Publication:

A prospective comparative analysis of functional outcomes and recurrence rates in wrist ganglion cysts: excision versus aspiration versus threading

Background Wrist ganglion cysts are recognized as the most common benign soft-tissue tumors of the hand and wrist. Despite multiple available treatment modalities, there is no consensus regarding the optimal approach, particularly in resource-limited settings. This study aims to evaluate and compare the functional outcomes, complication profiles, and recurrence rates of three common treatments: surgical excision, aspiration, and threading.

Methods This prospective observational comparative study included 91 patients with symptomatic wrist ganglion cysts treated at a rural tertiary care teaching hospital. Based on patient preference and feasibility, participants were categorized into three intervention groups: surgical excision (n=37), aspiration (n=26), and the threading/transfixation technique (n=28). Outcomes were assessed using visual analog scale (VAS) pain scores, a 5-point patient satisfaction scale, recurrence rates, and operative parameters such as procedure time.

Results All treatment modalities achieved a significant reduction in postoperative pain, indicating comparable short-term symptomatic relief. However, long-term efficacy varied significantly; excision demonstrated the lowest recurrence rate at 5.4%, followed by threading at 14.3%, while aspiration showed a highly significant recurrence rate of 65.4%. Patient satisfaction was highest following excision (mean 4.86) and threading (4.68), and comparatively lower for aspiration (4.11). While excision required a longer procedural time (11.2 minutes), threading and aspiration were minimally invasive and faster (4.7 and 4.8 minutes, respectively).

Conclusions Surgical excision provides the highest patient satisfaction and lowest recurrence rate, reaffirming it as the definitive gold standard for treating wrist ganglion cysts. However, the threading technique emerges as a highly practical, minimally invasive alternative that successfully balances low recurrence with feasibility, making it especially valuable in resource-constrained environments. Aspiration, due to its significantly higher recurrence rates, is limited in its role as a definitive long-term treatment.