Ganglions of the Wrist and Fingers
What is a Ganglion?
A Ganglion is a very common, benign swelling that occurs most commonly on the back of the wrist, sometimes on the front of the wrist, and occasionally in the fingers and thumb. They consist of a sac of tissue containing a clear jelly like material inside. They often connect to an underlying joint or tendon. They can occur in people of all ages and in males and females equally.
This is completely harmless but can sometimes be unsightly and sometimes be associated with an aching sensation. It may increase and decrease in size during the day.
When a Ganglion occurs on the back of a finger next to the nail (mucous cyst), it can cause the nail to grow with a ridge or groove along it. A mucous cyst is nearly always associated with arthritis in the finger joint.
This is a Ganglion, which occurs on the front of the finger, normally at the base of the finger. It is connected to the tunnel (sheath) in which the finger tendons run. It is often troublesome. The picture below shows an ultrasound scan of a seed ganglion.
How is a Ganglion diagnosed?
A Ganglion can often be diagnosed with a simple physical examination. Sometimes, however, an ultrasound scan is done.
How is it treated?
A Ganglion may be treated in a number of different ways depending on the type and site of the Ganglion.
Simple observation: The majority of wrist Ganglions will disappear on their own even though sometimes this may take over a year to happen. Finger Ganglions are far less likely to disappear on their own.
Aspiration: This can be done with a needle with or without local anaesthetic in the outpatient department. The contents of the Ganglion are removed to reduce its size. Unfortunately the sac sometimes refills and the swelling returns. Nevertheless, some patients find this procedure reassuring. The aspiration can be repeated on two or three separate occasions to try to reduce the chance of the sac refilling.
Surgery: If there is any doubt about the diagnosis or when the other methods of treatment fail surgery can be performed. The operation is done under local, regional (block), or general anaesthetic depending on the site of the Ganglion. The Ganglion is removed down to its connection with the joint or tendon beneath it. After the operation, the wrist or hand may be splinted for a short period. Sutures may have to be removed after 10 to 14 days.
Will my Ganglion come back?
Sometimes. Following surgery to remove a wrist Ganglion, the chance of the Ganglion reoccurring is 5 to 20 %. Following surgery to remove a mucous cyst, the chance of it reoccurring is 20 %. This chance can be significantly reduced by removing the underlying arthritis in the finger joint below the mucous cyst. However, this requires a fusion (stiffening) of the arthritic joint, which is rarely indicated. Very few seed Ganglions recur after surgery.
Will removing my Ganglion get rid of my pain?
There is no guarantee that surgery will remove the pain that you get with your Ganglion.
What are the risks of Ganglion surgery?
Any form of surgery will leave a scar. Scars are sometimes very visible and can be sensitive. During surgery to remove a Ganglion there may be damage to nerves, tendons and blood vessels. This is uncommon but can be serious.