Ganglion Surgery

A ganglion cyst is a non-cancerous, fluid-filled lump that usually develops near joints or tendons in the hand or wrist. The cyst arises from the joint capsule or tendon sheath, and it is filled with a thick, jelly-like fluid similar to the fluid that lubricates your joints. It is not the only swelling which can occur in the hand but it is probably the most common one.

Symptoms of a Ganglion Cyst

Ganglion cysts can vary in size and may be:

• Visible: A noticeable lump under the skin.
• Painless or Painful: Some cysts cause no pain, while others can be painful, especially with joint movement.
• Variable in Size: The size of the cyst may fluctuate, sometimes increasing with activity and decreasing with rest.
• Associated with Weakness: In some cases, the cyst can press on nearby nerves, causing weakness, numbness, or tingling in the hand or fingers.

Diagnosis

A ganglion cyst is usually diagnosed through a physical examination. Your doctor will examine the lump, assess its location, and check for any pain or limitations in movement. Transillumination, shining a light through the cyst, may also be used to confirm that it is filled with fluid.

In some cases, an X-ray may be ordered to rule out other conditions, such as arthritis or bone tumours. MRI scans are generally not required but may be useful if the diagnosis is unclear. A simple ultrasound scan can see if the swelling is fluid filled, and how close it is to other important structures and this can normally be performed in the clinic.

Natural History

Many ganglion cysts are harmless and may disappear on their own over time. If the cyst is not causing pain or limiting function, observation may be the best approach. Activity modification or splinting can sometimes reduce symptoms.

However, if the cyst is painful, interferes with activities, or causes nerve compression symptoms, treatment may be considered.

Summary

This document provides information about ganglion cysts and their surgical treatment. Surgery is an option when the cyst causes pain or functional limitations. While surgery aims to provide relief, it's important to be aware of potential risks and the possibility of recurrence. Discuss your specific situation with your surgeon to determine the best course of action.

AspirationThe cyst can have the fluid within it drawn off under local anaesthetic, sometimes in combination with injecting steroid. This may both confirm the diagnosis and treat the swelling. This can usually be performed in a clinic. The recurrence rate can be around 50% however.

Surgical Treatment

Surgical removal (excision) is an option for ganglion cysts that cause significant symptoms. The surgery involves removing the cyst and a portion of the joint capsule or tendon sheath from which it originates. This helps to reduce the chance of recurrence.The surgery is typically performed on an outpatient basis, meaning you can go home the same day. It can be done under local, regional, or general anaesthesia. The approach to the cyst depends on its location and size.

Procedure:

1. An incision is made over the cyst.
2. The cyst is carefully dissected away from surrounding tissues, including nerves and blood vessels.
3. The base of the cyst is identified, and a portion of the joint capsule or tendon sheath is removed along with the cyst.
4. The skin is closed with sutures.

Risks of SurgeryAs with any surgical procedure, there are potential risks associated with ganglion cyst removal. These include:

• Infection: Although rare, infection can occur at the incision site.
• Nerve Damage: There is a risk of injury to nearby nerves, which can cause numbness, tingling, or weakness.
• Vessel Damage: Damage to blood vessels can occur, but it is uncommon.
• Recurrence: The cyst can recur, even after surgical removal. The recurrence rate varies, depending on the location and size of the cyst.
• Stiffness: Some patients may experience stiffness or decreased range of motion after surgery.
• Scarring: A scar will remain at the incision site.
• Pain: Postoperative pain is common, but it is usually manageable with medication.

Your surgeon will discuss these risks with you in detail before the procedure.

Expected OutcomesThe goal of surgery is to relieve pain and improve function. Most patients experience significant improvement after ganglion cyst removal. However, it is important to have realistic expectations and to understand that:

• Complete pain relief may not be achieved in all cases.
• The cyst can recur.
• Recovery time varies depending on the individual and the extent of the surgery.

You can download a copy of my information on ganglion excision to keep and read .

Post-operative Care:

• Keep the wound clean and dry and keep the bandage in place for 1 week.
• Elevate the hand to reduce swelling.
• Take pain medication  - Paracetamol and Ibuprofen are usually sufficient.
• Once the bandage is off apply a cold compress for 10-15 minutes 3-4 times per day to help with swelling.
• Do hand wrist and finger exercises 4-5 times per day.
• Sutures removed a 10-14 days and then scar massage.
• Do gentle day to day activities for the first two weeks and avoid strong gripping.
• After 2 weeks you can increase your activities.
• Attend all scheduled follow-up appointments.

Hand therapy may be recommended to improve range of motion and strength after surgery if you are not progressing as expected.