When should I consider referring a patient with a ganglion cyst for surgical intervention?

Consider referring a patient with a ganglion cyst for surgical intervention if the cyst causes significant pain, functional impairment, or neurological symptoms such as nerve compression. This includes cases where the cyst leads to sensory or motor deficits, or deformities like claw hand due to ulnar neuropathy, as seen in ganglion cysts located in anatomically sensitive areas such as Guyon's canal (Chiang and Shieh, 2025)¹.

Referral is also appropriate if conservative management fails, the cyst recurs after aspiration, or if there is diagnostic uncertainty requiring specialist evaluation. Surgical excision is generally reserved for symptomatic cysts that impair daily activities or cause persistent discomfort, rather than asymptomatic or minimally symptomatic cysts, which can often be managed conservatively in primary care ¹.

In summary, the decision to refer should be based on symptom severity, functional impact, neurological involvement, and response to initial treatment. Early referral is particularly important when neurological signs develop, to prevent permanent nerve damage (Chiang and Shieh, 2025)¹.