Wrist Ganglion Removal - Tetbury Hospital Trust

Symptoms

Ganglions are entirely benign (they never become malignant/cancerous) and never damage nearby structures. They occur spontaneously, often near your wrist joint as a swelling on the back or front of the wrist. A ganglion often gets to the size of a broad bean, and sometimes even larger. They cause local discomfort but are not normally painful, and the wrist function is rarely impaired significantly.

Diagnosis can be made on the basis of your history and a clinical examination. The diagnosis can be confirmed by aspirating the ganglion (using a syringe and needle in the clinic) and sometimes an ultrasound scan.

As ganglions are benign and cause no local damage surgery is not essential. About 50% of wrist ganglions may resolve spontaneously over a five-year period although recurrence is very common (around 80%).

Risks

At least 10% of ganglions recur, despite surgery.
Ganglions on the front of the wrist have a higher recurrence rate.

General surgery risks

With planned operations complications are unusual. Statistically about 5% of patients have a post-operative problem, the vast majority of which are temporary and do not affect the final result.

Infection. The signs may develop after a few days, with increasing pain, swelling and redness. Treatment with antibiotics is usually sufficient. Very occasionally an infection can be severe and cause major problems.

Wound healing problems. Excessive bleeding, causing a painful swollen wound (haematoma) or delayed healing may slow down the recovery. A few people react to the dissolving suture material, and this can lead to localised areas of tenderness and swelling that persist for a couple of months.

Swelling and stiffness. It is very important to elevate and exercise the hand after an operation or injury. Occasionally the swelling is severe, prolonged and associated with pain, due to the development of the poorly understood condition called complex regional pain syndrome (CRPS). This can be treated with physiotherapy and pain tablets. Very rarely it leads to long-term stiffness and disability, compromising the function of the hand permanently.

Surgery

All rings on the hand must be removed before hand surgery.

The operation is usually done as a day case under regional anaesthetic (the whole arm is numbed) or general anaesthetic.

If you have a general anaesthetic, you will be able to go home the same day but you must arrange for someone to drive you, and for the first 24 hours:

Someone should stay with you until the general anaesthetic has worn off.
Do not drive, operate machinery, or do any potentially dangerous activities (like cooking) until you have fully recovered feeling, movement and co-ordination.
Do not sign any legal documents or drink alcohol.

The consultant will make an incision; if the ganglion is on the back of the wrist, it is usually crosswise, on the front it is usually lengthwise. This allows the removal of the ganglion and the track that arises from the joint. The incision will be closed with dissolving stitches and the wound is dressed, leaving the fingers and thumb relatively free to move.

Recovery

The hand must be elevated for 48 hours when still but should be moved and used as normally as possible. Any pain after the operation usually settles if the hand is kept elevated. Painkillers may be needed for the first few days.

The wrist will be a bit stiff and uncomfortable for at least three weeks, often up to two months and occasionally more.

The dressings can come off after about five days but keep the wound clean and dry for 14 days. Any knots from the dissolving stitches should be rubbed off after two weeks.

Ability to drive after the procedure varies from person to person. It is up to you to decide when you feel comfortable to do so. It will probably be about a week if the right wrist is operated on, but it may be longer for the left because of the need to use the hand brake.

Manual workers normally need about six weeks off work while office workers can get back sooner.

The scar will remain tender for at least two months, and it should be massaged with cream (lanolin, E45, Double Base) regularly. In about 10% of people the scar, after healing well initially, thickens and becomes itchy, red and more painful after the first month. If this happens the scar settling down to normal, thin, mobile skin can take more than a year.

When to seek further help

Signs of wound infection may develop after a few days, with increasing pain, swelling and redness. Seek advice from your GP as treatment with antibiotics is usually sufficient.