Aspiration of wrist ganglion cysts: a scoping review of aspiration alone versus aspiration with intralesional corticosteroid injection and implications for contemporary ultrasound-guided practice.

OBJECTIVES: To map the extent, nature and quality of the available comparative literature evaluating aspiration alone versus aspiration with intralesional corticosteroid injection for wrist ganglion cysts, and to identify evidence gaps relevant to contemporary ultrasound-guided practice. Given the anticipated scarcity of comparative studies, the review aimed to characterise the evidence base rather than determine treatment superiority.

MATERIALS AND METHODS: Given the anticipated scarcity and heterogeneity of comparative studies, a scoping review was conducted in accordance with the PRISMA-ScR framework. Embase, PubMed and Google Scholar were searched from inception, with additional studies identified through citation tracking. Comparative studies involving adults with wrist ganglion cysts managed by aspiration alone or aspiration combined with corticosteroid injection, with or without image guidance, were included. Studies comparing aspiration-based treatments with surgical excision were included for contextual mapping only. Two published systematic reviews were used exclusively as secondary contextual evidence. No meta-analysis was performed.

RESULTS: Database searches identified 335 records, with one additional record identified from other sources. After duplicate removal, 219 records were screened; 35 full-text articles were assessed; and 10 studies were included. Only two studies directly compared aspiration alone with aspiration plus corticosteroid injection. These studies reported conflicting findings regarding recurrence and were insufficient to permit definitive conclusions regarding the effect of adjunct corticosteroid injection. Contextual comparative studies consistently reported higher recurrence rates following aspiration-based treatments compared with surgical excision. Evidence derived from radiology-led or ultrasound-guided practice was limited.

CONCLUSION: The evidence directly comparing aspiration alone with aspiration plus intralesional corticosteroid injection for wrist ganglion cysts is sparse, dated, and methodologically heterogeneous. The available direct comparative evidence is insufficient to determine whether adjunct corticosteroid injection reduces recurrence following wrist ganglion aspiration. The principal finding of this review is the scarcity of high-quality comparative studies, particularly within contemporary ultrasound-guided practice. This evidence gap supports the need for adequately powered prospective comparative studies before robust treatment recommendations can be made.