Ganglion Cyst Excision 25111

Volar wrist ganglion cyst image

Ganglion cyst fluid image
CPT Coding
 Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms:ganglion cyst excision

Ganglion Cyst Excision CPT

Ganglion Cyst Excision Indications

  • Painful ganglion which has failed conservative management

Ganglion Cyst Excision Contraindications

  •  

Ganglion Cyst Excision Alternatives

  • Aspiration
  • Conservative care

Ganglion Cyst Excision Pre-op Planning

Ganglion Cyst Excision Technique

Ganglion Dorsal Ganglion Technique

  • Supine, arm board, +/-antibiotics, turniquet, 3.5x loupe magnification
  • Transvers incision along Langer’s lines
  • Skin hooks for retraction, iris/tenotomy scissors
  • Mobilze circumferentially, retract extensor tendons(usually 4thcompartment)
  • Identify pedicle, dissect to origin(usually scapholunate ligament)
  • Excise portion of dorsal wrist capsule and small portion of scapholunate ligament with pedicle.
  • Irrigate wound
  • Sub-q closure, skin closure
  • 5cc 5% bupivicaine for post-op pain
  • Dorsal/palmar splint

Ganglion Volar Ganglion Technique

  • 65% arise form radioscaphoid joint near scapholunate interval, 34% from scaphotrapezial joint, 1% trapeziometacarpal joint.
  • Usually located radial to FCR tendon
  • Dissection may involve the palm, carpal tunnel, even dorsum of wrist due to extent of cyst
  • Protect palmar cutaneous branch of the median nerve and terminal branches of lateral antebrachial cutaneous nerve. 
  • Follow ganglion down to its origin and excise with small portion of capsule.
  • 30% chance of recurrence.

Ganglion Cyst Excision Complications

  • Cosmesis(scar)
  • Nerve injury
  • Decreased motion
  • Instability
  • We discussed the risks of ganglion excision including but not limited to: incomplete relief of pain, incomplete return of function, cosmesis (scar), infection, nerve or vascular injury, stiffness, wrist instability, CRPS and the risks of anesthesia including heart attack, stroke and death.
  • Infection
  • CRPS

Ganglion Cyst Excision Follow-up care

  • Post-op: volar splint
  • 7-10 Days: wound check.  Place in cock-up wrist splint for 2 weeks followed by gradual
  • 3 Weeks:
  • 6 Weeks:
  • 2 Months:
  • 3 Months:
  • 6 Months:
  • 1Yr:

Ganglion Cyst Excision Outcomes

  • @15% recurrence risk after dorsal ganglion excision
  • @30% recurrence risk after volar ganglion excision

Ganglion Cyst Excision Review References

  • Thornburg LE, JAAOS 1999;7:231