Ganglion cysts of Hand and Wrists

Ganglions related to the wrist joint

Ganglion cysts of the wrist result from minor holes or tears developing in the outside lining tissues of a joint ( the joint capsule). Once this occurs the inner lining of the joint (the synovium) pops out through this tear and forms the cyst. The synovium makes the lubricating fluid for a joint and it is the synovial fluid which fills the cyst.

People often observe their ganglion fluctuates in size. What happens when this occurs is that the fluid filling the cyst (the synovial fluid) empties back into the joint through the neck of the cyst which still communicates with the joint through neck of the cyst.

Treatment options:

No treatment: If a ganglion is not painful then usually there is no strong indication for it to be treated. Occasionally a ganglion may spontaneously resolve without treatment.

Aspiration and/or injection: This is sometimes attempted. The results vary but recurrence rates are high.

Surgery: If a ganglion is painful or limiting wrist movement then surgery may be considered.

Normally surgery is performed as a day procedure at the hospital. For wrist surgery usually general anaesthesia or an arm block (a regional local anaesthetic block) is required.

The surgery involves an incision over the area of the ganglion. The cyst is then dissected free of other tissues and is traced down to the neck where it enters the joint capsule. The joint is opened and the origin of the cyst is traced into the joint and totally removed. If this is not done the risk of recurrence of the cyst is high.

After surgery you will have a splint on your wrist preventing movement and a bandage. The splint stops movement to reduce post operative pain and allow the joint capsule tissues which have been repaired to heal properly before exposing the wrist to further stress.

You will likely have splint on your wrist for 3-4 weeks. Your fingers will be free to move normally and this will be encouraged.

The major risk of ganglion surgery is the risk of recurrence. A ganglion can recur after surgery.

As with any surgery there is risk associated with having an anaesthetic. We will discuss these risks at your consultation.

In any elective hand operation there is a small risk of developing a chronic pain syndrome known as chronic regional pain syndrome (CPRS). We can also discuss this in more detail at your consultation.

Ganglions of the fingers

Flexor tendon sheath ganglions are the common ganglions seen in the fingers. They relate to a split or tear developing in the flexor tendon tunnel on the front of the fingers. Once this split occurs some of the lining tissue of the tunnel (the synovium) can pop out through the tear forming a cyst.

These ganglions usually present as little "pea like", very mobile lumps at the base of the fingers.

They can be painful when you grasp objects.

If the ganglion is not painful it does not need to be removed.

If the ganglion is painful it can be removed.

Surgery for a flexor tendon sheath ganglion is performed as a day procedure at the hospital.