Excision of Ganglion Surgery
A ganglion cyst is a fluid-filled, non-cancerous swelling that develops under the skin and grows out of the tissues surrounding a joint, such as ligaments, tendon sheaths and joint linings. The cyst looks like a smooth lump and is filled with synovial fluid, the jelly-like substance used to lubricate the areas that surround your joints and tendons.
They are most likely to develop along the tendons or joints in the wrists or hands but can also develop in the ankles or feet. Ganglion cysts can change size, quickly appear and disappear and can be painful if it presses on a nerve and, depending on its location, may limit joint movement.
Ganglions cause no harm but can often be painful. If they cause no pain, they can often be left to dissipate on their own, although this may take a few years. However, if the ganglion is causing you pain or restricting movement there are a number of treatment options available.
Causes of Ganglion Cysts
Ganglion cysts are more likely to develop on women, especially if you repeatedly apply stress to your wrists (such as gymnastics). Ganglions that develop at the end joint of a finger (also known as mucous cysts) are usually connected with arthritis in the finger joint and generally affect women between the ages of 40 and 70.
Ganglion cysts grow out of a joint or the lining of a tendon and typically look like a small water balloon, occurring when fluid accumulates in a joint or around the tendons in your hand, wrist, ankle or foot. This accumulation can happen due to injury, trauma, or overuse, but often the cause is unknown.
Symptoms of a Ganglion Cyst
The most common symptoms of a ganglion cyst include a noticeable lump, discomfort, and pain. The lumps associated with ganglion cysts can be identified by:
Location
Ganglion cysts usually grow along the tendons or joints of your wrists, hands, ankles or feet.
Shape and size
Ganglion cysts are round or oval and can be so small that they cannot be felt. The size of a cyst can change, often growing when you use that joint for repetitive movements. The swelling may develop gradually over time or appear abruptly. It may also get smaller in size, possibly even disappearing, only to reappear at another time.
Pain
Ganglion cysts are typically painless. However, if a cyst presses against a nerve (even if it is small) it may result in pain, a tingling sensation, numbness and weakness. If you are experiencing pain, it is usually chronic and worsened by joint movement.
Diagnosis of a Ganglion Cyst
It is difficult to prevent a ganglion cyst, so early evaluation and treatment are recommended. Your doctor will start by asking you about your symptoms and whether there has been any fluctuations in the size or the pain level. They will examine the lump, and assess the tenderness. If the lump is not visible, imaging tests may be carried out such as:
X-rays
X-rays are most commonly associated with bone or joint problems. While X-rays will not show a ganglion cyst, they can be used to discount other conditions, such as arthritis or a bone tumour.
Magnetic resonance imaging (MRI) scans
An MRI scan produces a detailed picture of the tissue and organs inside of your body, using strong magnetic fields and radio waves. An MRI scan is a safe and painless diagnostic tool used by doctors to help figure out what is causing your illness or pain.
Ultrasound
An Ultrasound scan is a non-invasive diagnostic tool that is used to look for abnormalities or changes in organs and tissue and can distinguish the cyst from other tumours.
The doctor may also take a sample of the fluid from in the cyst for testing.
Treatment and Procedure
Ganglion cysts are not cancerous and often vanish without treatment. If the cyst does not cause discomfort or create difficulty in day-to-day life, action is not necessary. Your doctor may suggest waiting to make sure that no unusual changes develop and give you advice on how to manage the cyst at home. These include:
- Avoiding repetitive movements with your hand and wrist as activity often causes the ganglion to increase in size and puts extra pressure on the nerves resulting in pain.
- Wearing a wrist brace to limit movement, which could help the cyst decrease in size and relieve symptoms. As pain lessens, your doctor may recommend exercises to strengthen the wrist and recover range of motion.
- If the cyst is on your foot or ankle, wear loose fitting shoes that do not touch the cyst.
- Do not try to puncture a cyst yourself as it increases the risk of recurrence and can cause infections.
Aspiration
Aspiration is commonly the first treatment option offered for ganglion cysts, as it is less invasive than surgery. Aspiration is a simple and painless procedure where your doctor numbs the area around the ganglion cyst and uses a needle and syringe to puncture the cyst and drain as much fluid as possible. Aspiration often fails to eradicate the ganglion because it is not removed from the root. Following the procedure, a dressing is placed over the puncture made in your skin.
This procedure is performed on an outpatient basis and you will be able to go home straight away.
Surgery
The excision of a ganglion is a surgical procedure to remove a painful ganglion. The operation usually takes 15-30 minutes and various anaesthetic options are available. Your surgeon will make a cut over the ganglion and separate it from nearby tendons, nerves and blood vessels. The ganglion will be removed entirely. There are 2 ways surgery can be used to remove a ganglion cyst:
Open surgery
The surgeon will make an incision over the affected area.
Arthroscopic surgery
A type of keyhole surgery where a small camera (athroscope) is used to look inside the joint. Using the asthroscope as a guide, they then pass instruments through the incision to remove the cyst.
Both techniques can be performed under local or general anaesthetic depending on where the ganglion is.
Following your procedure, the surgeon will stitch up the incision and dress the surgical site; this helps reduce the risk of infection and keep it clean. After your surgery it is likely your joint will be splinted for up to 10 days.
Post-Operative Recovery
You will usually be able to go home the same day following the procedure. Rest and limited movement will encourage the cyst removal to heal, minimise pain and avoid irritation. You may need to wear a sling for the first few days if you had your cyst removed from your wrist or hand. You will usually completely heal within 2-6 weeks.
The wound is not usually painful; however, if you do experience any pain or discomfort you can take over the counter painkillers. You may experience some swelling and bruising after the operation but this should heal quickly and can be soothed with ice. There is a chance that you may experience some stiffness, which can be benefitted with physiotherapy.
Depending on your job and where the ganglion cyst has been removed, you may have to take some time off while it heals. You can typically start driving again once it feels safe (check with your doctor how long they recommend).
Risks and Complications
Undergoing a surgery to have your ganglion cyst removed is a minor procedure that rarely results in serious complications, however any surgical procedure includes a certain degree of risk. Complications following ganglion removal may include:
Infection
You must keep your bandages and wounds clean to prevent infection. If an infection arises, your doctor may prescribe an antibiotic to stop the infection from spreading.
Scarring
You will be left with a scar following the surgery, which can sometimes be thick and red. In some cases, the skin around the wound remains numb after the operation. To encourage the healing process and keep your nerves stimulated, you may be advised to rub lotion over the skin.
Pain and stiffness
You may experience pain that can be alleviated with over the counter painkillers. However, in some cases a small number of people suffer from permanent stiffness and pain after the procedure.
Reaction to the anaesthetic
In rare cases, you may experience allergic reactions due to the anaesthetic. Swelling, redness and inflammation will be indicators for this. Make sure you inform your doctor prior to the surgery if you have experienced reactions to anaesthetic previously.
Any pre-assessment tests performed are aimed to make the risks as low as possible. Contact your doctor should you be worried about symptoms you are experiencing following the removal of the ganglion cyst.
Outlook
The surgery does not guarantee that it will not return. Ganglion cysts are harmless and can generally go away on their own, after a needle aspiration or surgery. It is likely that you will make a full recovery following the procedure. The possibility of the ganglion returning are low but not impossible.
Need Help?
At One Healthcare we can book you in to see a specialist Orthopaedic Hand Surgeon, usually within 48 hours, for an initial consultation. Ganglion excision is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire
You can use your private medical insurance or pay for your Excision of Ganglion Surgery treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at One Ashford Hospital
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