Cause

Ganglion cysts are not normally associated with any significant disease processes, however: patients with early osteoarthritis, or with damage to the ligaments of the wrist, may form ganglion cysts around the damaged joint.

Most ganglion cysts are harmless, and many will spontaneously dissipate over months or years. A minority will cause intermittent pain, particularly when the cyst is within the capsule of a joint. Some ganglion cysts cause pain with movement of the hand or when attempting a powerful grip. Some ganglion cysts can cause a lump, which many patients consider unsightly.

Treatment

Aspiration with a needle is usually relatively straightforward, particularly for cysts that are clearly visible and palpable. Aspiration can provide a patient with some confirmation of the diagnosis, however most patients (more than 50%) will get recurrence.

Surgery is appropriate for patients with symptoms. The procedure is usually performed as a day case, using either local or general anaesthetic. The risks of surgery include: recurrence of the cyst, stiffness, ache, numbness, and as with any hand surgery there is a small risk of complex regional pain (a stiffness and swelling in the hands which can take several weeks or months to dissipate).

I usually remove dorsal wrist ganglion cysts using a short transverse scar. The wrist is supported with a padded bandage containing a strip of Plaster of Paris to support the wrist.

Aftercare

The bandage is removed after one week. I use absorbable sutures that do not need removal. Patients are usually advised to apply a piece of Micropore™ tape across the wound for a further 1 week. Two weeks after surgery patients can apply moisturizer to the wound twice-daily. There will be some pain and stiffness after surgery, particularly after removal of a dorsal wrist gangiion. Patients should expect some weakness and discomfort for up to 2 months.

Most patients can return to clerical or managerial work within a week. Most patients can return to driving within about 10 days of surgery. Patients should avoid a strong power grip, and extremes of flexion and extension for about 1 month.

Patients should avoid racquet sports, contact or combat sports, or competitive cycling for at least 1 month.