What is it?
This is a benign lump that generally appears at the back of the wrist. It can however also present on the palm side of the wrist or any part of the fingers (see section on mucous cyst). This is a fluid-filled lump containing a 'jelly-like' substance and is normally attached to either joints or tendons by a narrow stalk. A ganglion can increase or decrease in size and this is often related to how much you exert your wrist.
What causes it?
The cause for this condition is unknown. It can occur at any age but is seen most often in people between the age of 15-40 years. Ganglia tend to present in both men and women equally.
What are the signs and symptoms?
Ganglia often cause no symptoms whatsoever. They can however be unsightly and can ache with repeated exertion of the wrist. If the ganglion is situated close to a nerve it can occasionally cause pins and needles and pain travelling into the fingers.
How is it diagnosed?
A detailed history and examination is often all that is required to make the diagnosis. An X-ray is sometimes requested to exclude another cause if the wrist is very painful. An Ultrasound or MRI scan may be requested when the diagnosis is unclear.
How is it treated?
In the vast majority of cases no treatment is necessary. These are harmless lumps that settle without any treatment in 60% of patients. This can however, take as long as 6 years in some cases. For ganglia that come to requiring treatment, two main options exist. The first of these is an aspiration where the fluid is drawn from the lump after numbing the skin. The second option is to remove the lump surgically. This is the preferred option as the ganglion is least likely to return after this method of treatment.
What does the operation involve?
The operation is normally performed with the patient asleep. The ganglion is removed along with the stalk that connects it to the underlying joint or tendon. This is necessary as leaving the stalk behind can lead to the ganglion returning. This is the equivalent of removing a weed from your garden along with it's root to reduce the chance of it re-growing. This can be performed through an open or key-hole procedure. The benefit of the key-hole procedure is smaller scars however this is to be weighed up against a longer operating time and as a result a longer anaesthetic.
Following the operation you will normally have a bulky dressing covering your wound for 48hours. This is then replaced with a sticky dressing at 48hours until 10 days following your operation. The stitches will dissolve and do not require removal.
Return to work
This depends on the nature of your work. For a sedentary occupation the time off is normally 2 weeks. For a manual occupation this can be as long as 6 weeks.
It is normally safe to drive within 6-7 days of your operation but can take up to 2 weeks before you are completely comfortable to start driving.
Return to sport
This depends on the intensity of the sport but in most cases a return by 6 weeks is the norm. However more physically demanding sports can require as much as 3 months off.
Like with any surgery there are a number of small risks associated with this operation.
Infection (1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.
Swelling and Stiffness can remain for many months following surgery. It is important to elevate the limb and keep all joints that are not immobilised with a splint, active.
Scar Sensitivity is often a problem with surgery in the hand, particularly the palm. This is often self-limiting and daily massage of the scar can shorten the duration of the symptoms. The sensitivity does settle in all cases with time.
Nerve Injury is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the nerves supplying feeling to the back of the hand on the thumb side. An injury to these nerves may result in an area of numbness that is not often troublesome. However a neuroma (swollen cut end of the nerve) can occasionally form causing pain and may require further surgery.
Recurrence The ganglion may return even after surgery in up to 10% of cases.
Complex Regional Pain Syndrome is an extremely rare (1%) complication that can follow any injury or surgery to a limb. In this situation the nerves in the arm over-react to the point where the hand becomes very painful, swollen and sensitive. This condition does improve with time but can be problematic for many months (see section on Complex Regional Pain Syndrome).