Vol. 13 Issue 4
Ganglion Cyst Aspiration
A simple ganglion cyst is a cystic tumor that develops on or in a tendon sheath. It is filled with a thick, gel-like material that leaks from the joint into the weakened tendon sheath and forms a cyst sac. A ganglion cyst is usually caused by frequent strains and contusions, resulting in joint inflammation.
The usual location is the back of the wrist, but a ganglion cyst can occur at any joint. Aspiration and injection of a ganglion cyst can diminish pain and promote joint mobility.
This procedure is contraindicated in any patient who is on anticoagulant therapy, has problems with clotting, has not responded to previous injections, or has sepsis or recent joint fractures.
As with any invasive procedure, informed consent is required. The patient must be informed of the risk of infection and recurrence, steroid flare 24 to 36 hours after injury, and subcutaneous atrophy. Necessary equipment is listed in Table 1.
Position the patient so that the ganglion cyst is accessible. Cleanse the skin in a 3-inch diameter area around the ganglion cyst with antiseptic skin cleanser. Drape the area with a fenestrated drape; put on sterile gloves.
Procedure and Post-Procedure Instructions
Using the 22- to 25-gauge needle on 3-mL syringe, draw up 2.5 mL of 1% to 2% lidocaine and 0.5 mL corticosteroid. Mix well by gently rotating the syringe back and forth.
Insert the empty 10-mL syringe with the 18-gauge needle into one side of the ganglion cyst (for aspiration), as shown in the figure accompanying this article. If no blood is present, aspirate the fluid from cyst. If the aspirate is cloudy, send it to the pathology laboratory for culture and sensitivity.
Insert the syringe with the medication into the other side of the ganglion cyst, and aspirate for blood. If blood is aspirated, remove the needle, and dress the wound. If no blood is present, inject the medication.
Remove both needles. Apply a pressure dressing.
After the procedure, instruct the patient to keep the wound covered for 8 to 12 hours and to rest and elevate the joint above the heart as much as possible for 24 hours. Advise the patient to take acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) every 4 to 6 hours as needed for pain.
Some degree of redness, swelling and heat are normal. However, if yellow or green drainage starts coming from the wound or red streaks develop, the patient should return to the office for evaluation.
Schedule a routine recheck for 1 week after the procedure. If the cyst recurs, surgical removal may be indicated.
To bill for this procedure, use the following current procedural terminology (CPT) codes:
• 20612 aspiration and/or injection of ganglion cyst(s) any location (for multiple ganglions, add modifier 59)
• 25111 excision of ganglion, wrist; primary
• 25112 excision of ganglion, wrist; recurrent
• 26160 excision of lesion of tendon sheath or capsule (e.g., cyst, mucous cyst or ganglion), hand or finger.
Margaret Colyar is a family and pediatric nurse practitioner who is co-director of the NP program at the University of Utah in Salt Lake City. She is an assistant professor and has a doctorate in nursing science. Reach her at Margaret.Colyar@nurs.utah.edu.