Published: 2019-04-26

Double intra venous cannula versus single needle technique of aspiration and methylprednisolone injection in the treatment of wrist ganglion: a comparative study

Siddharth Gupta, Rajesh K. Chopra, Mozammil Pheroz, Manish R. Gupta, Arvind Kumar, Gyanendra Puri, Surya V. Singh, Vikash K. Pandey


Background: Ganglion is the one of the common soft tissue swellings in the hand and wrist. Treatment options available include reassurance, nonsurgical means like aspiration with or without steroid or hyaluronidase injection and surgical or arthroscopic excision. All current treatment options produce suboptimal results. This study endeavours to compare the outcome and recurrence rate and other complications after treatment of wrist ganglion by aspiration and methylprednisolone injection by double Intravenous cannula versus single needle technique.

Methods: A prospective comparative clinical study was done with a total of 72 patients. 36 patients in group 1 were treated with double intravenous cannula technique and 36 patients in group 2 were treated with single needle technique. All the patients were followed up for 6 months to look for recurrence and any complication. The patient’s age, sex and various characteristics of the ganglion cyst like side, site, size, etc. were recorded.

Results: In group 1, recurrence was seen in 6 patients (15.7%) while in group 2, recurrence were seen in 14 (38.8%) patients. There was statistical significant difference between the two groups with p value of 0.04. No complication was seen in both groups due to methylprednisolone injection.

Conclusions: Inspired by the results we advise to use aspiration and methylprednisolone injection by double intravenous cannula technique in the treatment of wrist ganglion before any surgical intervention. It is safe, simple, cost effective method and is less invasive and less time consuming with recurrence rate comparable to surgical and arthroscopic interventions.


Ganglion, Intravenous cannula, Aspiration, Methylprednisolone, Recurrence

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Suen M, Fung B, Lung CP. Treatment of Ganglion Cysts. Int Scholarly Res Notices. 2013;2013:940615.

Nahra ME, Bucchieri JS. Ganglion cysts and other tumour related conditions of the hand and wrist. Hand Clin. 2004;20(3):249-60.

Stack HG. Tumours of the hand. Br Med J Part. 1960;1:919-28.

Angelides AC, Wallace PF. The dorsal ganglion of the wrist: its pathogenesis, gross and microscopic anatomy and surgical treatment. J Hand Surg Am. 1976;1(3):228-35.

Lowden CM, Attiah M, Garvin G, Macdermid J, Osman S, Faber K. The prevalence of wrist ganglia in an asymptomatic population: magnetic resonance evaluation. J Hand Surg [Br]. 2005;30:302-6.

Osterman AL, Raphael J. Arthroscopic resection of dorsal ganglion of wrist. Hand Clin. 1995;11(1):7-12.

Thornburg LE. Ganglions of the hand and wrist. J Am Acad Orthop Surg. 1999;7(4):231-8.

Sharma MM, Batra KM, Kakria H, Chandra R. Wrist ganglia-treatment by aspiration and methylprednisolone injection into the cavity with IV cannula needle -our experience in a rural teaching institution. Sch J App Med Sci. 2016;4:1366-70.

Dharamdas P, Nayak D, Mathur RK, Kushwah K. Double dart technique of instillation of triamcinolone in ganglion over the wrist. J Cutan Aesthet Surg. 2010;3(1):29-31.

Nield DV, Evans DM. Aspiration of ganglia. J Hand Surg Br. 1986;11(2):264.

Singhal A, Angmo N, Gupta S, Kumar V, Mehtani A. Ganglion cysts of the Wrist : a prospective study of a simple outpatient management. Acta Orthop Belg. 2005;71(5):528-34.

Faithfull DK, Seeto BG. The simple wrist ganglion- more than a minor surgical procedure. Hand Surg. 2000;5(2):139-43.

Richman JA, Gelberman RH, Engber WD, Salamon PB, Bean DJ. Ganglions of the wrist and digits and results of treatment by aspiration and cyst wall puncture. J Hand Surg. 1987;12(6):1041-3.

McEvedy BV. The simple ganglion. A review of modes of treatment and an explanation of the frequent failures of surgery. Lancet. 1954;263(6803):135-6.

Korkmaz M, Ozturk H, Senarslan DA, Erdogan Y. Aspiration and Methylprednisolone injection to the cavity with IV cannula needle in the treatment of volar wrist ganglia: New technique. Pak J Med Sci. 2013;29(1):103-6.