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What are Ganglion Cysts?

Ganglion cysts are the most common type of swelling found in the hand and wrist. These cysts are due to leakage of the thick, clear fluid which lubricates a nearby tendon or joint. They typically occur in four common locations:

  1. In the middle of the back of the wrist
  2. On the front of the wrist at the base of the thumb
  3. At the base of a finger on the palmar side
  4. Near the fingernail on the back of the finger.

Ganglion cysts typically present as painless swellings, although they may become painful during certain activities. For example, a wrist cyst may cause discomfort when pushing a door open with the palm of the hand. Ganglions near the fingernail can sometimes put pressure on the nail plate as it grows, causing grooving. In some cases, the skin over the cyst may wear thin and discharge fluid.

Most ganglion cysts arise with no obvious cause. However, occasionally there is a history of injury, or they are related to a joint with arthritis.

Diagnosing ganglion cysts is usually straightforward as they tend to be smooth and round, fluctuate in size, and occur at characteristic locations. However, if the diagnosis is uncertain, scans may be helpful.

How are ganglions treated?

Ganglion cysts are generally harmless and can often be safely left alone. Many disappear spontaneously, and those that persist often cause little trouble, with no long-term consequences.

Treatment options include:

  1. Explanation, reassurance, and observation to see if the cyst resolves on its own.
  2. Aspiration: Removal of the liquid contents of the cyst with a needle under local anaesthetic. This is a short term solution only and the ganglion will typically recur after some days, but may be appropriate for temporary symptom relief in some situations.
  3. Surgical removal of the cyst, by tracing it back to its origin from the underlying tendon or joint and surgically treating the leak.

What outcomes can I expect from surgery?

Ganglion surgery is a relatively small operation performed as a day case. It is a well known operation with good outcomes. However, it can uncommonly be complicated by infection or bleeding. Even under the care of an experienced surgery, approximately 10% of ganglions return after surgery. Special surgical techniques may be required for finger ganglions where the skin is worn through and needs to be reconstructed. Some stiffness after wrist ganglion surgery may take time to rehabilitate.

What questions should I ask my plastic surgeon about ganglion surgery?

  • Are you vocationally registered with the Medical Council of New Zealand as a specialist plastic surgeon?

  • Are you a member of the New Zealand Association of Plastic Surgeons?

  • Will the procedure be conducted in a hospital or office-based setting, and is the facility accredited for this type of surgery?

  • What type of anaesthesia is needed for this procedure?

  • Based on my medical history and condition, is surgery the best option for me? If so, am I a suitable candidate for this surgery?

  • Which surgical technique do you recommend for my case, and why?

  • What are the realistic expectations for the outcome of this procedure in my case?

  • What steps or lifestyle changes are necessary for me to get the best result from my surgery?

  • What is the anticipated duration of recovery, and what assistance will I need during this period?

  • What potential risks and complications are associated with this procedure? How would you manage these should they arise?

  • How will my results change over time?

  • If I’m unhappy with the outcome, what recourse options are available?

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