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Short-Term Immobilization Reduces Recurrence after Aspiration of Ganglion Cysts in Children: A Retrospective Study
Theodore Hyman, MD1, Matthew Seebald, B.S.1, Athena Zhang, MD1, Liara Ortiz Ocasio, BS1, Jessica R Ong, MD, PhD2, Albert K Oh, MD1; Gary F Rogers, MD, JD, MBA, LLM, MPH1
(1)Children's National Hospital, Washington, DC, (2)MedStar Georgetown University Hospital, Washington, DC

Introduction

Ganglion cysts are the most common benign masses of the pediatric hand1. While these can be successfully treated with needle aspiration, recurrence occurs in up to 80% of cases within two years2-a similar rate as cysts treated conservatively3. Temporary immobilization of the affected joint may reduce recurrence of aspirated ganglia4, but this has not been well-studied in pediatric patients. The present study retrospectively compares the rate of recurrence after ganglion aspiration in patients whose wrists were immobilized after aspiration to those that were not.

Materials & Methods

Patients under 18 years of age who underwent an initial aspiration of a ganglion cyst between 2004 and 2024 were included. Patients were excluded if they had experienced recurrence of a ganglion prior to aspiration, or if they were lost to follow up. Patients who were immobilized were placed in a short-arm fiberglass cast for three to four weeks after aspiration. Statistical analysis was conducted using Fisher's exact and Mann-Whitney U tests.

Results

N=44 patients underwent aspiration, n=35 with immobilization and n=9 without. Median follow-up for the entire cohort was 22.2 months, with no significant difference between cysts that did recur and those that did not (21.1 months vs 22.2 months, p=0.76). There was a significant difference in follow-up between the immobilization and non-immobilization groups (13.7 vs 39.5 months, respectively, p=0.04), as this practice has performed immobilization for all aspirations since 2019. Significantly fewer patients in the immobilization group reported recurrence of the cyst (n=9, 25.7%) than those who did not (n=6, 67%, p=0.02). In cysts that did recur, the median time from aspiration to recurrence was 4.0 months.

Conclusions

This is the first examination of efficacy of temporary immobilization after ganglion cyst aspiration in pediatric patients. Though retrospective, this study supports immobilization as a safe and effective means of reducing recurrence of aspirated ganglia in children.

References

  1. Zhou J, et al. Wrist Ganglion Cysts in Children: An Update and Review of the Literature. Hand N Y N. 2022;17(6):1024-1030. doi:10.1177/1558944720966716
  2. Colon F, Upton J. Pediatric hand tumors. A review of 349 cases. Hand Clin. 1995;11(2):223-243.
  3. Calif E, et al. Simple wrist ganglia in children: a follow-up study. J Pediatr Orthop B. 2005;14(6):448.
  4. Richman JA, et al. Ganglions of the wrist and digits: Results of treatment by aspiration and cyst wall puncture. J Hand Surg. 1987;12(6):1041-1043. doi:10.1016/S0363-5023(87)80108-9
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