Ganglions are swellings found around joints and tendons. Synovial fluid is a thick viscous fluid which helps to lubricate joints and tendons and is normally contained by the surrounding joint and tendon tissues. But when there is a breach the fluid leaks out and because of its viscosity cannot get back – a bit like a one way valve. This breach can be through injury, arthritis or it just occurs for no reason. Common sites for this to occur are the back and front of the wrist, at the base of the finger or base of the nail. The ganglions can sometimes be uncomfortable, get in the way or be unsightly. They don’t do any specific harm.
involves taking a history, examining the hand and confirming the diagnosis. Dr Mills may occasionally request an Xray or ultrasound, but this is not usually necessary. Conservative measures for management include observation or aspiration. Sometimes steroids may be injected. Aspiration or rupture of the ganglion has a high rate of recurrence (30-60%), meaning that surgery may be recommended.
is usually done under general anaesthetic or arm block (patient is awake but the arm is put “asleep” by an anaesthetist), although cysts at the finger tip can be done under local anaesthetic. A tight cuff is placed around the arm to stop the blood while operating. Surgery involves removing the cyst and cleaning out the area where the ganglion has arisen from. Once this is completed a bulky bandage is placed around the hand.
the patient can go home on the same day. It is advisable that someone else is with the patient for the first night. Prescribed pain medication is taken for pain relief. The patient should keep their wrist elevated as much as possible. Bandages are removed after 1 week and sutures removed after 2 weeks. There may be some stiffness of the hand for a couple of weeks. Even with adequate surgery there is still a significant recurrence rate of ganglions (10%).