Modified thread technique, 2 threads 7 days in cases of wrist ganglions: a case series

Ganglion cysts are soft tissue swellings occurring most commonly in the hand or wrist, they are usually asymptomatic. The 70% cases of ganglion are observed on the dorsal side of wrist. Ganglion cysts arise from mesenchymal cells at the synovial capsular junction as a result of the continuous micro-injury. Ganglion cysts have a recurrence rate of approximately 15% to 20%. Gang et al introduced the technique of treating ganglion by passing a silk thread to induce chronic inflammation leading to obliteration of the cyst. Three cases with wrist swelling without tenderness. On examination swelling is firm consistency, slightly mobile, not adherent to underlying or overlying structures, without local rise of temperature. Ultrasonography has confirmed the diagnosis of ganglion cyst. Modified thread technique has been planned. Patient has been followed on day 3, 5, 21, 90th day. Patient has no suture site complications, with no recurrence on 3 month follow up. The cyst was stabilised and a sterile silk/linen thread on a cutting needle was passed through the cyst and taken out from the opposite side from 3 O’clock to 9 O’clock position. Second thread was passed perpendicular to first one from 12 O’clock to 6 O’clock position. The contents of ganglion were expressed out by firm pressure. Thread was removed on the seventh day irrespective of presence or absence of yellowish discharge. Patients were followed up on the fifth day after thread removal. Patients were then followed at monthly intervals for first three months. Non-surgical techniques used are aspiration, sclerotherapy, steroid injection, hyaluronidase injection, immobilization and thread technique. These have high recurrence rates. Surgical excision has lower recurrence rates, but they have a high complication rate. The thread technique is being considered as a newer option since it has recurrence rates comparable to surgical excision and complication rates comparable to nonsurgical techniques.