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ganglion cyst treatment

Ganglion Cyst Treatment

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Ganglion cysts are fluid-filled swellings which usually develop near a finger joint or the wrist. They can range from a pea to a golf ball in size, with the difference being dictated by the amount of synovial fluid filling the cyst. Synovial fluid is the lubricant that surrounds joints and tendons.

Causes of Ganglion Cyst

The exact cause of a ganglion cyst is still yet to be discovered, all we know so far is that synovial fluid leaks from the joint and collects in a sac that develops into the cyst you may be seeing on your hand. This could be a result of trauma (outstretching a hand to break a fall) – while other research indicates that ganglion cysts may occur due to joint and tissue lining degeneration.

Symptoms

    • Pain in the palmar aspect of the finger as they get bigger
    • Pain in the wrist in the region of the ganglion
    • Palpable or visible lump

Diagnosis & Investigations

Ganglion cysts are usually diagnosed by talking through your symptoms with your doctor. They will be able to examine the cyst, ensuring that the shape and location is consistent with what you expect. Larger cysts may force doctors to perform additional testing to rule out disorders like synovitis. An ultrasound scan or MRI scan often shows the origin and the location of the cyst.

 

ganglion cyst treatment causes

Ganglion Cyst Treatment

Non-operative treatment

If it does not cause a problem I recommend leaving it alone.

Operative treatment

If causing problems, I usually recommend surgery. The surgery is a day case procedure usually under local anaesthetic and takes about 10 minutes to remove a ganglion from the finger. A tourniquet is used; which is like a blood pressure cuff around the upper arm that prevents blood from obscuring the surgeons view. It is quite tight, but well tolerated for up to 20 minutes.

Local anaesthetic is infiltrated at the base of the finger. Once numb the skin is incised and the skin flap elevated. The ganglion is dissected taking care not to puncture it or damage adjacent blood vessels and nerves. The base of the ganglion is identified and excised. The skin is sutured and a bulky dressing is applied.

Removal of the ganglion from the wrist is slightly different and a general anaesthetic is often required.

Aftercare & Follow Up

Hand should be kept dry and clean until the stitches are removed. One week after the procedure the dressing are reduced by the practice nurse and the sutures are removed in the clinic 2 weeks after surgery. Normal daily activities and use of the hand is encouraged to avoid tendon and nerve adhesions immediately after surgery.  

diagram of ganglion cysts

Driving

Driving should be avoided for 2 weeks until the wound has healed.

Time off work

Your return to work will depend on your job. Light manual workers can return to duty in 2 – 3 weeks. Heavy manual workers should not exert maximal grip for 6 weeks.

Risks of Surgery

  • Infection
  • Injury to digital nerve, blood vessels and tendons
  • Neuroma (painful growth of nerve ends)
  • Scar sensitivity (Scar desensitisation exercises after removal of stitches help to improve scar sensitivity however this can last up to 6 months after surgery)
  • Recurrence (up to 40%)
  • Further surgery (in event of recurrence or other complications)
  • Reduced grip strength
  • CRPS (chronic pain syndrome: A small percentage of patients will develop a severe reaction after hand surgery, with lifelong permanent pain and stiffness which requires extensive physiotherapy and pain medication)

Scar Desensitisation Exercises

Circular motion massages to the scar, from the palm moving towards the wrist using a simple moisturising cream. This must be carried out for 10 minutes, at least 3 times a day.

Rubbing the scar on different textured materials to improve skin sensitivity.

Submerging the hand under the cold and warm water to improve the temperature sensitivity.

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