Ganglions have been recorded since the time of Hippocrates and are the commonest lump found on the hand.

A ganglion consists of a jelly filled bag that balloons out from the wrist joint. The lump normally occurs on the back of the hand and the size varies. Variations in size with activity is common. They enlarge with activity and subdue with rest. Sometimes the lump appears at the front of the wrist where a pulse is commonly felt. Malignancy (cancer) has never been reported from ganglions. You may seek medical advice due to cosmetic appearance, pain or due to weak grip. 

Common site

Less common site

What treatments are available?

Non-surgical

Injections of the lump or dispersal with a small needle have all been tried. All non-surgical treatment have a limited success rate, but may alleviate symptoms for varying periods of time. 

The majority of ganglia resolve themselves over a 2-4 year period.

Many ganglia in older patients are related to arthritis and therefore the removal of the lump often does not resolve pain issues which are due to the underlying arthritis.

Surgery

There are strict guidelines to undergo surgery and it is only essential when there is a neurological compromise related to the lump.

An operation involves a visible scar left in place of the lump which is occasionally as tender as the lump was previously.

What happens on the day of surgery?

The operation can be performed under a regional block (only the arm is anaesthetised), rarely a general anaesthetic required. The procedure is carried out in the operating theatre and is normally performed under tourniquet (blood squeezed out of the arm and a cuff applied above the elbow). The operation takes approximately 45 minutes and consists of removal of the ganglion with tracing the root of the lump back onto the lining of the joint beneath.

What happens after the surgery?

After the operation you will have either a bulky dressing or a plaster cast. The plaster cast prevents unwanted movement whilst the wound settles.

Most patients can be discharged on the same day of their operation: However you are not safe to drive after anaesthetic or with a wrist plaster.

The plaster slab is normally removed at two weeks after the operation and stitches are also due for removal at this time if not dissolvable. The hand and wrist will normally regain full strength after approximately six weeks. You should discuss returning to work with your clinician.

No operation carries a guarantee of cure. If the operation is successful, there is less  than 10% chance of recurrence.