cysts are treated surgically or conservatively. (Level of Evidence: 4)