Ganglion cyst of the hand and wrist

Cysts or swellings around the hand and wrist are extremely common and may be troublesome if interfering with daily activities or become unsightly if they grow very large. The most common swelling is found on the back side of the wrist and is a simple ganglion.

They may vary in size from barely visible, to large troublesome swellings that won’t go away. They may also get bigger and then smaller again. They may occur in multiple locations, but when occurring on the palmar surface of the wrist they may be troublesome, as they may cause intermittent symptoms related to compression of arteries or nerves, and it is advisable to seek specialist opinion if these are troubling you.

Typically they come on over weeks to months. There may be the presence of a niggling swelling that can cause pain or interfere with wrist movement or both. Discreet or small ganglions tend to present more with discomfort, especially on extremes of flexion and extension (sometimes the ganglion is visible only when flexing the wrist). Pain may be caused due to mechanical impingement or because the ganglion irritates the nerve.

The contents of a ganglion may vary from thin fluid, to a thick, viscous, almost nodular substance. Hence the swelling may be very soft or quite firm. Management of ganglions is different depending on whether they are on palm (volar) or on the back of the wrist (dorsal)

  • Management

Dorsal ganglions

In some cases these may resorb on their own, so doing nothing is an option. Most patients however wish to have something done about it, and needle aspiration performed under local anaesthetic can be performed. The recurrence rates of aspiration are high, as more than one in two recur.

If managed surgically, open surgical removal is effective over 90% of the time. The key to the surgery is to remove the stalk in its entirety.

An attractive alternative to open surgery is through removing the ganglion from the inside of the wrist through a wrist arthroscope. This makes two small keyholes at the back of the wrist and the ganglion is removed under direct vision.

Volar ganglions

These are often very close to the radial artery and should not be aspirated. If there is any concern regarding the lesion, it should have a formal excision biopsy in theatre by an experienced surgeon who has done these before.

Conditions Managed

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