This study examined the treatment of anterior wrist ganglions by aspiration and injection or surgical excision. Eighty-four patients treated for an anterior wrist ganglion were studied, with an average followup period of 5 years. Initial treatment by aspiration and injection with corticosteroid was performed in 24 patients, with recurrence in 20. A second aspiration and injection was associated with recurrence in all. Of the 72 patients who underwent surgical excision 14 experienced a recurrence of the ganglion. Four patients with a recurrence underwent a second surgical procedure with successful excision in two patients. The origin of the majority of surgically treated ganglions was on the scaphotrapeziotrapezoid joint and radiocarpal joint. Because of a large number of recurrences after nonoperative treatment, surgical excision is recommended as the primary definitive treatment for anterior wrist ganglions Aspiration and injection may provide palliative relief of symptoms.