Surgical Excision Versus Aspiration Combined with Intralesional Triamcinolone Acetonide Injection Plus Wrist Immobilization Therapy in the Treatment of Dorsal Wrist Ganglion; A Randomized Controlled Trial

Ganglion is the most common benign soft tissue tumour of hand and represents about 60-70% of all such soft tissue tumours. Treatment options include observation, aspiration, intralesional steroids and surgical and arthroscopic excision. Aspiration with intralesional steroid, with its many advantages, may be an alternative choice for its treatment but the operative treatment is the best method when considering the recurrence rate. Objective: To compare the result of surgical excision versus aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization therapy in the treatment of dorsal wrist ganglion. Study period: November 2007 to October 2009. Participants: 36 patients above 15 years of age, having the disease for first time, having no history of wrist injury and with no history of use of steroid or any allergy to it, were selected for the study. Setting: The study was undertaken at SKIMS Medical College Hospital, Bemina Srinagar Kashmir. Patients were randomly allocated to undergo either surgical excision (group A, n=18) or aspiration combined with intralesional triamcinolone acetonide injection plus wrist immobilization (group B,n=18) using table of random numbers. All the patients were operated under local anaesthesia. Fisher-exact-test, Chisquare test were used for statistics. The success rate of surgery was 94.4% and that of aspiration with triamcinolone acetonide injection plus wrist immobilization was 61.1%. The difference in success rate was statistically significant (p=0.041). Surgery is the most successful form of treatment when considering the cure rate of dorsal wrist ganglion.