They are essentially outpouchings of the fluid from nearby joints or tendons. They most commonly occur on the back or the front of the wrist, although they may also occur in the palm or any or the fingers. They can fluctuate in size and if large enough can cause pain. About half of them will disappear within 1-2 years,
What causes ganglions?
It most cases it is unknown, but it is associated with osteoarthritis in older patients, but can also been seen in children and young adults without arthritis, and these cases is likely to be caused by microtrauma, but we think there are multiple factors involved.
Imaging with ultrasound or MRI may be requested after the consultation to confirm the size, where it is arising and to help exclude other types of lumps.
What can be done about it?
Aspiration
The fluid is very viscous and in certain circumstances can be removed with a needle and syringe in the office, after local anaesthetic is injected. This may work for a ganglion on the back of the wrist but is not usually offered for the ones on the front because they are so close to the radial artery or if they are very small or difficult to see. There is still a recurrence rate of about 50%.
Surgery
This is done as a day case where the arm maybe numbed (a brachial block) or a general anaesthetic and surgery may take 45-60 minutes depending on the complexity.
How long does it take to recover?
A bandage is applied at the end of the procedure and allows moderate hand use. The wound is checked at 1 week to ensure no problems and at 2 weeks, the dressings are removed completely and stitches taken out. Dissolvable stitches may sometimes be used. Even after surgery there is a recurrence rate of 20%.
What can go wrong?
Surgery for ganglion removal is generally very safe and the results predictable, with good patient satisfaction. However no surgery is without their potential risks and these will be discussed in detail by Mr Colville at the consultation.