Other popular names
- Dorsal wrist ganglion ( back of the wrist)
- Volar wrist ganglion ( front of the wrist)
Who does it affect?
Why does it happen?
Normally, joints and tendons are lubricated by a special liquid that is sealed in a small compartment. Sometimes, because of arthritis, an injury, or just for no good reason, a leak occurs from the compartment. Now, the liquid is thick, like honey, and if the hole is small, it can be like having a pinhole in a tube of toothpaste - when you squeeze the tube, even though the hole is small and the toothpaste is thick, it will leak out - and once it is out, there is no way it can go back in on its own. It works almost like a one- way valve, and fills up a little balloon next to the area of the leak. When we use our hands for normal activities, our joints squeeze and create a tremendous pressure in the lubricating compartment - this can pump up a balloon leak with so much pressure that it feels as hard as a bone.
The lubricating liquid has special proteins dissolved in it that make it thick and also make it hard for the body to absorb it when it has leaked out. The body tries to absorb the liquid, but may only be able to draw out the water, making it even thicker. Usually, by the time the lump is big enough to see, the liquid can have got to be as thick as jelly.Symptoms
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 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 this is well known and easily identifiable. In unusual situations an ultrasound scan may be used.
What can be done?
Some people, following non-medical advice, will smash the lump with a heavy book (an old wives remedy), and rupture the cyst. Sometimes this works, but this is not a recommended way of treating it. The lump can come back even if it has been successfully treated this way.
What can a doctor do to help?
- Confirm that this actually is the problem.
- Burst and drain the cyst with a needle and possibly inject the area with cortisone.
- Perform surgery to remove the cyst and clean out the area where the cyst comes from.
Ganglions can be aspirated under local anaesthetic. A needle is then introduced into the lump and the fluid sucked away. Multiple wall perforations are performed to help prevent their reoccurrence. A small pressure bandage is applied for a few days afterwards.
If the lump has reappeared 6 weeks after aspiration, surgery will be recommended. Surgery will be carried out as a day case procedure usually under local anaesthetic and takes about 20 minutes.
Regional anaesthetic is administrated. 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 is removed soon after surgery. 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.
- Bruising and swelling around the site of the ganglion that can last for weeks sometime months.
- Wound infection
- Stiffness especially when the ganglion comes from a joint.
- Nerve and blood vessel damage.
- Distorted nail growth especially if the ganglion is very close to the nail bed
How successful is treatment?
It depends on several things.
Tendon sheath cysts are more likely to be cured with a cortisone injection than cysts coming from joints.
Cysts coming from joints are less likely to come back after surgery if the joint itself is "cleaned out", but cleaning the joint out increases the chance that the joint will be somewhat stiff after surgery.
Cysts on the front of the wrist (volar wrist ganglions) are more likely to come back after surgery than cysts on the back of the wrist (dorsal wrist ganglions).
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.