Ganglion Cysts: Treatment Options for Recurring Cases

Ganglion cyst

I have a cyst located between the tendons and bones in my calf and ankle joint.
I have already undergone surgery once, but it has recurred.
I have also tried acupuncture treatment with traditional Chinese medicine, but there has been no improvement.
Now, I experience soreness when walking.
Should I consider another surgery, or are there other treatment options available? Thank you.

Su Xiansheng, 40~49 year old female. Ask Date: 2015/07/29

Dr. Chen Yongxue reply Orthopedics

Hello, the recurrence rate of a ganglion cyst after surgery is quite high, averaging about 1 in 3.
If a second surgery is performed, the recurrence rate will be even higher.
Therefore, it is recommended that if your symptoms are not severe, you should coexist peacefully with it.

Reply Date: 2015/07/29

More Info

Ganglion cysts are fluid-filled sacs that commonly develop near joints or tendons, particularly in the wrist, hand, and ankle. They can vary in size and may cause discomfort or pain, especially if they press on nearby nerves or structures. When a ganglion cyst recurs after surgical removal, as in your case, it can be frustrating and concerning.

Treatment Options for Recurring Ganglion Cysts
1. Observation: If the cyst is not causing significant pain or functional impairment, some doctors may recommend a watchful waiting approach. Ganglion cysts can sometimes resolve on their own without intervention.

2. Aspiration: This is a minimally invasive procedure where a doctor uses a needle to withdraw the fluid from the cyst. While this can provide immediate relief, it does not guarantee that the cyst will not return. Aspiration is often used in conjunction with corticosteroid injections to reduce inflammation and help prevent recurrence.

3. Corticosteroid Injections: After aspiration, injecting a corticosteroid can help reduce inflammation and may decrease the likelihood of the cyst returning. However, this treatment is not always effective, and the cyst may recur.

4. Surgical Removal: If the cyst is recurrent and causing significant discomfort, surgical excision may be the best option. During surgery, the entire cyst and its stalk (the connection to the joint or tendon) are removed to minimize the chance of recurrence. It's important to discuss with your surgeon the reasons for the previous recurrence and what steps will be taken to prevent it from happening again.

5. Physical Therapy: If the cyst is affecting your mobility or causing pain, physical therapy may help strengthen the surrounding muscles and improve function. This can be particularly beneficial if the cyst is causing discomfort during activities like walking.

6. Alternative Therapies: While you mentioned trying acupuncture, other alternative treatments such as ultrasound therapy or herbal remedies may be explored. However, the effectiveness of these treatments can vary, and they should be discussed with your healthcare provider.

Considerations Before Surgery
Before deciding on another surgery, consider the following:
- Consultation with a Specialist: It may be beneficial to consult with an orthopedic surgeon or a hand specialist who has experience with ganglion cysts. They can provide insights into the likelihood of recurrence and the best surgical techniques to minimize this risk.

- Imaging Studies: Sometimes, imaging studies like ultrasound or MRI can help assess the cyst's characteristics and determine if there are any underlying issues contributing to its recurrence.

- Recovery Time: If you opt for surgery, be aware of the recovery time and rehabilitation process. Discuss with your surgeon what to expect post-operatively, including any restrictions on activity.

Conclusion
In summary, while surgery is a viable option for recurrent ganglion cysts, it is essential to weigh the benefits and risks of each treatment approach. Consulting with a healthcare professional who specializes in this area will provide you with the best course of action tailored to your specific situation. Remember, the goal is to alleviate pain and restore function while minimizing the chance of recurrence.

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