Mr Prash Jesudason MB, ChB, MSc., FRCSEd (Trauma & Orth), Dip. Hand Surg (Br)

Consultant Hand & Orthopaedic Surgeon

Wrist Ganglion

 

What is a ganglion?

A ganglion is a fluid filled sac that forms around a joint. Wrist ganglia most commonly occur over the back of the wrist, but around 1 in 4 can present at the front of the wrist.

 

What are the symptoms?

A ganglion can present in all age groups, from children to old age. The lumps are often painless, and generally change in size over time. They can cause pain on activity and on movement of the wrist.

 

What is the cause?

A ganglion forms as a pouch of fluid from the wrist joint. Exactly why this happens is unknown. The fluid tends to thicken and becomes a jelly like substance.

 

What is the treatment?

The historic treatment was that the lump should be hit hard with the family bible! There is some truth to this treatment, as trauma will breakdown the capsuleof the ganglion and disperse the lump. If the symptoms are mild, and the diagnosis of a ganglion made, I tend advise the lump is generally ignored, as many do settle over time. If the symptoms are severe surgical excision is offered. On occasion I aspirate the ganglion (draw the fluid out with a needle), and puncture the sac repeatedly with the needle.

 

For recurrent ganglia, I consider arthroscopic removal (keyhole surgery), as the stalk of the ganglion can be seen from inside the joint

 

What are the results of surgery?

Surgery is usually successful, and patient satisfaction is high. The main risk is recurrence, which is usually around 10-15%. Other risks include infection, nerve injury, stiffness, abnormal pain response and scar sensitivity, but these are relatively rare.

 

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