Surgery for ganglion cyst

This is a summary of the NHS Devon commissioning policy for surgery for ganglion cyst.

Supporting referral guidelines

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Signs and Symptoms

A ganglion cyst arises when the synovial fluid leaks out of a joint or tendon tunnel and forms a swelling beneath the skin. The cause of the leak is generally unknown. Ganglion cysts occur most frequently on the hand or wrist. Ganglion cysts may also occur on the knee, ankle or foot but these cases are comparatively rare.

Long-term follow-up studies of patients with untreated ganglia of the wrist report that approximately 40% of ganglia resolve spontaneously. Surgery may initially be successful in a high proportion of patients, however, recurrence rates of up to 20% have been reported depending on the location of the ganglion and duration of follow-up. Two studies suggest there is little difference in symptoms in the long term between patients who underwent surgery and patients whose ganglion was left untreated. Complication rates vary according to the type of surgery and are reported to range from 5% to 10% of procedures.

Limited information is available for the outcome of surgery in patients with ganglion cysts of the lower limbs. Lower recurrence rates were reported during long-term follow-up of patients with ganglion cysts of the lower limb compared with the figures reported for ganglia of the wrist but there are fewer studies of lower limb ganglion cyst and these studies have small numbers of patients.

Referral Criteria

Wrist ganglia

Treatment for a ganglion cyst will be routinely commissioned only if it is causing pain, tingling or numbness
Initial treatment is by aspiration
Surgical excision of a ganglion cyst will be routinely commissioned only if aspiration fails to resolve the tingling, numbness or significant pain and there is significant functional impairment*

Seed ganglia

Treatment for seed ganglia will be routinely commissioned only if they are painful
Initial treatment is to puncture/aspirate the ganglion
Surgical excision will be routinely commissioned only if a ganglion persists or recurs after puncture/aspiration

Mucoid (myxoid) cysts at distal interphalangeal joint (DIP)

Surgery will be routinely commissioned only if a mucoid (myxoid) cyst is causing significant functional impairment* or pain, or there are cysts that discharge

Lower limb ganglion cyst

Surgery will be routinely commissioned only if a ganglion cyst is causing significant pain or significant functional impairment*

*Significant functional impairment is defined as a loss or absence of an individual's capacity to meet personal, social or occupational demands.

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of NHS Devon upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Exceptional /Individual Funding Requests (IFR)

NHS Devon CCG commissioning policy: Surgery for ganglion cyst