FIGURE 6.45 Dorsal wrist ganglion cyst.

PATIENT POSITION

Supine on the examination table with the head of the bed elevated 30 degrees.
For ganglion cysts over the dorsal aspect, the wrist is held in pronation and slight flexion.
The wrist is supported with the placement of chucks pads or towels.
Rotate the patient’s head away from the side that is being injected. This minimizes anxiety and pain perception.

LANDMARKS

1. With the patient supine on the examination table, the clinician stands lateral to the affected wrist.

2. Identify the cystic structure over the dorsal aspect of the wrist joint.

3. The injection point is located directly over the cyst.

4. At that site, press firmly on the skin with the retracted tip of a ballpoint pen. This indention represents the entry point for the needle.

5. After the landmarks are identified, the patient should not move the wrist.

ANESTHESIA

Local anesthesia of the skin using topical vapocoolant spray.

EQUIPMENT

3-mL syringe
18-gauge, 1½ in. needle
One alcohol prep pad
Two povidone–iodine prep pads
Sterile gauze pads
Sterile adhesive bandage
Nonsterile, clean chucks pad

TECHNIQUE

1. Prep the insertion site with alcohol followed by the povidone–iodine pads.

2. Achieve good local anesthesia by using topical vapocoolant spray.

3. Position the needle and syringe perpendicular to the skin with the needle tip directed posteriorly.

4. Using the no-touch technique, introduce the needle at the insertion site (Fig. 6.46).

5. Advance the needle quickly but carefully into the cyst.

6. Apply suction with the syringe and withdraw the expected small amount of a clear gel.

7. Withdraw the needle.

8. With gloved fingers, apply firm pressure to the tissues surrounding the punctured cyst. Do not contact the injection site with nonsterile gloves. Remove all extruded clear gel with sterile gauze pads (Fig. 6.47).

9. Apply a sterile adhesive bandage.