What is a ganglion cyst?
Ganglion cysts are fluid-filled swellings which usually develop near a finger joint. They can range from a pea to a golf ball in size, with the difference being dictated by the amount of synovial fluid filling the cyst. Synovial fluid is the lubricant that surrounds joints and tendons.
What causes a ganglion cyst?
The exact cause of a ganglion cyst is still yet to be discovered, all we know so far is that synovial fluid leaks from the joint and collects in a sac that develops into the cyst you may be seeing on your hand. This could be a result of trauma (outstretching a hand to break a fall) – while other research indicates that ganglion cysts may occur due to joint and tissue lining degeneration.
What are the symptoms of a ganglion cyst?
- Pain in the palmar aspect of the finger as they get bigger
- Palpable lump in line with the finger
Ganglion cysts are usually diagnosed by talking through your symptoms with your doctor. They will be able to examine the cyst, ensuring that the shape and location is consistent with what you expect. Larger cysts may force doctors to perform additional testing to rule out disorders like synovitis.
What is Seed Ganglion?
Seed ganglion is a fluid filled sac that is seen at the base of a finger on its palm surface. They are cysts arising from the tendon sheath or adjacent joint. It is not clear why they develop.
An ultrasound scan often shows the origin and the location of the cyst.
If it does not cause a problem I recommend leaving it alone.
If causing problems, I usually recommend surgery. The surgery is a day case procedure usually under local anaesthetic and takes about 10 minutes. A tourniquet is used; which is like a blood pressure cuff around the upper arm that prevents blood from obscuring the surgeons view. It is quite tight, but well tolerated for up to 20 minutes.
Local anaesthetic is infiltrated at the base of the finger. Once numb the skin is incised and the skin flap elevated. The ganglion is dissected taking care not to puncture it or damage adjacent blood vessels and nerves. The base of the ganglion is identified and excised. The skin is sutured and a bulky dressing is applied.
Aftercare and follow up
Hand should be kept dry and clean until the stitches are removed. One week after the procedure the dressing are reduced by the practice nurse and the sutures are removed in the clinic 2 weeks after surgery. Normal daily activities and use of the hand is encouraged to avoid tendon and nerve adhesions immediately after surgery.
Driving should be avoided for 2 weeks until the wound has healed.
Time off work
Your return to work will depend on your job. Light manual workers can return to duty in 2 – 3 weeks. Heavy manual workers should not exert maximal grip for 6 weeks.
Risk of surgery
- Injury to digital nerve, blood vessels and tendons
- Neuroma (painful growth of nerve ends)
- Scar sensitivity (Scar desensitisation exercises after removal of stitches help to improve scar sensitivity however this can last up to 6 months after surgery)
- Recurrence (up to 40%)
- Further surgery (in event of recurrence or other complications)
- Reduced grip strength
- CRPS (chronic pain syndrome: A small percentage of patients will develop a severe reaction after hand surgery, with lifelong permanent pain and stiffness which requires extensive physiotherapy and pain medication)
Scar desensitisation exercises
- Circular motion massages to the scar, from the palm moving towards the wrist using a simple moisturising cream. This must be carried out for 10 minutes, at least 3 times a day.
- Rubbing the scar on different textured materials to improve skin sensitivity.
- Submerging the hand under the cold and warm water to improve the temperature sensitivity.