Ganglion Cysts are very common swellings (lumps) that sometimes grow in the hand and wrist.
These cysts are not malignant (cancerous).
It is a sack of fluid arising from the sheath around the flexor tendons.
Occasionally it will appear after minor trauma to the hand.
Ganglions in the hand occur in 4 characteristic sites:
1. Flexor sheath ganglion -base of a finger arising from the sheath around the tendons.
2. Dorsal wrist - the back of the wrist
3. Volar wrist - palm / thumb side of the wrist
4. Mucous cyst - the end joint of a finger associated with arthritis & may cause finger nail deformity or ridging
Although there is usually no specific cause for ganglions.
Occasionally it will appear after minor trauma to the hand.
These cysts can be painful with direct pressure to the finger, especially when they first appear and with use of the hand eg driving.
Ganglions may fluctuate in size and may disappear spontaneously.
DIAGNOSIS
The diagnosis of a ganglion cyst is usually based on the location of the cyst and what it looks and feels like.
Dr Myers may perform an ultrasound to confirm the diagnosis when a ganglion is very small.
Often no tests are required.
TREATMENT
1. Observation - some ganglions resolve spontaneously
2. Injection with cortisone & bursting or draining the ganglion.
Not very effective for wrist ganglions but is of use for flexor sheath ganglions.
Injection can be performed under ultrasound control to reduce the risk of nerve or artery damage if the ganglion is to the side of the finger. See diagram.
3. Surgery
- Indicated if the cyst is painful or limits activity, & other treatments have failed
- Remove not only the cyst but a small flap of the flexor sheath from which the ganglion is arising
- Is performed in hospital as a day only procedure.
Post Surgery:
-Keep the hand dry for 2 days.
Bandaid. Move finger immediately.
-Sutures for 8 – 10 days.
-Unrestricted activity after 2 weeks.
-Scar massage after the operation may be required.