A ganglion is a cystic swelling, which is entirely benign in nature, filled with a clear jelly-like substance and associated with either a joint or tendon sheath. They occur commonly over the back of the wrist, the front of the wrist over the radial pulse, the base of the fingers on the palmar aspect and on the back of the fingers near the joints. In the latter position the pressure they exert may cause grooving of the nail. The underlying joint in this situation often has a little wear-and-tear damage to it and they thus occur in slightly older people. Otherwise they occur commonly in younger people and, besides a little pain when they first appear, are usually symptom free besides just “being there”. Some deeper ones are painful and may cause other problems, such as pinching of nerves.
The precise cause is not known, although it is postulated that some degenerative changes of the tissues around the joints and/or tendons occurs, possibly as a result of trauma. They often come and go and may even disappear – most will eventually disappear if you wait long enough! It depends how patient you are and how much of a problem your ganglion is.
Waiting may be the most sensible option. A good slap with the family bible was the recommended treatment for millennia! This will spread it out, but it will be painful and the ganglion will almost certainly come back. Other options include sucking the jelly out of the cyst, this may include putting a steroid injection back in, but both of these lead to high recurrence rates. Surgery is the next step, but it is important to realise that even this procedure has a certain recurrence rate. This does not mean the surgery was inadequate; they just tend to come back again.
This is a day-case procedure. Under either local or regional anaesthetic the arm or finger will be numbed. The scar left after excision of the ganglion will depend on where the ganglion is – often a transverse scar over the back of the wrist and base of the finger, maybe a little flap on the back of the finger
After the operation your arm will remain numb for up to 10 hours and it is wise to take a painkiller as you sense the anaesthetic is wearing off. You will have a bulky bandage on and this remains in situ until you come back for your first dressing change. You should try and sleep with your hand elevated on a couple of pillows. Hand elevation is important to prevent swelling and stiffness of the fingers. Please remember not to walk with your hand dangling, or to sit with your hand held in your lap. Exercise your fingers as much as possible.
You will be given an appointment to attend a dressing clinic within a week of the operation. Try and keep your dressings dry until that time. At this stage it should be safe to get the hand wet in a bath or shower. The wound and the surrounding skin often become very dry and will be more comfortable if a moisturiser is applied, including to the wound itself (e.g., E45, Diprobase and Nivea Creams).
Infection |
Any operation can be followed by infection and this would be treated with antibiotics and dressings. |
Scar |
You will have a scar that will be somewhat firm to touch and tender for 6 – 8 weeks. This may be helped by massaging the area firmly with a moisturising cream. |
Stiffness |
This can occur if the hand is not used and exercised after the operation. About 5% (1 in 20) of people are sensitive to hand surgery and their hand may become swollen, painful and stiff after any operation (algodystrophy). This problem cannot be predicted but will be watched for afterwards and treated with physiotherapy. |
Recurrence |
Up to 10% (1 in 10) of ganglions return after being removed. |
Nerve |
Nerve damage can occur during your surgery and this results in either a painful spot in the scar (neuroma) or some loss of feeling in the hand. This complication is very rare but may require a further operation to correct. |
Artery |
Ganglions on the front of the wrist are often close to major arteries. Damage to the arteries is very rare and can be immediately repaired. |
Nail |
Ganglions on the tip of the finger often cause a groove in the nail. It usually settles after the operation, but occasionally it can persist after, or result from, the surgery. |
Driving |
This is an issue between yourself, your insurance company and the Police. Generally you must be able to show that you are in complete control of a vehicle. With very bulky dressings and/or a splint this would be very difficult to prove and you should not drive. |
If you experience any of the following in the post-operative period, contact me or the hospital where you had your operation: