Nonsurgical treatment of ganglion cyst in the dorsal wrist: randomized clinical trial comparing aspiration versus aspiration and infiltration of corticosteroids

Abstract

Ganglion cyst is the most common tumor of the hand and wrist, representing around 70% of soft tissue tumors found in this segment of the body. It is a benign tumor, there is no description in the literature of malignant transformation. Clinically is mostly asymptomatic. On physical examination, there is a visible and palpable mass, volume and consistency variable and not adherent to the skin. Surgical resection is considered the definitive treatment for ganglion, but may be associated with neurological injuries and painful scars. As a result, non-surgical procedures gained supporters, and are common practice in the treatment of wrist ganglions. Among the conservative treatment options, the most popular are isolated aspirations or followed infiltration of corticosteroids. In literature there are several articles published regarding the efficacy of these two methods, but most of them show considerable divergence of results, and poor methodology. As a result of this knowledge gap, we propose a prospective, randomized study to evaluate the success rate of these two methods, being able to assert if there is a superior method compared to another. The proposed study gains relevance because the use of corticosteroids had theoretical foundation in reducing inflammation. Although the inflammatory etiology had already been departed. Added to this, there is still the fact of infiltration of steroids can cause subcutaneous atrophy and skin depigmentation. Therefore, if the use of corticosteroids is clinically superior, its use is justified, otherwise, isolated aspiration tends to cause fewer collateral effects. Our goal is to compare the effectiveness of non-surgical treatment of dorsal wrist ganglion puncture with aspiration versus aspiration and infiltration of corticosteroids, in the rate of healing and recurrence of ganglions. The sample will consist of patients with ganglions of the dorsal wrist, single, no other injuries in this segment. The diagnosis is clinical, and performed by routine physical examination (palpation) and radiography (to exclude the presence of intraosseous cysts). The inclusion criteria are: age over 15 years, with no other wrist injuries, without allergy to corticosteroids and not forming chronic use of corticosteroids. The exclusion criteria are under 15 years old, history of previous surgery for resection of ganglions, presence of intraosseous ganglion - or any other injury to the wrist - chronic use of corticosteroid and / or allergy to corticosteroids. Patients will be allocated randomly into two groups: Group 1: will undergo aspiration; and Group 2 will undergo aspiration followed by corticosteroid infiltration. All cases will be treated in the outpatient clinic, a hospital or surgical setting to achieve the procedures. In relation to follow-up, no patient will be immobilized, and all will return in one month, two months, three months and six months after the procedure. On all returns will be evaluated patients' pain complaints and recurrence of the ganglion. In relapse, patients will be asked about the motivation of performing the procedure again. Both group A and for group B, a maximum number of three aspirations and / or infiltration, according to the randomization performed initially be conducted, as the current literature is unanimous in stating that successive episodes of aspiration of the ganglion did not increase the success rate of patients procedures. All sign a term of informed consent, and may leave the study, as well as changing the therapeutic option, at the time they choose. Such patients will be excluded from the final sample. (AU)