Ganglions

 A ganglion is a cyst or “blister” filled with clear jelly-like fluid.  They are caused by a breakdown of the tissues around a joint or tendon sheath allowing the lubricating fluid to leak out.  The body then forms a bag of scar tissue around it.  They are a nuisance and only require treatment to relieve pain or because of very large size.  The size varies with activity (which produces more fluid).  The “ache” is produced by fluid pressure within the ganglion or by abrasion and inflammation of surrounding tissues.  Small ganglions can produce the most pain, as the pressure in the sac can be higher.

Typically in the hand they occur at the back (dorsal wrist) or front (volar wrist) of the wrist, on the back of the finger over the end joint (mucous cyst) and at the base of the fingers in the palm (flexor sheath).  They frequently disappear in babies but rarely do in adults, except over many years.

Non-surgical treatment (breakage, aspiration and injection of steroid) may be effective but is unreliable.

Surgical excision is more reliable but “recurrences” may occur.  The recurrence rate is about   5 - 10% for most ganglions however ganglions on the front (palmar surface) of the wrist are more likely to recur.  The wrist ganglions usually require a general anaesthesia, but finger ganglions can be excised with local anaesthesia and sedation.  Most are down as day cases in hospital.

The hand is bandaged after the surgery with a splint across the affected joint.  This allows scar tissue to form and “seal off” the hole into the joint. The hand should not be immersed in water.  Wrist ganglions may require about 4 weeks off work, finger ganglions 1 – 2 weeks in most cases.

Risks include bleeding or infection of the wound, hypertrophic (thick, red, raised, lumpy) scar, numbness near or past the surgical incision, swelling and stiffness of the fingers or wrist, recurrence of the ganglion. Nerve damage is rare but could lead to numbness or sensitivity (neuroma). 

The relationship to work is not clear however insurance companies may accept work as a causal or aggravating factor.