Ganglions are the most common lump in the hand. A ganglion is a jelly filled cyst that is found around the wrist, on the back of the hand and around the base of the finger. Ganglions are usually not painful but can interfere with using the hand and may be unsightly. They are not dangerous. We are not sure what causes ganglions; it is thought that a minor injury to the ligaments around the many joints in the wrist and hand may lead to this gelatinous cyst forming.
The diagnosis can usually be made by examining the lump. Sometimes it is necessary to do a scan to establish the diagnosis.
In most cases ganglions eventually resolve but this may take a year or more. The simplest treatment for a ganglion is 'aspiration', drawing the jelly material off. This is a quick procedure done in the outpatient's clinic (local anaesthetic is used). This is not a one off treatment – it is repeated on 2 occasions (average) over an 8 week period and in most cases the ganglion will resolve following this treatment. Surgery is the most definitive treatment and is recommended for ganglions that are causing pain or have not resolved with aspiration treatment.
The treatment of finger ganglions (flexor sheath ganglions) is different. (See below).
Surgical excision of a ganglion is performed under general anaesthetic; some surgeons do the operation under local anaesthetic but this is painful. An incision is made over the lump and the cyst is excised with the narrow stalk or attachment to the joint or tendon where it arises. I use as small an incision as is possible and stitch the wound meticulously to ensure a good scar.
The wrist or hand is placed in a splint for 5-7 days and then sees one of my hand therapists who will remove the splint and help with some wrist and hand exercises. Stitches are removed at 10-14 days after surgery. You will be able to use the hand for light things as soon as the splint is removed (1 week), but it will take about a month before you can return to heavier manual activities.
Finger ganglions (flexor sheath ganglions)
Ganglions occur at the base of the finger and where the finger joins the palm of the hand. These are often tender and cause difficulty with gripping things. The treatment of flexor sheath ganglions is surgical excision. This is a small operation performed with local anaesthetic. A light dressing is used. The recovery time is quite short, most patients are using their hand normally by 2 or 3 weeks after surgery.