Written by Dr Richard Lawson FRACS - Hand Surgeon

What is a ganglion?

A ganglion is a mucous filled cyst. Most importantly, it is not malignant or cancerous and is not dangerous in the same way that a cancer is.

Why do ganglions form?

We are not sure exactly why they form. Ganglions may arise from areas of degeneration in ligaments or the capsules of joints. However, ganglia can occur in young patients where degeneration would not be expected. They may represent pouches of the normal recesses within joints.

Do they grow?

Ganglia can get bigger and can also shrink. Sometimes they can seem to go away completely.

Where are ganglia found?

Ganglia tend to present in certain characteristic areas. The most common is on the back of the wrist joint; slightly less common is the front of the wrist joint. They are also often found on the front of the fingers.

How are ganglions treated?

Some need no treatment. Many patients are reassured after learning that the lump is not a cancer.

If the ganglion is causing trouble, one can consider aspirating it (sucking the fluid out with a needle). This is a fairly simple procedure and will successfully treat a small percentage of ganglia. Ganglia at the front of the fingers respond better than other types to this treatment.

When do ganglions need to be surgically treated?

If the diagnosis of a ganglion has been confirmed (usually with an ultrasound), the ganglion doesn’t absolutely have to be removed. Common reasons for wanting to have the lump removed include pain, stiffness and objections to the appearance of the swelling if it is large.

What does surgery entail?

Ganglion surgery is usually day stay surgery. A small incision is made over the ganglion and the lump is removed and the skin sutured. Local anaesthetic is injected into the area to help with post operative pain relief.

After the surgery the main problems are stiffness and sensitivity of the scar. The former can be prevented by conscientious movements of the hand; the latter by massaging the scar with moisturising cream from around two weeks after surgery. Infection can occur as with any operation and is treated with the appropriate antibiotics.

Can ganglions recur after surgery?

Yes. Ganglions on the dorsum of the wrist have a recurrence rate of around 5%. The recurrence rate in other areas is slightly higher.