Ganglion cysts

This leaflet gives general information about ganglions of the hand and wrist, including the treatment options available. It is not a substitute for your doctor’s advice.

What is a ganglion cyst?

A ganglion cyst is a soft tissue lump that is found in the hand. They are fluid filled sacs, which contain a thick clear liquid called synovial fluid.

What causes ganglions?

The cause of most ganglions is unknown, but they can appear when the synovial fluid leaks out of a joint or tendon tunnel and forms a swelling beneath the skin.

How is a ganglion diagnosed?

Usually the diagnosis will be obvious and no tests will be needed. Occasionally, a wrist x-ray may be taken, particularly in older patients, or an ultrasound can be performed.

What are the symptoms?

You will notice a swelling / lump, which may or may not cause you discomfort. This swelling / lump can vary in size, from the size of a pea to the size of a golf ball.

What are the treatment options?

Your medical practitioner will advise you on the best course of treatment for your particular ganglion. This will depend on a number of factors, including how much pain it is causing you and the impact it is having on how your hand works.

Ganglions can be left alone if they are not causing pain or problems with how your hand works. Many disappear on their own, although this may take several years.

Two treatments are used by East Kent Hospitals.

1. Aspiration is the removal of the fluid from the ganglion with a needle. This can be done in a clinic and you can use your hand normally afterwards. Aspiration has a very low success rate and is less likely to be recommended.

2. Surgery is used in a small number of persistent or painful cases. It involves a small operation to remove the ganglion under anaesthetic.

What does the operation involve?

This operation is carried out as a day case (you go home after your surgery), using general anaesthetic (you are asleep) or a local or regional anaesthetic (where you are awake but all or part of your hand is numb). Which anaesthetic you have will depend on the size and position of your ganglion, and will be discussed with you before your surgery.

During the operation your ganglion will be removed by a cut to the skin. The size of the cut depends on the ganglion’s size and where it is on your hand. Your skin can take 10 to 14 days to heal.

What non-surgical treatments are available?

Avoiding repetitive movements and using a wrist brace may help with your symptoms and the size of your ganglion.

What are the risks and possible complications from surgery?

As with any surgery, complications can happen. With ganglions they tend to be mild.

Complications can include the following.

• Delayed wound healing or infection. One or two in every 100 patients will develop an infection and may need antibiotics or a washout procedure (this is more common in patients with diabetes).

• How often ganglions reoccur depends on the type of ganglion you have, and can be discussed with your medical team. This happens to between 10 and 30 out of every 100 patients.

• Your scar may be tender for a number of months. If this does not stop over time, regular scar massage therapy may help. Please ask a member of staff for more information.

• A few patients may have long-term aching, usually in their wrist. This is mainly due to the underlying abnormalities in the joint or ligament. If the underlying joint is degenerative (arthritic) this will not be affected by removing the ganglion. Aching in this case may continue or get worse with time.

• Stiffness may be a problem, particularly in the fingers. This is usually short-term and occasionally needs therapy. It is important that it is dealt with quickly though (within three months) to avoid permanent stiffness.

• Patients can develop nerve damage during surgery, which may result in either a painful spot in their scar (neuroma) or some numbness around their scar.

• Damage to the blood vessel. Ganglions on the front of the wrist are often very close to major arteries, and very rarely damage to these arteries can occur. If this does happen they can be immediately repaired.

• Nail damage. Ganglions on the tip of the finger can cause a groove in the nail, which normally settles after the operation but occasionally it can continue after surgery.

• Complex Regional Pain Syndrome (CRPS) is a rare but serious complication. The nerves in the hand “over-react”, causing swelling, pain, discolouration, and stiffness. If this happens the patient will usually need therapy to try to settle this. Please ask a member of staff for more information.

Please remember that most patients have an uncomplicated routine operation, with very satisfactory recovery and outcome.

What happens before my operation?

You will be contacted by the Preassessment Clinic. A nurse will discuss the operation with you. You may need to have some routine tests before your operation, such as a blood test. Please feel free to ask questions and raise any concerns that you may have about your operation. Remember that you can withdraw your consent for treatment at any time.

You will be asked some routine questions about your general health. It would be helpful if you bring your usual medicines with you to hospital. The nurse will need to know their names and the strengths. This includes non-prescription medicines such as herbal / complementary medicines.

If you need to stop eating or drinking before your surgery, this will be explained to you beforehand.

Please remove any jewellery, including rings, from your fingers before your surgery.

Compared to non-smokers, smokers are more likely to have complications in tissue healing and infections after injuries or surgery. For free friendly support and medication to help you stop smoking, contact One You Kent on telephone 03001 231 220, or email.

What happens after my operation?

Following your operation you will spend a short time in the recovery area of the operating theatre, and then you will be taken back to the ward area.

Following your operation your arm will be elevated (raised) either using a sling or a pillow.

How will I feel after my surgery?

You may feel some discomfort in your limb following your operation. If necessary, painkillers will be given to you to help with any pain.

How do I look after my hand following surgery?

The care of your hand following surgery is very important.

• To help keep you comfortable, you will be encouraged to elevate your hand as much as possible to reduce the swelling.

• You should use your limb gently within the limits of your bandage, avoiding pressure over the site of your surgery.

• The anaesthetic can stay in your system for up to 48 hours, so do not be alarmed if your hand remains numb during this period. Please contact your consultant if this does not stop after 48 hours.

• The bandage on your hand can be reduced in size after 72 hours, to leave the small sticky dressing underneath.

• Do not get the affected area wet until the sticky dressing is removed.

• You may have dissolvable stitches, or ones which will need to be removed between 10 and 14 days after surgery either by your GP or consultant. This will be explained to you after your surgery.

• Further therapy after your surgery is not normally needed, unless wrist or hand stiffness remains a problem.

Will I need a follow-up appointment?

You will not need a follow-up appointment after your surgery, unless one is requested by your consultant. Instead you will be given a leaflet with a contact number on, for you to call the Orthopaedic Hand Service if you have any problems after your surgery, to arrange a follow-up if needed. This is called Patient Initiated Follow-Up (PIFU).

What size scar will I have? and, how many stitches will I have?

The length of your scar will depend on the size of your ganglion and where it is. The number of stitches varies, but we aim to make the scar as cosmetically acceptable as possible.

How soon after surgery can I drive?

You can start driving as soon as you feel confident enough to control your car safely, including completing an emergency stop. This is normally one to two weeks after surgery.

When can I return to work?

When you can return to work depends on what job you do. Please discuss this with your GP / consultant.

If you are in a supervisory or managerial position that does not need full use of the hand, you could return to work within a few days of surgery. Other jobs may need two to three weeks off work, depending on your comfort and how you are recovering.

Further information

If you have any questions or problems regarding your diagnosis or surgery, please speak to your consultant.