General Guideline Principles for Ganglion Cyst
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Ganglion Cyst.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Ganglion Cyst of Hand, Wrist and Forearm Injuries 1

Most ganglion cysts are asymptomatic and can develop in any joint of the hand or wrist. They make up between 50 and 70 percent of all wrist masses. Giant cell tumours, also referred to as localised nodular tenosynovitis and fibrous xanthoma, epidermal inclusion cysts, and fibromas, are some additional causes.

Diagnostic Studies of Ganglion Cyst

1. Diagnostic Studies of Ganglion Cyst X-Rays

   Diagnostic Studies of Ganglion Cyst X-Rays are recommended Typically, physical exam results serve as the basis for the diagnosis. Typically, aspiration of mucinous fluid from the mass confirms the diagnosis.

   Indications – to assess patients with ganglia resulting from trauma in order to (fractures, dislocations, and sprains)

   Frequency/Duration – Typically, one set of x-rays is enough.

    

2. Diagnostic Studies of Ganglion Cyst

   Diagnostic Studies of Ganglion Cyst X-Rays is not recommended to assess the non-traumatic dorsal or volar wrist ganglia routinely

    

3. MRI of Ganglion Cyst

    

   • MRI of Ganglion Cyst

     MRI of Ganglion Cyst is not recommended for routine assessment of suspected occult dorsal or volar wrist ganglion in wrist pain.

      

   • MRI of Ganglion Cyst

     MRI of Ganglion Cyst is recommended when an occult ganglion cyst is suspected in a select group of patients who have persistent pain for at least three weeks that is not responding to treatment (injections or splinting)

     Rationale for Recommendation- In order to decide on the best course of treatment, MRI may be useful in differentiating between ganglion and synovitis

      

4. Ultrasound of Ganglion Cyst

    

   • Ultrasound of Ganglion Cyst

     Ultrasound of Ganglion Cyst is not recommended and is typically not advised for the evaluation of occult dorsal or volar wrist ganglion suspected in chronic wrist pain.

      

   • Ultrasound of Ganglion Cyst

     Ultrasound of Ganglion Cyst is recommended if an MRI is not recommended for the evaluation of recurrent wrist pain with suspected occult dorsal or volar wrist ganglia (MRI is preferred).

Medications of Ganglion Cyst

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients.

For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even though the majority of research indicates it is only marginally less effective than NSAIDs. There is proof that NSAIDs are less dangerous and just as effective at treating pain as opioids, such as tramadol.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Wrist Ganglia Pain

   Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Wrist Ganglia Pain are recommended for the treatment of wrist ganglia pain that is either chronic or subacute.

   Indications – NSAIDs are advised as a treatment for wrist ganglion pain that is acute, subacute, or chronic. First, try over-the-counter (OTC) medications to see if they work

   Frequency/Duration: Many patients might find it reasonable to use as needed.

   Indications for Discontinuation: the symptom’s resolution, the medication’s ineffectiveness, or the emergence of side effects that require stopping.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended for patients at high risk of gastrointestinal bleeding to take misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors concurrently

   Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a longer course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

   Frequency/Dose/Duration: H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

   Indications for Discontinuation: Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

   The advantages and disadvantages of NSAID therapy for pain should be discussed with patients who have a history of cardiovascular disease or who have multiple cardiovascular risk factors.

    

   • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

     NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended As far as adverse cardiovascular effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options.

      

   • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

     NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended If necessary, non-selective NSAIDs are preferred to COX-2-specific medications. To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in patients receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.

      

4. Acetaminophen for Treatment of Wrist Ganglia Pain

   Acetaminophen for Treatment of Wrist Ganglia Pain is recommended for the treatment of wrist ganglia pain, especially in patients who have NSAID contraindications.

   Indications: Acute, subacute, chronic, and post-operative wrist ganglia pain in all patients.

   Dose/Frequency: As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of hepatic toxicity.

   Indications for Discontinuation: pain, side effects, or intolerance are gone.

    

5. Opioids

   Opioids are not recommended for radial nerve entrapment pain that is either acute, subacute, or ongoing.

Treatments of Ganglion Cyst

1. Conservative Management for Acute Asymptomatic Wrist and Hand Ganglia

   Conservative Management for Acute Asymptomatic Wrist and Hand Ganglia is recommended given that the natural history for spontaneous resolution is greater than 50% and that most other treatment methods have a high recurrence rate, as first-line management for asymptomatic ganglia.

   Rationale for Recommendation – It is reasonable to reassure asymptomatic patients that a mass they have is benign and that waiting is a reasonable option because most benign masses naturally resolve without treatment.

    

2. Aspiration (without Other Intervention) for Ganglia Related Pain

   Aspiration (without Other Intervention) for Ganglia Related Pain is recommended because it might cause ganglia-related pain to manifest right away.

   Duration – The suggested aspiration is one. No advice is given regarding the number of times aspiration should be tried before moving on to other interventions.

    

3. Aspiration with Steroids

   Aspiration with Steroids is not recommended the addition of steroids with aspiration.

    

4. Aspiration and Multiple Punctures of Cyst Wal

   Aspiration and Multiple Punctures of Cyst Wall are not recommended because it does not offer more advantages over simple aspiration.

    

5. Immobilisation

   Splinting after Aspiration for Acute or Subacute Dorsal or Volar Wrist Ganglia

   Splinting after Aspiration for Acute or Subacute Dorsal or Volar Wrist Ganglia are not recommended when treating acute or subacute dorsal or volar wrist ganglia with aspiration.

Rehabilitation of Ganglion Cyst

The need for rehabilitation (supervised formal therapy) following a work-related

Injury treatment should concentrate on regaining the functional capacity necessary to meet the patient’s Trying to get the injured worker back to normal daily and work activities and return to pre-injury status, to the extent that is possible.

Active therapy calls for the patient to put forth an internal effort to finish a particular exercise or task. The interventions known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their part.

Passive interventions are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Interventions that are active should be prioritised over those that are passive.

To extend the therapeutic process and maintain improvement levels, the patient should be advised to continue both active and passive therapies at home.

To facilitate functional gains, assistive devices may be used as an adjunctive measure in the rehabilitation plan.

Therapy: Active of Ganglion Cyst

1. Therapeutic Exercise – Acute

   Therapeutic Exercise – Acute is not recommended for acute ganglion cyst

   Rationale for Recommendation – In general, acute exercise is not recommended; however, recovery or post-operative phases may require exercise. Increased grip strength, key pinch strength, range of motion, and the development of work skills should all be considered functional goals.

    

2. Therapeutic Exercise – For Residual Deficits

   Therapeutic Exercise – For Residual Deficits is recommended especially after surgery

   Frequency/Dose/Duration –With documentation of ongoing objective functional improvement, the total number of visits may be as low as two to three for patients with mild functional deficits or as high as 12 to 15 for those with more severe deficits.

   If there is evidence of functional improvement toward specific objective functional goals, more than 12 to 15 visits may be necessary when there are persistent functional deficits (e.g., increased grip strength, key pinch strength, range of motion, advancing ability to perform work activities). A home exercise programme should be created as part of the rehabilitation strategy and carried out alongside the therapy.

Injection Therapy of Ganglion Cyst

1. Hyaluronidase Instillation after Aspiration

   Hyaluronidase Instillation after Aspiration is not recommended after aspiration, hyaluronidase is inserted into the cystic structure.

    

2. Aspiration and Sclerosing Agents

   Aspiration and Sclerosing Agents are not recommended use of sclerosing substances like phenol and hypertonic saline, which, when injected, are meant to cause scarring and close the cystic potential space

Surgery of Ganglion Cyst

Surgical Excision for Subacute or Chronic Wrist Gangli

Surgical Excision for Subacute or Chronic Wrist Ganglia are recommended for the treatment of subacute or chronic wrist ganglia in some patients.

What our office can do if you have a Ganglion Cyst

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.