Schematic view of a ganglion and small tail.

Dorsal wrist ganglion (left), Volar wrist ganaglion (right)

What is it?
Ganglions represent 50-70% of all soft tissue lumps in the hand. These cysts contain thick clear fluid and are usually attached to the lining of an underlying joint (capsule) or tendon (sheath) by a tail. A good analogy is a blown-up party ballon, full of gelatinous goo, not tied at the bottom but attached to the joint or tendon. They are most common in women (up to 3 times more than in men) and 70% occur in the late teens and young adulthood.

The most common sites are (i) the back of the wrist, (ii) the back of the finger-tip (mucous cyst), (iii) the tendon sheath on the base of the finger and (iv) the front of the wrist.

The cause of ganglions remains unknown. The majority can be left alone if they are causing no pain or functional problem, as they are harmless. They can sometimes disappear by themselves (some reports quote up to 50%). It is only rarely obligatory to treat a ganglion, for example if it is pressing on a nerve.

What can be done ?
A number of methods are used for treating ganglions including (i) rupture by pressure or hitting them (not recommended), (ii) aspiration – drawing the fluid off with a needle, followed by an injection with substances such as steroids, (iii) surgery. Surgery involves removal of both the ganglion and the tail. This can be done under a general or local anaesthetic. The site and size of the ganglion will influence which type of anaesthetic we advise. In some instances ganglions on the back of the wrist can be removed with an arthroscope (key-hole surgery). I will discuss with you the most relevant treatment for your ganglion.

Post-operative care
After the operation, you will be in a big bandage, but the fingers will be free to move. It is important to move all fingers and thumb straight away, as well as keep the hand raised (above the level of your heart) for at least 72 hours to help with swelling and stiffness. This bulky dressing can be taken down at 3-5 days after surgery and a light sticky dressing applied to the wound. There will initially be some swelling and bruising, however, if you have any worries contact your G.P (i.e increasing pain, swelling, redness). Occasionally a Plaster of Paris or thick dressing will be used and left on for a full 2 weeks.

Stitches are usually dissolvable. You will be reviewed in the Orthopaedic clinic at 2-6 weeks. Timing of your return to work is variable according to your occupation and you should discuss this.

Infection
Any operation can be followed by infection and this would be treated with antibiotics.

Scar
You will have a scar that will be somewhat firm to touch and tender for 6-8 weeks. This can be helped by massaging the area firmly with moisturizing cream.

Stiffness
About 5% (1 in 20) of people are sensitive to hand surgery and their hand may become swollen, painful and stiff after any operation (Complex regional pain syndrome).This problem cannot be predicted but will be watched for afterwards and treated with physiotherapy.

Recurrence
Between 20 and 30% of ganglions return after being removed surgically. The recurrence after aspiration and injection is higher and reported as between 40 and 80%.

Nerves
Nerve damage can occur during your surgery which 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 close to major arteries, which can be damaged.

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.