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Subject: Wrist Ganglia Aspiration and Injection
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Needle (25 gauge, 1
inch long) on a 3-mL syringe with 2 mL of
1% lidocaine with epinephrine (for
Needle (18 gauge, 1.5
inches long) on a 5 mL syringe (for aspiration)
Methylprednisolone acetate (Depo-Medrol;
0.4 mL [10 mg]) and 1.6 mL of 1% lidocaine without epinephrine in a 3-cc syringe (for
Ganglia over the wrist
that cause limitation of motion, pain, weakness, or
ganglia or infectious concerns (no injection of steroid if
Ganglia for which
patients select nonsurgical intervention for cosmetic
Presence of septic
arthritis or bacteremia
PITFALL: The location of the radial artery
is particularly important in the assessment of volar wrist
ganglia because they may be intimately associated with or
adjacent to this vessel.
PEARL: Insertion of a large-bore needle
for aspiration later in this procedure is painful. This pain
is alleviated by prior intradermal injection of
1% lidocaine at
the site where the aspiration needle is to be inserted.
PITFALL: Movement of the large needle when
replacing syringes can make the procedure very uncomfortable
and may dislodge the needle tip from inside the cyst.
PEARL: Keep the needle tip immobile by
maintaining a firm grasp on the needle hub, and by bracing
(anchoring) the hand or hemostat holding the needle on the
patient’s wrist or forearm.
PITFALL: Care must be taken to avoid the
radial artery during injection of a volar wrist ganglion
because injury to this vessel may potentially compromise
circulation to the hand.
Ganglion recurrence is
the most common complication following treatment.
nerve and tendon injury, scarring, and vascular injury are
Joint stiffness and
decreased range of motion may also occur.
Skin and fat atrophy
and thinning, as well as hypopigmentation are possible because
of the superficial position of ganglia.
Depending on anatomic
location, injury to the superficial sensory branch of the radial
nerve is a potential complication following dorsal ganglion
injection, whereas injection of a volar ganglion can cause a
radial artery injury.