FREQUENTLY ASKED QUESTIONSQ. Fasting before Operation?
A. Nothing to eat or drink at least 6 hours before the operation.
Q. Anaesthetic?
A. General anaesthetic or arm block anaesthetic can be used.
Q. Duration of Operation?
A. Usually around 45 minutes
Q. Pain?
A. Usually very little; local anaesthetic is also administered at the time of surgery. You will be given oral pain relief to take home with you.
Q. Will I be in a plaster after the operation?
A. Usually a bulky bandage will be placed on your hand or finger for comfort for the first week. Any fingers or thumb not included in the bandage should be moved immediately.
Q. Will I need physiotherapy after surgery?
A. Usually your own movements and activity is enough therapy, although if your strength is slow to recover, some hand therapy may help.
GANGLIONS
Ganglions are very common masses (lumps) that sometimes grow in the hand and wrist. The ganglion or “cyst” is generally found on the top of the wrist, sometimes on the palm side of the wrist, the end joint of a finger (mucous cysts) or at the base of a finger. Ganglions usually come up from nearby joints or tendon sheaths.
There is no specific cause, but they may indicate underlying problems in the joint, ligaments or tendon.
These cysts can be painful, especially when they first appear and with strenuous use of the hand or wrist. Ganglions often change in size and may disappear completely. These cysts are not malignant (cancerous).
DIAGNOSIS
The diagnosis of a ganglion is usually based on where the cyst is and what it looks like. Your hand surgeon may recommend X-rays, ultrasound or MRI examination to rule out problems in nearby joints.
TREATMENT
Treatment of ganglion cysts may be just watching for any changes. However, if the cyst is painful, limits activity, or its appearance is unacceptable to the patient, other treatment may be recommended. Half will go away without treatment.
Treatment may include removing fluid from the cyst and injection of cortisone, which has a 60% chance of success. Wearing a splint to keep the hand or wrist from moving may provide short-term relief. The old-fashioned method of hitting the ganglion with a bible has been found not to be effective.
SURGERY
Surgery to remove the cyst may be recommended by your hand surgeon. This surgery is generally performed on an outpatient basis, and may be excision via a joint arthroscopy, or by open operation.
Removal by arthroscopy (or “keyhole” surgery) only applies to some types of ganglions, but has the advantage of reduced post-operative stiffness and pain, and a lower recurrence rates, as compared to open excision.
Anaesthesia may be local, general or regional (where only the arm is numbed).
The goal of surgery is to remove the source of the ganglion. This may require removal of a portion of the joint capsule or tendon sheath next to the ganglion. If a mucous cyst of the finger is being treated, this may need removal of bone spurs within the joint, or even permanent stiffening of the joint.
THERAPY
After the ganglion is removed from the wrist, you will be placed in a bulky bandage for approximately 1 week. Some patients may feel tenderness, discomfort, and swelling at the site of their surgery a little longer than others, but full activity can be resumed once comfort permits.
While surgery offers the best success in removing ganglions, these ganglions may return. Currently, the risk of recurrence is around 5 - 10%.