Ganglion Cyst

A ganglion cyst is a soft tissue lump that can develop under the skin in the bodies’ joints or tendons. Ganglion cysts are most commonly seen around the joints of the hands or feet and are especially common in the area around the wrist.

The lump under the skin develops as a result of a thick, jelly-like fluid called synovial fluid. Ganglion cysts occur when the synovial fluid surrounding a joint or tendon leaks, and starts to collect and build up beneath the skin.

Consultant Orthopaedic Hand and Wrist Surgeon, Mr Raj Bhatia, specialises in ganglion cyst removal surgery, which he performs at his Bristol Hand and Wrist clinic.

Treatment

The majority of ganglion cysts are not harmful. Therefore it is not advised to have the cyst removed as they often heal by themselves. However, they can sometimes be painful especially if next to a nerve. If this is the case, there are two common forms of treatment. The first being the extracting of the fluid from the cyst using a needle and syringe (aspiration). This is a simple procedure that can be done at your local GP practice or hospital and in most cases, allows you to leave as soon as the procedure is completed. Firstly the doctor numbs (using a local anaesthetic) and cleans the skin on the soft tissue lump. Once there is no feeling in that area, the doctor will extract as much of the liquid as possible from the cyst, using a needle and syringe. Then a plaster is applied to the area and can be removed 6 hours after the procedure. This form of treatment is the most common and the first treatment recommended by doctors as it is painless and relatively straight forward. However, unfortunately almost half of those who go to their doctors for ganglion removal of this kind, find that at some point their cyst returns. If this does happen, the only other option is to have the ganglion cyst surgically removed.

Ganglion Removal Surgery

It is important to note that ganglion surgery is only recommended if the mass is painful, interferes with the function of the hand or if you experience numbness or tingling in the surrounding areas. There are two forms of surgery that can be performed to remove a ganglion cyst- open surgery and arthroscopic surgery. Both of these procedures can be performed under a local or general anaesthetic. A local anaesthetic means that you will be awake but will feel no pain whereas a general anaesthetic means you are asleep during the operation. The anaesthetic you have depends on where the ganglion cyst is located on the body and what your doctor recommends.

Open surgery involves the surgeon making one incision in the area over the cyst and removing the synovial fluid from the joint or tendon. The cut is then closed up using stitches or staples.

Arthroscopic surgery involves the surgeon making three small incisions on the cyst. A small camera is then inserted into one of the incisions to allow the surgeon to assess the area around the joint. The camera allows the surgeon to see the inside of the cyst and makes it possible to pass other surgical instruments through the incisions to help them remove the cyst. The area is then bandaged. You may experience a little discomfort once the anaesthetic wears off but you will be given pain killers to relieve this.

Recovery

After the cyst has been removed from your wrist or hand, it is recommended that you wear a sling for a few days after the operation. This will support the hand, protect it and help reduce the swelling. It is important to keep moving your fingers to maintain the flexibility in your joints.

It is common to experience some bruising in the area after your operation but this should soon fade. It is also possible that you will feel temporary stiffness, swelling or pain afterwards which is caused by minor infection. This can be easily treated using antibiotics that the doctor can prescribe to you. If you experience long-lasting pain or stiffness you may need further treatment with a physiotherapist.

The length of time recommended to have off work after the operation depends on your job. If your job involves manual labour, it is necessary for you to take several weeks off. The majority of people are able to start driving again about two to four weeks after the surgery.

After the operation, there will be some scarring in the affected area which will look red and raised. However, over time, this scarring will fade.

Complications

The removal of a ganglion cyst is a minor procedure so serious complications are very rare. However, a small percentage of people do experience permanent stiffness and pain after surgery. Furthermore, if you have the operation under general anaesthetic, there is a very small risk of complications to your heart and lungs. The pre-assessment tests taken before your surgery however, will make sure that your risks are as low as possible.

There is always a chance that the ganglion cyst may return after the procedure. Between one and four in every 10 cysts that are surgically removed, come back. You can have the cyst removed again and the procedure is often successful the second time round, if it was not already. However, it is important to be aware that having further surgery does increase the risk of complications, such as the damaging of any nearby nerves.