Ganglion Removal

During a ganglion cyst removal surgery, the fluid-filled lump is excised, while the limb is under local anesthesia. The surgery is performed in an outpatient setting, the patient can leave the hospital on the same day aftre just a few hours of monitoring.

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What is a ganglion cyst?

Also known as “Bible cysts”, ganglion cysts are benign lumps filled with thick, clear, jellylike fluid. They usually form on the back of the hand, the palm side of the wrist, or at the base or top of the fingers. They can also develop on the ankles or feet. They tend to appear over tendons or joints. The cyst is typically round or oval in shape, it can feel firm or spongy. Its size can vary from pea to walnut size.

How does a ganglion cyst develop?

Ganglion cysts develop over joints and tendon sheaths. Fluid accumulates inside a small sac which is connected to its surroundings at first, then slowly separates, creating a fully formed cyst.

It is not known why ganglion cysts develop. Trauma to the limb, overexertion, joint wear, inflammation of the tendon sheath can all contribute to the formation of ganglion cysts. They can occur in both men and women, and at any age, but they are most common in women between the ages of 20 and 40.

The size of the cyst may change over time: it can grow, shrink, disappear or reappear, depending on how much the affected limb is used.

What are the symptoms of a ganglion cyst?

The most common symptom of a ganglion cyst is the appearance of a round or oval-shaped, fluid-filled lump on the wrist, ankle or knee. It can be soft or firm – cysts at the base of the fingers are usually very hard, while the ones on the wrist tend to be soft.

The cyst is only visible when the limb is stretched, and disappears in a bent position. The cyst is usually painless, but it can cause pain, tingling, numbness and muscle weakness if it compresses a nerve.

How are ganglion cysts treated?

The diagnosis is usually based on the location, texture, and shape of the cyst. Your orthopedic specialist may request imaging tests, such as MRI, CT or X-ray, to confirm the diagnosis and exclude the possibility of other conditions.

Treatment depends largely on the symptoms. If the cyst is painless, treatment may not be necessary, as there is a good chace it will disappear spontaneously. The first line of treatment is usually conservative therapy. It includes the use of splints as well as anti-inflammatory and pain medication. If conservative therapy does not provide relief, surgical removal of the cyst is recommended.

When is surgical intervention needed?

Surgery is usually recommended if the cyst causes complaints besides the deformity. If it compresses a nerve, causing a feeling of numbness, weakness, pain or a limited range of movement in the limb, excision is advised. Furthermore, if conservative treatment did not lead to significant imporvementt, surgical removal of the cyst can provide long-term relief.

Draining the fluid from the ganglion cyst is not an ideal solution, as the risk of recurrence is high due to the fact that the sac containing the fluid remains attached to the joint or tendon sheath and can fill up again.During surgery the entire cyst is excised, so the risk of reecurrence is minimal.

What happens during the surgery?

During your first appointment your orthopedic specialist will provide you with detailed information regarding the preoperative tests you need to undergo, the surgery itself (techniques, potential risks and recovery), and aftercare.

At our hospital ganglion removal is performed as outpatient surgery, under local anesthesia. The aim of the surgery is to locate the cyst and to remove it completely by excision. Often the additional removal of a small part of the joint capsule and/or of the tendon sheath is necessary. The surgeon closes the wound with a few stitches which are removed after a few days.

Are there any risks associated with this type of surgery?

The excision of a ganglion cyst is a very safe procedure. However, as with any surgical intervention, there are some risks and possible complications to take into account before making a treatment decision. On rare occasions the surgical site may become infected and the resulting inflammation can spread to the surrounding tissue, potentially affecting tendons, muscles, blood vessels, nerves and bones. In most cases pharmaceutical treatment is sufficient to control the infection, but in severe cases further operation may become necessary. The most serious complication that can occur is inflammation, which can easily be prevented by the strict adherence to hygiene.

What to expect after surgery?

After a few hours of monitoring, you will be ready to leave the hospital. The bandage has to be changed on the next day, stitches removal is due 10 days after surgery. Until then your hand should not come into direct contact with water.

The wound may remain swollen for a couple of days after surgery. Spare your hand as much as possible to accelerate recovery. The entire healing process takes about 2 weeks, but there may be some individual differences depending on age, general health and other factors.