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Ganglions

Ganglions are fluid-filled sacs that usually communicate either with an underlying joint or tendon sheath. They are benign and pose no threat to the patient's general health. The fluid contents are thick, gelatinous and under some tension, giving the resultant lump a firm feel. The commonest site for a ganglion is the dorsal surface of the wrist, but they can also occur in the following sites, amongst others:

What are they?

What are the symptoms?

The presence of a visible and/or palpable lump is the most obvious symptom. There is not usually a history of recent injury.

Ganglions are not generally painful, although a small subset of dorsal wrist ganglia can cause wrist pain, especially when the patient places weight on an extended wrist, such as during press-ups or certain yoga postures. Paradoxically smaller dorsal wrist ganglions, which may be palpable but are not easily visible, more often seem to cause pain. Occasionally larger examples of both dorsal and volar wrist ganglions can simply get in the way, due to their size.

Flexor sheath "seed" ganglions are also not painful at rest, but because of their position can cause pain when gripping objects forcefully.

Mucous cysts are not in themselves painful, but the underlying terminal finger joint (DIP joint) is often arthritic, and therefore may be a source of pain. Occasionally they can expand to a size where the integrity of the overlying skin is threatened.

How are they Diagnosed?

Very often the diagnosis is clear on examination of the hand. X-rays can be helpful to look for associated osteoarthritis (degeneration) of underlying joints, particularly in the case of finger ganglions. An ultrasound scan can be helpful at times to confirm the diagnosis. An MRI of the wrist may be required in two scenarios – to confirm the suspicion of a ganglion that is barely palpable, but is causing wrist pain (also allowing some other causes of wrist pain to be ruled out), or if there is a suspicion of an underlying wrist (scapholunate) ligament injury.

How are they treated?

The treatment varies depending on the site of the ganglion, associated symptoms and the presence of underlying joint disease. Very often however, it is entirely appropriate not to pursue any active treatment at all, particularly as approximately 50% percent of wrist ganglions will spontaneously regress.

Mr. Gidwani will be able to give you more detailed information during your consultations, regarding the pros and cons of surgery, and the post-operative care.