Wrist Ganglia in Children: Observation or Surgery?

Objective: his study evaluated 2 groups of children with wrist ganglia. One group was treated with observation and the other with surgery. We compared how often cysts resolved in those treated with observation to how often the cysts recurred after surgery. Together, this information can guide the clinician on rational treatment.

Methods: For the past 10 years, patients that were seen in the healthcare plan Clalit in Jerusalem, were treated with observation alone. At Shaare Zedek Medical Center, patients were referred for surgical treatment. Charts were identified for children 17 years of age or less with follow-up for at least one year.

Results: There were 90 patients analyzed, 50 in the observation group and 40 in the surgical group. Average follow-up was 44 months (12-83) in the observation and 80 months (13-282) in the surgical group.

Observation Group: In the children treated with observation, 52% of the cysts persisted or resolved then recurred. In those that resolved, nearly all did so by 18 months from when the cyst first appeared. 64% of patients had some complaints of pain of which 38% were reported as moderate or severe. The average QuickDASH was 15.

Surgical Group:

In the children treated with surgery, 12.5% had recurrence of the cyst after surgery. 40% of patients had some complaints of pain of which 30% were reported as moderate or severe. 10% reported persistent wrist stiffness and 15% had some scar complaints. The average QuickDASH was 12.

Conclusions: With a child that presents with a wrist ganglion cyst, we recommend an observation period of 18 months after which surgery is a reasonable option.

The observation group had an unexpectedly high rate of persistent pain and persistent cyst. The surgical group had a low rate of recurrence but had post-surgical complaints of stiffness and scar complaints.