Minimally Invasive Treatment of Ganglion for Rural Surgeons

By Dr. Nandamani Chongtham MBBS, DNB [Rural Surgery] and Dr. J. Gnanaraj MS, MCh [Urology], FICS, FIAGES, FARSI


A ganglion is a synovial cyst filled with myxoid secretion and is commonly known as Gideon’s disease, Bible cyst or Bible bump (1). It is a non-neoplastic soft tissue lump occurring around joints and tendons. It is caused by leakage of fluid from the joint to the surrounding tissue. Although the average size is about 2 cm, it can grow larger, and cysts of greater than 5 cm are usually excised (2). All the modalities of treatment including excision, drainage and corticosteroid injection and rupture (2, 3, 4) have a high incidence of recurrence, which could be as high as 50% for surgical treatment and 60% for aspiration.

We describe the minimally invasive method of aspiration of the ganglion, followed by tetracycline injection, thus sclerosing the cyst.


The injection fluid is prepared by mixing 500 mg of tetracycline powder (from a tetracycline capsule) in 100 ml of water for injection, under sterile conditions (Figure 1).

injection fluid 1 injection fluid 2
Figure 1: The preparation

The local site is prepared as for regular surgery, by cleaning and draping. The fluid inside the ganglion is aspirated with thick (18F) needle, and the prepared tetracycline solution is injected back into the ganglion (Figure 2).

injected back into the ganglion 1 injected back into the ganglion 2
Figure 2: Aspiration and injection

The amount injected varies with the size, and the ganglion is back to the original size. A compression dressing is then applied, and the patient is sent home with analgesics. Some patients required anti-inflammatory agents. A single dose of Inj. Ceftriaxone was given for prophylaxis before the procedure.

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