Ganglions are common 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).

Where can they occur?

A)  Back of wrist

B)  Front of wrist

C)  Distal Interphalangeal Joint

D)  Flexor tendon sheath

Do they need to be treated?

If they are not causing any pain, or functional problems they can be left alone. They sometimes disappear by themselves. One can draw the fluid out of a ganglion with a needle and syringe, but this is associated with a high recurrence rate.

Surgery can be performed in ganglions causing pain, deformity or functional issues. In most cases it can be performed under local anaesthesia. However in some clinical scenarios the ganglion can be close to the radial artery, in these cases I prefer to use regional anaesthetic to carefully dissect the ganglion away from the artery.

How do I perform the surgery?

For ganglions at the distal interphalangeal joint so called ‘mucous cysts’ I make a T shaped incision and identify the ganglion and go towards its root from the underlying joint capsule. I rarely have to advance local tissues (local flaps) to cover the joint. I also remove any bone spurs (osteophytes) in these cases. The latter procedure is usually performed under local anaesthetic. (See pictures)

Dorsal ganglions I remove with a 2cm transverse incision. I trace the stalk of the ganglion down to the wrist joint. This procedure can also be performed under local anaesthesia. (See pictures).

Volar wrist ganglions I prefer to do under regional or general anaesthetic. For these I make a zig-zag incision. The ganglion is in close proximity to the radial artery and should be carefully dissected free (See pictures).

In all cases sutures are removed at 2 weeks.

What are the complications?

Infection

Scar

Stiffness

Complex Regional Pain Syndrome

Recurrence - quoted in some series as 10%

Nerve or artery damage

Nail deformity

Ganglion excision

Anaesthetic : Local Anaesthetic ( Some cases may need Regional or General)

Operative time : 15 - 60 minutes

Hospital Stay : Day Case

Time off work : 1-2 weeks ( Depends on Occupation) 

Recovery Time : 2 weeks