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Ganglion cyst:

Introduction

A ganglion is a benign (non-cancerous) cyst that forms around the joints or tendons.
Ganglion cysts usually appear on the back of the wrist. They look and feel like a smooth soft lump under the skin. They are made up of a thick jelly-like fluid, called synovial fluid, that surrounds joints and tendons to lubricate and cushion them during movement.
Ganglions can occur alongside any joint in the body but are most common around the wrist, hands and fingers.
It is not certain why ganglions form but they can be related to the ageing process or to injury to the joint or tendon. They occur when the synovial fluid that surrounds a joint or tendon collects and forms a swelling beneath the skin.
Ganglions are harmless but can vary in size and may cause mild pain, especially if they lie next to a nerve. If they do not cause any pain or discomfort they can be left and may disappear without treatment.

If a ganglion is particularly big or is causing pain, it can be removed by draining out the fluid with a needle or syringe (a procedure known as aspiration) or by surgery.

 

Diagnosis

A ganglion cyst is usually diagnosed during an examination by a doctor. The cysts often occur on the back of the wrist, hands or fingers. They tend to be smooth and round and can vary in size.
If there is any uncertainty about whether a lump is a ganglion, your GP may refer you for tests, such as an X-ray, to determine the cause of the lump.


Treatment:


Treatment options


Ganglion cysts are harmless and do not require treatment. Some disappear on their own when left untreated. If a ganglion is unsightly or causes pain or discomfort it can be removed.
Treatments include:

  1. aspiration, draining the fluid with a syringe, or
  2. surgical removal.

Your GP can help you to decide if you need treatment and the best treatment option for you. This will depend on where your ganglion cyst is and whether it is causing any symptoms.


Aspiration


The contents of a ganglion cyst can be removed with a needle and syringe in a procedure called aspiration. The procedure is carried out under local anaesthetic (where the area is numbed) and is usually performed in the outpatients department of your local hospital or GP surgery.
The skin over your lump is cleaned and numbed with a small local anaesthetic injection. Your doctor will remove as much of the contents of the ganglion as possible with a syringe.
The area is sometimes injected with a dose of steroid to help prevent the ganglion returning. A plaster is placed over the needle hole, which can be removed about six hours after the procedure.
Aspiration is a simple and painless procedure and you will be able to leave the hospital or surgery straight afterwards. It is often the first treatment option offered for ganglion cysts as it is less invasive than surgery. However, there is a chance of a ganglion cyst returning after aspiration. If a cyst returns, surgery may still be necessary.


Surgery


Surgery removes the ganglion cyst completely rather than just removing the contents.
The operation is done under local or general anaesthetic, depending on where the ganglion is, which anaesthetic you would prefer and what your surgeon thinks is best.
Having a local anaesthetic means that you will be awake but will not feel any pain. Having a general anaesthetic means that you will be completely asleep during the operation.


The operation


During the opera
tion an incision is made into the skin that is at least as wide as the lump. The ganglion is then extracted.
The surgeon will stitch up the wound and a bandage will be placed over the area. This helps to keep the area clean (to reduce infection) and safe from any accidental bumps. The wound is not usually painful but you will be given painkillers to take if you feel any discomfort after the operation.
Even after surgery some ganglions can reappear, but they do not always need to be removed again.


Recovery


After an aspiration on a ganglion cyst you can leave the hospital or surgery straight away.
After surgery to remove a ganglion you may have to wait to be discharged from the hospital. If you have had a local anaesthetic you will be able to leave soon afterwards. If you have had a general anaesthetic then you will have to stay for a few hours until the anaesthesia has worn off and you have been checked over by your surgeon.


Before leaving hospital


Before you leave hospital, you will be given painkillers. There is normally very little pain but if you do feel some the painkillers can be taken as directed by the hospital.
Before you can leave hospital, the staff will:

  1. check the wound is comfortable and the bandage is secure,
  2. check there is no bleeding or swelling,
  3. give you painkillers to take home,
  4. give you a note to give to your GP,
  5. give you a work certificate or note if required,
  6. give you a follow-up appointment for the removal of your stitches,
  7. check that you have the phone number of the hospital and ward if you have any questions, and
  8. make sure there is a friend or relative to take you home.

After leaving hospital


If the cyst was removed from your wrist or hand you may need to wear a sling for the first few days. This will help keep your arm safe from any accidental knocks and may help reduce swelling and discomfort. Move your fingers regularly to help keep the joints flexible.
Try to rest as much as possible at home, and ask your friends and family for help. You may find it difficult to perform tasks that require using two hands.
Wash around your bandage and try not to get your wound wet until after the dressing and stitches have been removed. This is usually 10 days after your operation.
After having your stitches removed you should be able to start to use your hand as normal but continue to keep the area clean so that it does not get infected. If you experience worsening pain or feel unwell, seek medical help at your hospital or GP surgery.
Returning to work after having a ganglion removed varies from patient to patient and often depends on how much you use your hands for your job. The time away may vary from a few days (light office work, no typing) to six weeks (heavy manual or repetitive work).


Complications


Having a ganglion cyst removed is a minor procedure, so complications are rare and seldom serious.
If you have the operation under general anaesthetic there is a very small risk of complications to your heart and lungs. Pre-assessment tests before surgery should make sure that your risks are as low as possible.
Surgery to remove a ganglion cyst will leave a scar that can occasionally be thick and red. For some people the skin around the scar remains numb after the operation.
It is likely that you will experience some bruising in the area after your operation, but this should fade quickly. There is also a small possibility of unexpected stiffness, swelling or pain afterwards. This may be caused by a minor infection that can be treated using antibiotics. Lasting pain or stiffness may need further treatment with physiotherapy.
There is always a chance that a ganglion cyst will come back after treatment. It can be removed again and with a good chance of success the second time round.


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