Management of flexor tendon sheath ganglions: a cost analysis

The purpose of this study was to determine success rates of 1 or more aspirations on flexor tendon sheath ganglions compared with surgical excision and to determine what treatment method is most cost-effective. Data were collected from documented history and physical examinations, operative reports, billing records, and telephone interviews. Of the 259 patients coded as having flexor tendon sheath ganglions, 175 met the inclusion criteria. In addition, 2001 Medicare-assigned relative value units and fees were used to calculate the most cost-effective treatment. Of the 141 patients treated with aspiration, 66% exhibited no recurrence after 2 consecutive treatments. Thirteen of 14 patients (93%) who had ganglions excised without prior aspiration showed no recurrence. All 29 patients who had excision after 1 (n = 24) or 2 (n = 5) failed aspirations were cured. Because few patients require excision after 2 aspirations, the most cost-effective treatment for recurrent flexor tendon sheath ganglions is 2 aspirations before excision.