Ganglion
What is a ganglion?
A ganglion is a collection of jellylike fluid that arises either from a joint or from the sheath of a tendon.
What causes a ganglion?
Quite often there is no obvious cause for a ganglion. However, a ganglion can arise due to degenerative change in a joint as in early arthritis or around a tendon.
What are the symptoms of a ganglion?
A ganglion may not give rise to any symptoms whatsoever. It can, however, be unsightly and can also result in discomfort or pain. Occasionally a ganglion may burst onto the surface of the skin or get infected (this commonly happens in the distal joint of the finger or thumb).
How is a ganglion treated?
If the ganglion is asymptomatic it may not require any treatment whatsoever.
Conservative management of a ganglion consists of aspiration of the jellylike fluid and an injection of a steroid solution into the ganglion sac. This may be effective in preventing long-term recurrence in approximately 30% of patients.
If a ganglion recurs following aspiration and is symptomatic it can be removed by a small operation which is normally carried out either by numbing the arm or under a general anaesthetic. This is usually successful in preventing long-term recurrence in 70-80% of patients.
What problems do patients experience following surgery for a ganglion?
Just like any other operation, ganglion excision can result in problems such as bleeding, infection or delayed healing of the wound although these are uncommon. There is a scar following surgery which in rare cases can become hypertrophic or keloid (raised, red, lumpy, itchy). Keloid scars can continue to grow and can be unsightly requiring further treatment.
There can be persistent pain at the site of the operation, along with altered sensation in the skin distal to the scar and the ganglion can recur.
What is the normal post operative course?
For 2 weeks following surgery the hand and wrist are supported in a splint. After wound inspection at 2 weeks gentle mobilisation is started under the supervision of the Hand Therapist. Most patients regain mobility 4 to 8 weeks following surgery but it takes longer to regain grip strength and to undertake heavy manual work, use of vibrating tools and heavy lifting.
