Summary of intervention

Ganglia are cystic swellings containing jelly-like fluid which form around the wrists or in the hand. In most cases wrist ganglia cause only mild symptoms which do not restrict function, and many resolve without treatment within a year. Wrist ganglion rarely press on a nerve or other structure, causing pain and reduced hand function.

 

Ganglia in the palm of the hand (seed ganglia) can cause pain when carrying objects.

 

Ganglia which form just below the nail (mucous cysts) can deform the nail bed and discharge fluid, but occasionally become infected and can result in septic arthritis of the distal finger joint.

 

Number of CCG intervention 201718

6,219

 

Recommendation

Wrist ganglia,

  • no treatment unless causing pain or tingling/numbness or concern (worried it is a cancer);
  • aspiration if causing pain, tingling/numbness or concern
  • surgical excision only considered if aspiration fails to resolve the pain or tingling/numbness and there is restricted hand.

 

Seed ganglia that are painful,

  • puncture/aspirate the ganglion using a hypodermic needle
  • surgical excision only considered if ganglion persists or recurs after puncture/aspiration.

 

Mucous cysts no surgery considered unless recurrent spontaneous discharge of fluid or significant nail deformity.

 

Rationale for recommendation

Most wrist ganglia get better on their own. Surgery causes restricted wrist and hand function for 4-6 weeks, may leave an unsightly scar and be complicated by recurrent ganglion formation. Aspiration of wrist ganglia may relieve pain and restore hand function, and “cure” a minority (30%). Most ganglia reform after aspiration but they may then be painless. Aspiration also reassures the patient that the swelling is not a cancer but a benign cyst full of jelly.

Complication and recurrence are rare after aspiration and surgery for seed ganglia.

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