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Mr Paul Jarrett MB ChB FRCSed (Orth) FRACS FA OrthA

CONSULTING & OPERATING
St John of God Murdoch

Direct Line 1300 527 738 Fax 1300 527 329 Email admin@pauljarrett.info

Hand and Wrist Ganglion

What is a Ganglion?

A ganglion is a fluid-filled sack most often communicating with a joint, or the sheath of a tendon (the tunnel that some tendons lie within).  This connection with another fluid-filled area accounts for the ganglion’s ability to fluctuate in size as fluid enters or leaves the ganglion.  If you shine a small pen torch onto the lump through the skin in a dark room and it glows, the lump is most likely to be a ganglion.  The exact nature of a ganglion and how it forms is not clear; however, ganglions are benign non-cancerous lumps.  Ganglions are quite common and do not always cause problems, but for some people they can be unsightly or cause discomfort.  Of course, it is also possible to have a ganglion and another condition which is separately causing symptoms not caused by the ganglion.

Ganglion Symptoms

A lump may appear in your hand or finger.  The lump often starts off small, but may grow or fluctuate in size. The lump may not cause any other problems other than being cosmetically displeasing, or involve minor aching.  Ganglions on the palm side of the fingers or hand may be tender when using the hand.  Ganglions found on the back of the fingertips may burst intermittently, and can occasionally become infected in the days after they burst.

The more common areas for ganglions to be present are; the back of the wrist, on the thumb side below the palm on the wrist, on the back of the end joint of the fingers, or on the palm side of the base of the hand, or in the fingers.  Although ganglions are the most common hand lump, other types of problems can cause hand lumps.  If in doubt you should consult your family doctor or discuss your concerns with Mr Jarrett.

Ganglion Treatment options

As ganglions are non-cancerous, once the diagnosis is confirmed the most frequent course of action is to leave them alone.  Should the ganglion cause symptoms, further investigations may be required to exclude other causes of the symptoms such as arthritis or tendonitis.

Aspiration

This can be carried out with a needle and syringe in the clinic, sometimes with an injection of steroid. Aspiration confirms the diagnosis as thick clear ganglion fluid is aspirated.  However, ganglions recur 70 to 90% of the time following aspiration.

Surgical Excision

The ganglion can be removed surgically either through a small wound or arthroscopically.  An operation will leave some form of scar.  Also, ganglion can recur with approximately 10% of ganglions following surgical removal recurring in the first year.  The risks of surgery are low, but include infection (1%), stiffness, injury to other structures, chronic pain and recurrence of the ganglion. Although ganglion treatment by aspiration or surgery often reduces or resolves the symptoms caused, relief is not guaranteed.

Ganglion Excision Postoperative Care

The operation is usually carried out as a day surgery case, either under local anaesthetic or a general anaesthetic.  It is sensible to take a painkiller before going to bed, in case the local anaesthetic wears off while you are asleep and causes discomfort.

A small bandage is worn for two days.  Upon removal of the bandage, a small dressing is worn for a further seven days and then removed.  Absorbable sutures are used and do not require removal.  The wound can be washed after the dressings are removed ten days following the operation, and the wound moisturised as desired.  Our wound care video can be seen on our website.

You are welcome to watch our postoperative wound care video for furthur information about managing your dressing and wound on https://goo.gl/AqrB8z or use the QR code below

 

The wound is usually tender for a few weeks and will resolve over this period.  The fingers can be moved immediately following the procedure, but heavy work is not possible until the wound has healed.

Should you have any problems following your operation, please do not hesitate to call Mr Jarrett’s rooms, or for out of hours issues, please contact the Murdoch Emergency Department.