Ganglions

Ganglions (sometimes called ganglion cysts) are a very common condition which presents with swellings usually around the back of the hand and the wrist.

Ganglion cyst on wrist

Ganglion cyst on wrist

 

What actually is a ganglion?

A ganglion develops when a small area of tissue (either in the sheath around a tendon or in the tissue linking the multiple bones in the wrist) degenerates a little bit (possibly with overuse or after trauma but usually for no obvious reason) and the fluid that was contained deep to it starts to push the tissue outwards until it eventually appears under the skin as the swelling.

 

A fluid filled ganglion being removed.

A fluid filled ganglion being removed.

 

I have a lump on the back of my wrist that appeared a few months ago but then disappeared for a while and has now come back. Is that a ganglion?

It certainly sounds like it as they can come and go. They are usually less than 2 cms or so in size but can be bigger.

My GP says there is no point in drianing the fluid out of it but wouldn’t that make it go away?

You are both right – it would go away if the fluid is aspirated (sucked out with a needle and syringe) but it will almost certainly come back again.

It isn’t causing me any problems so can I live with it?

Of course you can and it may disappear by itself eventually you never know.

Can you do an operation to get rid of it?

I certainly can and the indications for an operation are usually cosmetic i.e. it looks ugly or it is in an awkward spot and keeps getting caught or knocked.

Ganglions themselves don’t usually cause pain. There may be pain if they are knocked and there can be pain coming from the area of degenerate tissue which was the source of the ganglion.

So will the operation get rid of everything?

The operation will get rid of the swelling but, obviously, there will be a scar instead. Symptoms coming directly from the swelling will go but if you have a deep discomfort in the wrist say, then that might stay.

Can it come back?

I’m afraid so and I can’t guarantee that it won’t. However I do employ a couple of techniques to minimise that chance. First it is very important to track the ganglion right deep down to where it originated and remove that area and secondly I will immobilise your wrist with a plaster splint for 10 days – this stops you bending the wrist which could cause the swelling to recur.

My doctor said it would be a simple operation under local anaesthetic and I’d be back to normal straight away. How do I look after myself afterwards?

Although it is a ‘simple’ operation and is usually done under local anaesthetic, don’t underplay it or the recovery.

– you will have a padded bandage on for about 4 days but you can use your fingers and thumb as normal so can drive, dress, use a computer etc.

– for baths and showers you should put your hand in a rubber glove and tape it around the forearm to keep the dressing dry.

– once that comes off (you just unwrap it at home!) you will need to use Elastoplast type bandages over the wound for another week or so just to keep it clean and protected. But you can then shower and bath as normal.

– there are usually no stitches to come out as they are under the skin and will be absorbed by the body.

– you can do cardio exercises after 48hrs but keep off any gripping sports (weights, golf, tennis etc) for about 10 days.

– if you do a physical job you can get back to it after a couple of days but should wear a glove to protect the area.

 

Ganglions are common but not usually a serious problem. Some will disappear but others can be a cause of discomfort and they can be unsightly.

The NHS no longer funds surgery to remove ganglions unless they are pressing on a nerve or blood vessel. If you are fed up with your unsightly lump then you can pay to have it removed and I offer very, very competitive rates for that operation done at The Syon Clinic in Brentford. The cost would be approximately £1500.