Other common names
- Pulley ganglion
- Pearl ganglion
Who does it affect?
Why does it happen?
It is a fluid filled sac that occurs at the base of a finger on its front surface. They are thought to be related to changes in the lining of the joints and tendon sheaths.
A painless lump that comes and goes in size. The outline is quite smooth and may feel tense like a small ball or balloon (cystic).
A seed ganglion has quite typical features both in its location and appearance. With the lights turned down when a pen torch is shone through the lump, it transilluminates.
Usually none as it is a well known distinctive condition. In unusual situations an ultrasound scan may be performed.
Ganglions can be aspirated under local anaesthetic. A needle is then introduced into the lump and the fluid sucked away. However they can be quite small and difficult to aspirate with a needle.
If the lump has reappeared 6 weeks after aspiration or was too small to aspirate, surgery will be recommended. Surgery is performed as a day case procedure usually under local anaesthetic and takes about 10 minutes.
Local anaesthetic is infiltrated under the skin in line with the incision over the lump. Once numb the skin is incised and then the underlying fat is retracted. Care is taken not to injure nerves and blood vessels. At the base of the wound is the ganglion wall. The ganglion is dissected taking care not to puncture it. The base of the ganglion is identified and excised. The skin is sutured and a bulky dressing is applied.
You can go home soon after the operation. The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The hand should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers from day 1. The dressing should be removed soon after your operation. The wound is cleaned and redressed with a simple dressing. The sutures are removed at about 10 days.
Return to normal routine
Keep the wound dry until the stitches are out at 10 days.
Return to driving: The hand needs to have full control of the steering wheel and left hand the gear stick. You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.
Return to work: Everyone has different work environments. Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament. You will be given advice on your own particular situation.
Overall over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any hand surgery from a minor procedure to a complex reconstruction).
- Recurrence: this is reported between 10 and 40%. We are not sure whether it is the same ganglion recurring or simply another one forming nearby.