III. Preparation

  1. Needle: 18 to 22 gauge (1.5 inch)
  2. Anesthetic (in Syringe 1)
    1. Lidocaine 1%: 1-2 ml or
    2. Bupivacaine (Marcaine) 0.25% 1-2 ml
  3. Corticosteroid (in Syringe 2)
    1. Methylprednisolone: 20-40 mg or
    2. Celestone Soluspan: 1 ml or
    3. Triamcinolone 20-40 mg
  4. Other instruments
    1. Hemostat to hold needle while changing syringes

IV. Efficacy

  1. Aspiration alone as effective as aspiration + injection
  2. Recurrence rate after aspiration: 47%
  3. Dias (2003) J Hand Surg 28:172-6

V. Technique

  1. Joint position
    1. Hold joint in position that accentuates cyst
  2. Injection site
    1. Mark point of maximal cyst fluctuance
  3. Needle insertion and aspiration
    1. Apply antiseptic to skin (e.g. Betadine)
    2. Insert needle into cyst and aspirate fluid (1-2 cc)
  4. Corticosteroid Injection (questionable efficacy)
    1. Continued from needle insertion aspiration
    2. Consider not injecting Corticosteroid
      1. Not found to offer benefit over aspiration alone
    3. Apply hemostat to hold needle within cyst
    4. Replace anesthetic syringe with steroid syringe
    5. Inject Corticosteroid into cyst
  5. Needle removal and aspiration site care
    1. Remove needle and apply Bacitracin and bandage
    2. Apply ACE wrap over cyst site for 48 to 72 hours

VI. References

  1. Neustadt in Roberts (1998) Procedures, p. 912-13
  2. Pfenninger (1994) Procedures, Mosby, p. 1036-54
  3. Tallia (2003) Am Fam Physician 67(4):745-50

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