I have a ganglion cyst that comes and goes. But when it comes, it hurts like gang-busters. I’ve had it aspirated several times and now I’m going to have it surgically removed. My next decision is how to do the operation. Do you think it matters if it’s done with the open method versus arthroscopically?

A ganglion that isn’t painful and doesn’t interfere with activity can often be left untreated without harm to the patient. However, treatment options are available for painful ganglions or one like you have that causes problems. Altered sensation and loss of hand function can interfere with daily activities, self-care, and work or play.

Before treating it, there are three things to know about wrist ganglions. First, they don’t get much worse than what you are experiencing now. The medical term for that idea is limited morbidity of the lesion. Second, left alone, they often go away on their own. And third, even if you have them surgically removed, they often come back.

Treatment consists of reassurance that nothing needs to be done, aspiration, or surgical removal. Aspiration involves placing a needle into the cyst and removing any fluid inside. As you know, surgery can be done two ways: open incision or the less invasive arthroscopic approach.

Which treatment approach has better results? A review of studies done shows that even with equal results between doing nothing and having surgery or aspiration, patients who have the cyst removed or aspirated are happier (more satisfied) with the results than patients who accept reassurance alone.

The cyst comes back more often with aspiration compared with surgery. There’s some evidence that surgery works better because the surgeon can get all the way down to the stalk of the cyst. The stalk is where it connects into the tissue and draws synovial fluid from the joint. Recurrence rate after open versus arthroscopic surgery is fairly even (slightly more with arthroscopy).

Surgery (when it is done) may not be 100 per cent “successful” if success is defined by everything is perfect and the cyst never comes back. But the reality is that at least one out of every 10 patients who have a ganglion cyst surgically removed experience recurrence of the problem. Some studies report an even higher than 10 per cent incidence of recurrence after surgical removal (up to 39 per cent recurrence rate).

That doesn’t really answer your question because there isn’t enough evidence from high-quality studies to point to one approach as being superior to the other. Surgeons agree that more research into this problem is really needed.

It’s important to be able to sort through all the patient variables and find the right treatment for each person. Your surgeon may be able to shed some light on your situation that will guide you in this final decision.