Ganglions

What is a ganglion?

A ganglion is a cyst that is usually attached to an underlying joint capsule or tendon sheath. The walls of the cyst are made of connective tissue, and the cyst is filled with a thick clear fluid.

Ganglions can occur around the wrist, within the palm or associated with the little joints of the fingers (mucous cysts). Ganglions are benign.

 

Why does this cyst occur?

The cause of ganglions is unknown. Proposed causes include trapped joint fluid or outpouching of the joint lining. Another possible cause is degenerating connective tissue. This irritation can be related to trauma or certain patterns of repetitive use.

Ganglions of the little joints of the fingers are frequently associated with arthritis.

 

Does the ganglion need treating?

If the ganglion does not cause you any problems, you don’t have to get treatment. Ganglions can disappear by themselves, and I often recommend you wait 12 months before you have treatment. The ganglion may cause discomfort, limit your range of movement or put pressure on a nerve. You may dislike the look of the cyst. Ganglions of the end finger joint can press on your nail bed and cause grooving and distortion of the nail. When the ganglion causes prolonged problems, you may wish to talk to me about your treatment options.

 

What are my treatment options for ganglions?

Your options include aspiration (extraction of fluid with a needle), injection of steroid and surgical excision. Surgery has the lowest rate of recurrence and the highest rate of success.

Ganglion surgery

Ganglion surgery requires a general or local anaesthetic. During the procedure, I will remove the cyst sac right down to the underlying joint capsule or tendon sheath. If you have a ganglion on your finger tip, I may need to use a local flap or skin graft to replace the extremely thin skin over the cyst.

After the surgery, your hand is covered in a simple dressing. You are discharged with a sheet of instructions on how to care for your hand, as well as hand exercises to perform during the healing process. Depending on the affected area, the sutures I use are either dissolving or are removed about 2 weeks following surgery.

Recovery after ganglion surgery

You can drive after one week if you are comfortable and have a full range of finger movements. Your return to work does depend on your occupation – for heavy manual labourers it may be 4-6 weeks.

 

Possible complications after ganglion surgery

Wound complications

Possible problems include swelling, bruising, bleeding, blood collecting under the wound (haematoma), infection and splitting open of the wound (dehiscence). You may also experience delayed wound healing.

Scarring

The scar may become a little thickened and red as it heals, but this will settle with time. The scar will be tender, and this will also resolve. Firm massage with a plain cream or oil will help heal the scar.

Stiffness

The affected area may become stiff after surgery. Completing your hand exercises as directed will prevent this from occurring.

Complex regional pain syndrome

This is a syndrome of pain, stiffness and swelling that occurs in about 5% of people following surgery. The symptoms are out of proportion to the nature of the operation. At the moment, we are not sure why it happens but it seems that the nerves have am excessive response to the surgery. I cannot predict whom it will happen to but the symptoms to look out for include burning or electric shock type pain, that is not easily controlled with usually pain relief. I will monitor you for this after the operation, and the treatment involves special forms of pain relief and physiotherapy. Read more about Complex regional pain syndrome.

Recurrence

Your ganglion may redevelop over time. This occurs in about 10% of patients.

Nerve damage

Nerves and blood vessels running in the affected area can be damaged during the operation.

Lasting nail deformity

The nail may not recover completely, and some deformity may remain.

Please also read about Complications following hand surgery.