Ganglion Cysts / Oceanside Orthopaedics

Ganglion Cysts

Ganglions are cyst that originate from joints of tendon sheaths in the body.
They are filled with joint fluid that condenses over time and forms a gel.
The fluid escapes through a small gap in a joint capsule or tendon sheath
Ganglions are not dangerous or cancerous. They are usually very unlikely to cause permanent harm, if left untreated.

What is a Ganglion?

What causes?

How does it present?

Immobilisation with brace/splint to help reduce size of ganglion and relieve pressure on nerves.
Aspiration draining the fluid out of the ganglion with a needle can help alleviate symptoms but will not prevent the ganglion from reforming.
Use of an anti inflammatory, for discomfort caused by a ganglion.

What can be done?

When non operative treatment is unsuccessful
If there is persistent pain or discomfort
If the ganglion is interfering with movement/function of a joint
If symptoms
- Stop you doing the 'things you have to do' and/or
- The 'things you love to do' in life
If you would prefer a definitive cure for the problem.
If appearance is unacceptable

When is surgery needed?

This surgery is usually done under general anaesthetic
It is done as a day case in a hospital
- but you cannot drive home after the procedure
- and you should not be home alone on the night of your surgery

A skin incision is made directly over the ganglion
The ganglion is removed including the sac and an area of joint capsule where the ganglion originates. Removing the "stalk" minimizes the chance of recurrence.
Local anaesthetic is injected around the wound for pain relief
The wound is closed and a dressing and bandage are applied.

What do we do in surgery?

In Hospital

A large bandage is applied to the hand.
It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling
Do not hesitate to ask for pain killers. It is much better to ‘stay on top of pain’, than ‘to catch’ up when it is severe.
If the bandage feels too tight, do not hesitate to remove it.
It is usual to leave hospital 2-3 hrs after surgery

At Home

Continue to elevate your arm until swelling in your fingers subside.
Move your fingers (making a full fist and straightening your fingers out fully about 10-20 times a day).
Keep the wound dry covered and clean.
If it is not uncomfortable, leave the bandage in place until your first appointment after surgery
Blood thinning medication (if you are on any) can be started 2 days after surgery
An appointment usually arranged with my practice nurse at about 1-2 weeks after surgery.

The wound usually heals over 1-2 weeks and any sutures are then removed
Self care (washing, dressing, eating) with the operated hand – usually around 5 days
Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usually 5-10 days post surgery)
Most moderate activities (equivalent to lifting a pot of the stove or pouring a full kettle) can usually be achieved by 4-6 weeks,
It can take 3-6 months for stiffness and deep scarring in the site of the operation to resolve.
Returning to heavy manual activities can take 3-6 months
Golf, fishing, cycling etc.: usually around 3-4 months, but it can be longer (6 months)

Infection
Stiffness of the joint (wrist/finger). You will be given some exercises to do at home, but may need hand therapy.
It is common to have a bit of numbness next to the scar. Sometimes the scar can be very sensitive for a long time
Recurrence, the excision may be unsuccessful and need to be done again.
Very rarely (around one in a thousand) a severe pain reaction, (CRPS) can develop, which can be disabling for years.
A anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.

Wha can you expect?