Dorsal wrist ganglion
What is it?
A ganglion is a thin walled cyst containing jelly like material. It can arise from a joint or tendon sheath. It is usually degenerative. Occasionally, it may follow trauma.
What is it?
How is it diagnosed?
This ganglion can normally been seen or felt over the back of the wrist. It may fluctuate in size and be associated with pain which radiates up into the arm or down into the hand.
What is my approach to treatment?
Dorsal wrist ganglion is diagnosed on the basis of the history described above, and by clinical examination. If the ganglion is small, an MRI or ultrasound scan can confirm the diagnosis. Simple aspiration has an extremely high recurrence rate. My preferred treatment is removal, which can be carried out as open or keyhole surgery.
What does an operation involve?
Surgery is normally carried out as a day case under general anaesthetic. A tourniquet is applied to the upper arm, similar to a blood pressure cuff. This provides a clear view of the operative field for surgery. The ganglion is dissected down to the level of the wrist joint capsule and the stalk of the cyst is excised with a small cuff of wrist capsule. The skin is closed with non-absorbable sutures. A long acting local anaesthetic injection is then administered to provide pain relief. Finally, a dressing and bandaging are applied.
What is the recovery period?
Once the local anaesthetic has worn off, normally 6 to 8 hours, simple analgesics and anti-inflammatory tablets may be used for pain. The hand should be kept elevated as much as possible during the first week after the operation, although finger movements are to be encouraged. A high-arm sling may be useful for this purpose. Bandaging is reduced at 10 to 14 days. Sutures are removed in the clinic at two weeks. It should then be possible to wet the hand. Prior to this it’s possible to shower by keeping the extremity dry with a plastic bag secured over the limb using an elastic band or a purpose made shower cover. Most pain and swelling will have settled within four weeks after surgery. Driving is usually possible after seven days. When you’ll be ready to return to work depends on your specific job role and may also vary from individual to individual. It may be possible to return to light keyboard work towards the end of the first week. Heavy manual work should be avoided for 3 to 4 weeks.
Are there any possible complications?
Most patients are satisfied with the final result. However there are always risks involved as with any treatment; Infection: 2%, Chronic regional pain syndrome: 2-5%, Recurrence: 10%, Scar sensitivity: 5%, Nerve injury: 1%
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