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GANGLION

This is the most common soft tissue mass found in the hand. 

They are more common in women and occurs most commonly between the 2nd and 4th decades of life. It has been reported to arise from almost every joint of the hand and wrist.

Common sites include dorsum or back of the wrist (commonest site), volar wrist (front of the wrist close to where the pulse of the hand can be felt), proximal digital crease (base of finger) and furthest joint of the finger (distal interphalangeal joint; also called mucous cyst). 

 

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What causes it?

The cause remains unknown.  The current thinking is that it is related to tissue trauma or irritation such as stretching of the capsular and ligamentous supporting joint structures. 


What may I complain of?

They show as swellings or lumps and you may have no complaint except the swelling. You may dislike the cosmetic appearance (swelling) or wonder if it was as a result of something sinister.

You may complain of pain and aches in the wrist and weakness of the grip strength.

You may complain of a blister on the back of the furthest joint of the finger which can discharge gel like material (if tampered with). And this may be associated with grooving or deformity of the nail.

There may be a preceding traumatic event to the hand and wrist. 

 

What tests do I need to have?

Usually there are no tests to confirm these as they can easily be spotted.

Needle aspiration in clinic confirms the diagnosis of a ganglion.  In this case within the clinic, under local anæsthetic, a needle aspiration is performed and the gelatinous, commonly clear fluid is aspirated. 

Occassionally ganglion in deep tissues and associated conditions such as osteoarthritis may necessitate investigations such as X-rays, MRI and CT scan e.t.c.

 

How is it treated?

Most patients are treated non surgically by use of wrist splints, non steroidal antiinflammatory agents and needle aspiration in the out patient department with or without steroid instillation.

The needle aspiration is performed under local anaesthetic.

The advantages include that it is done as an outpatient procedure, convenient for most patients, cost effective and there are no scars. However patients who have a needle phobia may decide against this treatment.

Operative (surgical excision) is performed if there are very frequent recurrences.

Advantage is that if completely excised, this should theoretically reduce the risk of recurrence though the latter point is controversial. But a scar is introduced which can become raised or stretched and a potential for damage to one of the sensory nerves can lead to a neuroma and some degree of stiffness of the wrist. 

 

Anaesthesia

This is usually performed under local anaesthesia if on the finger or by regional anaesthesia if elsewhere on the limb. So the patient is awake. It can also be performed under general anaestheisa. This will be discussed at the consultation. It is done as a day case so you can go home the same day.