Ganglion removal
Published by Bupa's health information team, January 2008.
This factsheet is for people who are considering having surgery to remove a ganglion. Ganglions are swellings that stick out from the lining of a joint or tendon.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.
- About ganglions
- What causes ganglions?
- Treatment options
- Preparing for your operation
- About the operation
- What to expect afterwards
- Recovering from your operation
- What are the risks?
- Further information
- Questions and answers
- Related topics
- Sources
About ganglions
Ganglions are fluid-filled lumps that can occur anywhere in the body, but commonly appear around the wrist and fingers, and on the top of the foot around the ankle.
They vary in size from pea-sized swellings and lumps affecting the fingers, to larger lumps affecting the wrist or ankle and foot. They are firm and rubbery in texture, and may move freely under the skin. Ganglions are often associated with a dull ache.
The common sites of ganglion
What causes ganglions?
Most ganglions occur when the synovial tissue lining the tendon sheaths breaks down. Synovial tissue produces fluid to help lubricate joints and tendon sheaths. This helps the joints and tendons to move freely. The breakdown occurs spontaneously or is triggered by injury.
Treatment options
Ganglions are harmless and may disappear spontaneously. Therefore most people will not require any specific treatment. If a ganglion is causing pain or affecting normal function, the fluid may be drained and the area injected with a steroid. The procedure is called aspiration with steroid injection. Alternatively, your GP may recommend surgery to remove the ganglion.
Ganglions are usually removed as a day case in hospital.
Preparing for your operation
Most ganglions are removed under local or regional anaesthesia. This means that the treatment area will be completely numb but you stay awake. Local anaesthetics numb the small area that is being operated on, while regional anaesthesia numbs the whole limb.
You may be offered general anaesthesia for larger ganglions on the wrist or ankle. This means you will be asleep during the operation.
Your surgeon will advise which type of anaesthesia is most suitable for you.
If you are having regional or local anaesthesia you can eat and drink as usual on the day of your treatment.
If you are having general anaesthesia you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However some anaesthetists allow occasional sips of water until two hours beforehand.
At the hospital your nurse will explain how you will be cared for during your stay. Your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine.
Your surgeon will usually visit you to discuss the operation and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
You may be asked to change out of some of your clothes and put on a surgical gown. If you are having local or regional anaesthesia you will probably walk to the operating theatre.
About the operation
The operation usually takes 30 minutes.
A cut is made in the skin over the ganglion. The ganglion is removed from the joint or tendon lining without disturbing the surrounding structures. If the ganglion is tricky to remove, the cut will be larger than the size of the lump.
Afterwards, the cut is closed with stitches and covered with a dressing.
What to expect afterwards
After a general anaesthetic you will need to rest until the effects of the anaesthesia have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
After a local or regional anaesthetic it may take a couple of hours before the feeling comes back into the treated arm or leg. Take special care not to bump or knock the area while it's numb.
If the ganglion is removed from your hand or wrist your arm may be placed in a sling. Your treated arm or leg may need to be raised on a pillow.
You will be able to go home when you feel ready. However, you will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Your nurse will give you some advice about caring for your healing wounds and a date for a follow-up appointment before you go home.
You may be given a splint or cast to support your arm or leg.
Dissolvable stitches will disappear on their own in seven to ten days. Non-dissolvable stitches are removed a week after surgery.
Recovering from your operation
If you need them, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.
General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you should not drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.
You shouldn't drive until you are confident that you could perform an emergency stop without discomfort. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.
You should keep the dressing clean and dry. Covering the area with a plastic bag or wrapping it in cling film will help keep it dry while you wash.
Keep your treated arm or leg raised on pillows at night and when resting to help reduce swelling.
Physiotherapy is not usually needed. Gently bend your fingers and wrist (or toes and ankle) from time to time to reduce stiffness. Don't wear jewellery on the affected hand or foot until the wound has fully healed.
You should be able to return to work after a day or two. Complete recovery can take two to six weeks.
What are the risks?
Ganglion surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
Side-effects
These are the unwanted, but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic.
The area will feel sore, stiff and swollen for a few days after surgery.
You will have a permanent scar. This will be red and tender for two to six weeks, and will gradually soften and fade over a few months.
Complications
This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include infection, excessive bleeding or an unexpected reaction to the anaesthetic. These complications may need further treatment such as returning to theatre to stop bleeding or antibiotics to treat an infection.
Complications specific to having a ganglion removed are rare. These include excessive swelling, delayed healing, and damage to surrounding nerves.
It's possible for a ganglion to re-occur in the same place.
The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
Further information
- British Society for Surgery of the Hand (BSSH)
020 7831 5162
www.bssh.ac.uk
Related topics
Sources
- Burke FD, Melikyan EY, Bradley MJ, Dias JJ. Primary care referral protocol for wrist ganglia. Postgrad Med J 2003;79:329-331
- Ganglion (cyst) of the wrist. American Academy of Orthopaedic Surgeons.
www.orthoinfo.org
accessed 23 July 2007
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It's been reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: January 2008.
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