Ganglion Cyst Aspiration and Injection

Ganglion cysts are benign but can be annoying for patients. There are several acceptable approaches; no matter your choice, the recurrence rate is high.

You can:

1. Just aspirate it as best you can.
2. Inject hyaluronidase (not commonly available in acute care settings) and then aspirate.
3. Inject steroids after aspiration.
4. A combination of the above techniques.

This video shows a simple aspiration and a second patient who also got steroids. 

Once the skin is prepped and anesthetized, we can begin.

Hyaluronidase is not commonly available in acute care settings. Still, the described technique is to inject 150 units of (typically 1 mL) into the cyst with an 18-gauge needle and wait 10-20 minutes before aspiration. The concept here is that it will break down the viscous hyaluronic acid in the cyst, facilitating a more complete aspiration. This is also what’s used for dissolving unwanted dermal fillers in aesthetics. 

To aspirate, insert a 15-18 gauge needle on a 3 mL syringe into the cyst and aspirate as much fluid as possible. Apply manual pressure to “milk” the cyst contents as you aspirate. Expect the fluid to be thick and sticky. It may be less viscous if hyaluronidase is used.

Steroid injection is optional, and evidence of its efficacy is very mixed. Methylprednisolone and triamcinolone have both been described, and the dose is 10-20 mg. One of the risks of steroid injection is skin hypopigmentation. 

Apply pressure to the aspiration site and a bandage.

Peer Reviewed by Sean Nordt, MD, Jan Shoenberger, MD, Vanessa Cardy, MD, Anand Swaminathan, MD, Stuart Swadron, MD, and Mel Herbert, MD.