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A ganglion is a fluid-filled cyst that can be found in many different locations throughout the arms or legs. It is most commonly
found at the wrist or hand, and is the single most common tumor in the hand. Ganglions are always benign, with no chance of turning into a different type of tumor, or into a
malignant tumor. There is no specific cause for these tumors, and studies have shown them to not be related to lifting or repetitive motion.
Back of Wrist
The most common location for a ganglion is on the back, or "dorsum" of the wrist. It most often originates from a ligament in the wrist joint called the scapholunate ligament. The ganglion may be very small and deep, or very large and prominent against the skin.
The size may fluctuate, and ganglions are known to disappear and reappear at varying intervals without known cause. They can rupture after injury. If a ganglion disappears, it occasionally will not return. Some ganglions seem to cause pain and tenderness
with activity, while others do not.
Palm Side of Wrist
The second most common location for a ganglion is on the front, or palm side, of the wrist. In this location, the ganglion usually originates from the scaphotrapezial ligament deep in the wrist joint.
It will lie adjacent and often adherent to the radial artery.
Base of Nail
A special type of ganglion occurs at the base of the nail on the the back of the thumb or a
finger. This ganglion is also called a mucous cyst. It originates from the last joint of the
digit, and is almost always associated with an arthritic spur from that joint. It may drain
intermittently, and it can cause a deformity in the nail. Treatment needs to include removal
of the arthritic spur.
Base of Finger
Ganglions also commonly occur at the junction of the palm and digits. In this location, they originate from a tendon sheath instead of a ligament.
These ganglions are usually tender and painful, because of the pressure placed on them with gripping and grasping activities.
Treatment
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Observation
Ganglions are always benign, and may not be painful or tender. Not doing anything to the ganglion does not preclude other treatment options from being performed at a later date.
- Aspiration
This procedure is done in the office under local anesthesia. The risks of this technique
are small (a small risk of infection), but the success rate is also small. Most of the time,
the ganglion will only decrease in size or will recur later. Ganglions from the tendon sheath
respond best to needle aspiration, and many times may not come back. Aspiration of ganglions
originating from a joint (at the wrist or by the nail) is usually not successful. This
technique is a safer treatment method than hitting the ganglion with a book. That old
recommendation is no more successful than aspiration, is more painful, and can cause
other injuries.
- Surgical Excision
Surgery will remove the ganglion completely, but the main risk is a new ganglion occurring from the same location at a later date. Studies reveal new ganglions can occur after surgery from 5 - 15% of the time. This rate is not dependent on activity or occupation. Surgery from ganglions at the wrist level is usually done under regional or "block" type anesthesia as an outpatient surgery. Surgery for ganglions from the palm or digit are usually done under local anesthesia as an outpatient surgery.
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