A ganglion, or ganglion cyst, is a benign pouch or balloon of fluid originating in a tendon sheath or joint, usually in response to an injury or wear and tear. Think of it as a balloon-like weakness of the structural tissue that later fills with synovial fluid. The distal joints of the fingers are very common sites of osteoarthritis associated ganglions, but other types of ganglions can also be found on the wrists or the palmar surface of digits. Ganglions are common causes of lumps in the hand and wrist.
Usually ganglions are painless. However, if it is large or pressing on a nerve then there can be resultant pain, numbness, or even muscle weakness. Depending on the location of the ganglion, it may be clearly evident and palpable on the wrist or hand, or hidden from view.
Clinical examination, medical history, ultrasound and x-ray may all be used in the diagnosis of Ganglions. An MRI scan is not usually required unless the diagnosis is in question or other issues are complicating the symptoms.
Dr Mackay says the most definitive treatment option for management of ganglions is surgery, which, while more aggressive, will reduce the recurrence rate to something reasonable and leaves patients with significant relief. Surgery aims to remove the fluid with its surrounding capsule and to examine and repair the causative problem. Surgical removal has a much better prognosis that aspiration (removing the fluid with a needle), as 50% of aspirated ganglions will reappear.
It is important to note however, that not all ganglions need to be surgically removed. This is only required if you have ongoing pain, or if it bothers you in any way.
Temporary relief can be achieved with a steroid injection but this is rarely curative and the recurrence rate is very high. Dr Mackay would recommend a single trial of injection but if there is prompt recurrence, repeat injections are unlikely to be useful.
What to Expect in Recovery
Recovery will take a few weeks and is inconvenient. In order to reduce the risk of recurrence it is important to wear a wrist splint for 4 weeks after surgery. Hand therapy for a splint to protect the repair is highly recommended by Dr Mackay to get the best result. After that, guidance on some mobility exercises to get the joint moving again is beneficial. Recurrence does however remain a possibility, despite surgery.